Respiratory infectious disease outbreaks among people experiencing homelessness: a systematic review of prevention and mitigation strategies.

PURPOSE: People experiencing homelessness (PEH) are at increased risk of respiratory infections and associated morbidity and mortality. To characterize optimal intervention strategies, we completed a systematic review of mitigation strategies for PEH to minimize the spread and impact of respiratory infectious disease outbreaks, including COVID-19. METHODS: The study protocol was registered in PROSPERO (#2020 CRD42020208964) and was consistent with the preferred reporting in systematic reviews and meta-analyses guidelines. A search algorithm containing keywords that were synonymous to the terms "Homeless" and "Respiratory Illness" was applied to the six databases. The search concluded on September 22, 2020. Quality assessment was performed at the study level. Steps were conducted by two independent team members. RESULTS: A total of 4468 unique titles were retrieved with 21 meeting criteria for inclusion. Interventions included testing, tracking, screening, infection prevention and control, isolation support, and education. Historically, there has been limited study of intervention strategies specifically for PEH across the world. CONCLUSIONS: Staff and organizations providing services for people experiencing homelessness face specific challenges in adhering to public health guidelines such as physical distancing, isolation, and routine hygiene practices. There is a discrepancy between the burden of infectious diseases among PEH and specific research characterizing optimal intervention strategies to mitigate transmission in the context of shelters. Improving health for people experiencing homelessness necessitates investment in programs scaling existing interventions and research to study new approaches.

Perceptions of Digital Technology Experiences and Development Among Family Caregivers and Technology Researchers: Qualitative Study.

BACKGROUND: Caregiving is highly stressful and is associated with poor mental and physical health. Various technologies, including mobile and eHealth apps, have been developed to address caregiver needs. However, there is still a paucity of research examining the technology perceptions of informal caregivers, especially from the perspectives of sex, gender, and diversity. OBJECTIVE: To address the research gap and inform the development of future caregiving technologies, this study aims to examine how family caregivers perceive using technology to assist with their caregiving routines; identify the sex, gender, and diversity factors that shape these perceptions; and understand how these perceptions and needs are reflected within the current technology development process. METHODS: Semistructured interviews were conducted with 16 informal caregivers of individuals with a range of chronic medical conditions and 8 technology researchers involved in caregiving technology projects. RESULTS: Three main themes with subthemes were developed. The first main theme is that caregivers see a need for technology in their lives, and it comprises the following 3 subthemes: caregiving is a challenging endeavor, technology is multifaceted, and caregiver preferences facilitate technology use. The second main theme is that relationships play a vital role in mediating technology uptake, and it comprises the following 2 subthemes: the caregiver-care recipient dynamic shapes technology perceptions and caregivers rely on external sources for technology information. Finally, the third main theme is that barriers are present in the use and adoption of technology, and it comprises the following 2 subthemes: technology may not be compatible with personal values and abilities and technology that is not tailored toward caregivers lacks adoption. CONCLUSIONS: The findings highlight the multifaceted role that technology can play in aiding caregiving while drawing attention to the perceived drawbacks of these technologies among caregivers. The inclusion of technology researchers in this study provides a more holistic understanding of technologies in caregiving from their initial development to their eventual uptake by caregivers.

Virtual Hand Illusion in younger and older adults.

INTRODUCTION: Embodiment involves experiencing ownership over our body and localizing it in space and is informed by multiple senses (visual, proprioceptive and tactile). Evidence suggests that embodiment and multisensory integration may change with older age. The Virtual Hand Illusion (VHI) has been used to investigate multisensory contributions to embodiment, but has never been evaluated in older adults. Spatio-temporal factors unique to virtual environments may differentially affect the embodied perceptions of older and younger adults. METHODS: Twenty-one younger (18-35 years) and 19 older (65+ years) adults completed the VHI paradigm. Body localization was measured at baseline and again, with subjective ownership ratings, following synchronous and asynchronous visual-tactile interactions. RESULTS: Higher ownership ratings were observed in the synchronous relative to the asynchronous condition, but no effects on localization/drift were found. No age differences were observed. Localization accuracy was biased in both age groups when the virtual hand was aligned with the real hand, indicating a visual mislocalization of the virtual hand. CONCLUSIONS: No age-related differences in the VHI were observed. Mislocalization of the hand in VR occurred for both groups, even when congruent and aligned; however, tactile feedback reduced localization biases. Our results expand the current understanding of age-related changes in multisensory embodiment within virtual environments.

Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial.

INTRODUCTION: Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes. METHODS AND ANALYSIS: This will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed. ETHICS AND DISSEMINATION: This trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing. TRIAL REGISTRATION NUMBER: NCT03632343 (ClinicalTrials.gov).

Sex & gender considerations in concussion research.

The study of concussion, a common form of mild traumatic brain injury, has received increased notice over the last decade. Recently, more researchers have been addressing the historic paucity of attention over sex and gender influences on recovery outcomes after concussion. This development has led to exciting progress in our understanding of concussion incidence and outcomes. In this review, we will report on new findings from varying studies on sex differences in the epidemiology of concussion and clinical manifestations of mild traumatic brain injury/concussion, further discussing some key issues related to the integration of sex and gender in concussion research in a broad range of contexts, with recommendations to guide future research, along with sex- and gender-sensitive policy considerations.

The Rubber Hand Illusion in Healthy Younger and Older Adults.

Percepts about our body's position in space and about body ownership are informed by multisensory feedback from visual, proprioceptive, and tactile inputs. The Rubber Hand Illusion (RHI) is a multisensory illusion that is induced when an observer sees a rubber hand being stroked while they feel their own, spatially displaced, and obstructed hand being stroked. When temporally synchronous, the visual-tactile interactions can create the illusion that the rubber hand belongs to the observer and that the observer's real hand is shifted in position towards the rubber hand. Importantly, little is understood about whether these multisensory perceptions of the body change with older age. Thus, in this study we implemented a classic RHI protocol (synchronous versus asynchronous stroking) with healthy younger (18-35) and older (65+) adults and measured the magnitude of proprioceptive drift and the subjective experience of body ownership. As an adjunctive objective measure, skin temperature was recorded to evaluate whether decreases in skin temperature were associated with illusory percepts, as has been shown previously. The RHI was observed for both age groups with respect to increased drift and higher ratings of ownership following synchronous compared to asynchronous stroking. Importantly, no effects of age and no interactions between age and condition were observed for either of these outcome measures. No effects were observed for skin temperature. Overall, these results contribute to an emerging field of research investigating the conditions under which age-related differences in multisensory integration are observed by providing insights into the role of visual, proprioceptive, and tactile inputs on bodily percepts.