A remotely accessible plant-based culinary intervention for Latina/o/x adults at risk for diabetes: lessons learned.

Introduction: Little research has examined how community-engaged and -participatory dietary interventions adapted to remotely-accessible settings during the COVID-19 pandemic. Objectives: To identify lessons learned in design, implementation, and evaluation of a remotely-accessible, community-based, nurse-led approach of a culturally-tailored whole food plant-based culinary intervention for Latina/o/x adults to reduce type 2 diabetes risk, delivered during a pandemic. Methods: A mixed methods quasi-experimental design consisting of a pre-post evaluation comprised of questionnaires, culinary classes, biometrics, and focus groups. Lessons learned: Community partnerships are essential for successful recruitment/retention. To optimally deliver a remotely-accessible intervention, community leadership and study volunteers should be included in every decision (e.g., timeframes, goals). Recommendations include managing recruitment and supply chain disruption of intervention supplies. Conclusion: Future research should focus on increasing accessibility and engagement in minoritized and/or underserved communities, supply chain including quality assurance and delivery of services/goods, study design for sustainable, remotely-accessible interventions, and health promotion.

Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial.

BACKGROUND: Traditional health management requires many human and material resources and cannot meet the growing needs. Remote medical technology provides an opportunity for health management; however, the research on it is insufficient. OBJECTIVE: The objective of this study was to assess the effects of remote interventions on weight management. METHODS: In this randomized controlled study, 750 participants were randomly assigned to a remote dietary and physical activity intervention group (group DPI), remote physical activity intervention group (group PI), or control group (group C). At baseline (time 1), day 45 (time 2), and day 90 (time 3), data were collected, including data on dietary intake, physical activity, indexes related to weight control, and health benefits. RESULTS: A total of 85.6% (642/750) of participants completed the follow-up. Compared with group C, group DPI showed a significant decrease in energy intake (-581 vs -82 kcal; P<.05), protein intake (-17 vs -3 g; P<.05), fat intake (-8 vs 3 g; P<.05), and carbohydrate intake (-106.5 vs -4.7 g; P<.05) at time 3. Compared with time 1, groups DPI and PI showed a significant decrease in cereal and potato intake (P<.05). Compared with time 1, the physical activity levels related to transportation (group PI: 693 vs 597 metabolic equivalent [MET]-min/week, group C: 693 vs 594 MET-min/week; P<.05) and housework and gardening (group PI: 11 vs 0 MET-min/week, group C: 11 vs 4 MET-min/week; P<.05) in groups PI and C were improved at time 3. Compared with groups PI and C, group DPI showed a significant decrease in weight (-1.56 vs -0.86 kg and -1.56 vs -0.66 kg, respectively; P<.05) and BMI (-0.61 vs -0.33 kg/m2 and -0.61 vs -0.27 kg/m2, respectively; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in body weight (-4.11 vs -1.01 kg and -4.11 vs -0.83 kg, respectively; P<.05) and BMI (-1.61 vs -0.40 kg/m2 and -1.61 vs -0.33 kg/m2, respectively; P<.05) at time 3. Compared with group C, group DPI showed a significant decrease in triglyceride (-0.06 vs 0.32 mmol/L; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in systolic blood pressure (-8.15 vs -3.04 mmHg and -8.15 vs -3.80 mmHg, respectively; P<.05), triglyceride (-0.48 vs 0.11 mmol/L and -0.48 vs 0.18 mmol/L, respectively; P<.05), and fasting blood glucose (-0.77 vs 0.43 mmol/L and -0.77 vs 0.14 mmol/L, respectively; P<.05). There were significant differences in high-density lipoprotein cholesterol (-0.00 vs -0.07 mmol/L; P<.05) and hemoglobin A1c (-0.19% vs -0.07%; P<.05) between groups DPI and C. CONCLUSIONS: Remote dietary and physical activity interventions can improve dietary intake among participants with overweight and obesity, are beneficial for weight control, and have potential health benefits. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900023355; https://www.chictr.org.cn/showproj.html?proj=38976.

Are remote psychotherapy/remediation efforts accessible and feasible in patients with schizophrenia? A narrative review.

Background: Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings. Results: We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations. Conclusions: Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making.

How acceptable do parents experiencing mental health challenges find e-Health interventions for mental health in the postnatal period: a systematic review.

Poor mental health in the postnatal period is experienced by high numbers of parents, with a high associated cost to society, however accessing therapeutic support during this time is complicated by parenting commitments. This has been further compounded by the covid-19 pandemic, where access to traditional therapy has been impacted. A lack of access to support for poor mental health in this period can have long term impacts on both the parents and their child. E-Health provides a potential solution to parents accessing support during this period by providing a convenient and flexible intervention which overcomes the barriers of traditional face-to-face therapy. However, without investigating the acceptability of such support for parents, it is not possible to predict uptake and consequent effectiveness. The current review synthesizes data available on acceptability of e-Health interventions in the post-natal period, finding that parents valued e-Health interventions however considerations must be made to certain, key areas impacting the acceptability of these interventions for parents. An element of therapist support and individualised content was preferred, along with a smooth user experience. Parents valued that e-Health fit into their routines and provided anonymity in their interactions. Further research needs to be completed into acceptability for minority social and ethnic groups where access and preference may differ.

Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis.

BACKGROUND: Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. OBJECTIVE: This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. METHODS: This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women's views, and opinions were included. RESULTS: Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference -0.49, 95% CI -0.75 to -0.22; standardized mean difference -0.48, 95% CI -0.75 to -0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS: There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.

Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study.

OBJECTIVE: The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model. METHODS: The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the "workable" length with the CorPath GRX robotic system using transcarotid access. RESULTS: To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the microcatheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography. CONCLUSIONS: In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve "working length" compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.

A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders

Research is increasingly demonstrating the therapeutic benefits of virtual reality interventions for various mental health conditions, though these rarely translate from research to application in clinical settings. This systematic review aims to examine the efficacy of current virtual reality interventions for emotional disorders, with a focus on clinical and technological features that influence translation of treatments from research to clinical practice. A comprehensive systematic literature search was conducted following PRISMA guidelines, for studies including the application of a virtual reality intervention to a clinical population of adults with an emotional disorder. Thirty-seven eligible studies were identified, appraised, and assessed for bias. Treatment effects were typically large across studies, with virtual reality being considered an efficacious treatment modality for various anxiety disorders and post-traumatic stress disorder. Virtual reality interventions were typically used for delivering exposure in cognitive behavioural therapy approaches. Considerable variability was seen in cost, technological specifications, degree of therapist involvement, delivery format, dosage, duration, and frequency of treatment. Suboptimal methodological rigour was identified in some studies. Remote use of virtual reality was rare, despite increasing options for in home use. Virtual reality interventions have the potential to overcome barriers to care and better meet the needs of consumers. Future research should examine the efficacy of virtual reality for treatment of depressive disorders and obsesive compulsive disorder. Improved methodological reporting and development of transdiagnostic and remotely delivered virtual reality interventions, will likely increase the translation of this treatment modality. (AU)

Cada vez más la investigación demuestra las ventajas terapéuticas de las intervenciones mediante realidad virtual en distintos estados de salud mental, aunque esta investigación raramente se traslada a la aplicación en el contexto clínico. Esta revisión sistemática pretende analizar la eficacia de las intervenciones actuales de realidad virtual en trastornos emocionales, centrándose en las características clínicas y tecnológicas que afectan a la transferencia de los tratamientos desde la investigación hasta la práctica clínica. Se llevó a cabo una amplia búsqueda bibliográfica sistemática de acuerdo con las directrices PRISMA para estudios que abarcan la aplicación de la intervención mediante realidad virtual a población clínica adulta con trastornos emocionales. Se consideraron elegibles 37 estudios, que fueron valorados y revisados para descartar sesgos. Los efectos de los tratamientos eran normalmente grandes, siendo considerada la realidad virtual como una modalidad de tratamiento eficaz para diversos trastornos de ansiedad y el de estrés postraumático. Las intervenciones de realidad virtual normalmente se han utilizado para la exposición en los enfoques de terapia cognitivo-conductual. Se observó una considerable variabilidad en coste, especificaciones tecnológicas, grado de implicación del terapeuta, formato de presentación, dosificación, duración y frecuencia del tratamiento. En algunos estudios se observó que el rigor metodológico estaba por debajo de los niveles óptimos. (AU)

A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders.

Research is increasingly demonstrating the therapeutic benefits of virtual reality interventions for various mental health conditions, though these rarely translate from research to application in clinical settings. This systematic review aims to examine the efficacy of current virtual reality interventions for emotional disorders, with a focus on clinical and technological features that influence translation of treatments from research to clinical practice. A comprehensive systematic literature search was conducted following PRISMA guidelines, for studies including the application of a virtual reality intervention to a clinical population of adults with an emotional disorder. Thirty-seven eligible studies were identified, appraised, and assessed for bias. Treatment effects were typically large across studies, with virtual reality being considered an efficacious treatment modality for various anxiety disorders and post-traumatic stress disorder. Virtual reality interventions were typically used for delivering exposure in cognitive behavioural therapy approaches. Considerable variability was seen in cost, technological specifications, degree of therapist involvement, delivery format, dosage, duration, and frequency of treatment. Suboptimal methodological rigour was identified in some studies. Remote use of virtual reality was rare, despite increasing options for in home use. Virtual reality interventions have the potential to overcome barriers to care and better meet the needs of consumers. Future research should examine the efficacy of virtual reality for treatment of depressive disorders and obsesive compulsive disorder. Improved methodological reporting and development of transdiagnostic and remotely delivered virtual reality interventions, will likely increase the translation of this treatment modality.

Cada vez más la investigación demuestra las ventajas terapéuticas de las intervenciones mediante realidad virtual en distintos estados de salud mental, aunque esta investigación raramente se traslada a la aplicación en el contexto clínico. Esta revisión sistemática pretende analizar la eficacia de las intervenciones actuales de realidad virtual en trastornos emocionales, centrándose en las características clínicas y tecnológicas que afectan a la transferencia de los tratamientos desde la investigación hasta la práctica clínica. Se llevó a cabo una amplia búsqueda bibliográfica sistemática de acuerdo con las directrices PRISMA para estudios que abarcan la aplicación de la intervención mediante realidad virtual a población clínica adulta con trastornos emocionales. Se consideraron elegibles 37 estudios, que fueron valorados y revisados para descartar sesgos. Los efectos de los tratamientos eran normalmente grandes, siendo considerada la realidad virtual como una modalidad de tratamiento eficaz para diversos trastornos de ansiedad y el de estrés postraumático. Las intervenciones de realidad virtual normalmente se han utilizado para la exposición en los enfoques de terapia cognitivo-conductual. Se observó una considerable variabilidad en coste, especificaciones tecnológicas, grado de implicación del terapeuta, formato de presentación, dosificación, duración y frecuencia del tratamiento. En algunos estudios se observó que el rigor metodológico estaba por debajo de los niveles óptimos. La utilización remota de realidad virtual no era frecuente a pesar de las posibilidades que ofrece para usarse en casa. Las intervenciones de realidad virtual tienen el potencial de superar barreras en los cuidados y cubrir mejor las necesidades de los consumidores. La investigación futura debería analizar la eficacia de la realidad virtual para tratar los trastornos depresivos y el desorden obsesivo compulsivo. Mejorar los informes metodológicos y el desarrollo de las intervenciones mediante realidad virtual transdiagnósticas y practicadas a distancia podría facilitar la transferencia de esta modalidad de tratamiento.

Provision of Psychological Support to a 31-Year-Old Man with SARS-CoV2-Induced Pneumonia during and after Hospitalization: A Clinical Case Report.

A 31-year-old man hospitalized during the first wave of the pandemic in 2020 suffering from severe psychological distress, requested psychological assistance as his condition progressively worsened, eventually requiring intubation. After being referred to the clinical psychology service by a ward physician, the patient was assisted remotely for two months for a total of 22 sessions during hospitalization and after discharge. A psychometric evaluation was carried out when the patient was close to discharge and longitudinally, for a total of four times, for depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder Scale-7 (GAD-7)), post-traumatic stress disorder (Impact of Event Scale-Revised (IES-R)) and insomnia (Insomnia Severity Index (ISI)). Support was provided remotely, mainly through audio and video calls, and text chats were also utilized when possible and as required. The initial psychometric evaluation indicated moderate depression, severe anxiety, the presence of post-traumatic stress disorder and sleep problems. Psychological distress decreased until reaching a situation of no distress in the final evaluation. Psychological interventions from which the patient benefitted were stress reduction and breathing techniques, empathic support, elaboration of the possibility of grief and cognitive restructuring regarding fears relative to his condition. Psychological support provided remotely and the monitoring of psychological status after discharge are highly advisable in pandemic emergency situations. The CARE checklist of information to include when writing a case report was utilized in the writeup of this case report.

Can Myofascial Interventions Have a Remote Effect on ROM? A Systematic Review and Meta-Analysis.

CONTEXT: Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). OBJECTIVE: To determine if remote myofascial techniques can effectively increase the range of motion at a distant body segment. EVIDENCE ACQUISITION: In November 2018, the authors searched 3 electronic databases (CENTRAL, MEDLINE, and PEDro) and hand-searched journals and conference proceedings. Inclusion criteria were randomized controlled trials comparing remote myofascial techniques with passive intervention (rest/sham) or local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. EVIDENCE SYNTHESIS: Eight randomized controlled trials, comprising N = 354 participants were included (mean age range 22-36 y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just 2 used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (standard mean difference 0.23; 95% confidence intervals; -0.09 to 0.55; 4 studies) at immediate follow-ups. Effects sizes were small, corresponding to mean differences of 9% or 5° in cervical spine ROM, and 1 to 3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. CONCLUSIONS: Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.

Um estudo sobre letramento digital para idosos com o apoio de um aplicativo móvel personalizável / A study about alphabetization and digital literacy for older adults with the support of a customizable mobile apllication

O uso de sistemas computacionais para cuidados com a saúde de idosos é cada vez mais comum. No campo da educação, no entanto, as investigações enfocam mais em questões técnicas de desenvolvimento ou em adaptação de tecnologias, e não no processo de ensino-aprendizagem e aplicabilidade do uso de dispositivos móveis. Este trabalho buscou estimular, monitorar e avaliar o uso desses dispositivos no ambiente natural por idosos participantes de cursos de alfabetização e letramento digital. Também buscou promover novas metodologias para práticas de alfabetização e letramento digital para idosos. Foi realizado um estudo de viabilidade explorando o uso de um sistema denominado ESPIM, como um novo recurso pedagógico em cursos como este. O ESPIM permite a profissionais de diferentes áreas construírem programas de intervenção para realizar coletas de dados de forma remota com suas populações de interesse. Essa população responde a perguntas programadas pelos profissionais usando um aplicativo móvel. As perguntas planejadas podem ser questões abertas, de múltipla escolha, de escolha única, solicitação do envio de mídias como áudio, vídeo ou imagens. Neste estudo qualitativo, por duas semanas consecutivas, os participantes receberam alertas e instruções, por meio desse aplicativo, para realizar atividades práticas em casa sobre o conteúdo aprendido em sala de aula. Os resultados obtidos descrevem um comportamento positivo dos participantes em termos de engajamento na execução das atividades de casa, e também descrevem feedbacks sobre o aplicativo, tais como facilidades e dificuldades, autonomia no uso e adesão ao recurso tecnológico como forma de apoio a cursos como o supracitado.(AU)

The use of computer systems for health care for older people is increasingly common. In the field of education, however, investigations focus more on technical issues of development or adaptation of technologies, rather than on the teaching-learning process and the applicability of using mobile devices. This work aimed to stimulate, monitor and evaluate the use of these devices in the natural environment by older participants in literacy and digital literacy courses. It also sought to promote new methodologies for alphabetization and digital literacy practices for older adults. A feasibility study was carried out exploring the use of a system called ESPIM, as a new educational resource in courses like this. ESPIM allows professionals from different domains to plan intervention programs to carry out data collections remotely with their populations of interest. This population answers questions programmed by professionals using a mobile application. Planned questions can be open questions, multiple choice, single choice, request to send media such as audio, video or images. In this qualitative study, for two consecutive weeks, participants received alerts and instructions, through this application, to carry out practical activities at home on the content learned in the classroom. The results obtained describe a positive behavior of the participants in terms of engagement in the execution of home activities, and also describe feedbacks about the application, such as facilities and difficulties, autonomy in the use and adherence to the technological resource as a way of supporting courses such as above citied.(AU)