142,885 research outputs found

    Gait Velocity Estimation using time interleaved between Consecutive Passive IR Sensor Activations

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    Gait velocity has been consistently shown to be an important indicator and predictor of health status, especially in older adults. It is often assessed clinically, but the assessments occur infrequently and do not allow optimal detection of key health changes when they occur. In this paper, we show that the time gap between activations of a pair of Passive Infrared (PIR) motion sensors installed in the consecutively visited room pair carry rich latent information about a person's gait velocity. We name this time gap transition time and show that despite a six second refractory period of the PIR sensors, transition time can be used to obtain an accurate representation of gait velocity. Using a Support Vector Regression (SVR) approach to model the relationship between transition time and gait velocity, we show that gait velocity can be estimated with an average error less than 2.5 cm/sec. This is demonstrated with data collected over a 5 year period from 74 older adults monitored in their own homes. This method is simple and cost effective and has advantages over competing approaches such as: obtaining 20 to 100x more gait velocity measurements per day and offering the fusion of location-specific information with time stamped gait estimates. These advantages allow stable estimates of gait parameters (maximum or average speed, variability) at shorter time scales than current approaches. This also provides a pervasive in-home method for context-aware gait velocity sensing that allows for monitoring of gait trajectories in space and time

    Home-based therapy programmes for upper limb functional recovery following stroke

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    Background: With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. Objectives: To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. Search methods: We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. Selection criteria: Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm. Data collection and analysis: Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. Main results: We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. Primary outcomes: we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). Secondary outcomes: no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). Authors' conclusions: There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care

    Better Palliative Care for Older People

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    Most deaths in European and other developed countries occur in people aged over 65, but relatively little health policy concerns their needs in the last years of life. As life expectancy increases, the number of people living to older ages is also increasing in many countries. At the same time, the relaive number of people of working age is declining and he age of potential caregivers is increasing. Palliatve care is therefore of growing public health importance. Older people have traditionally received less palliative care than younger people and services have focused on cancer. This booklet is part of the WHO regional Office for Europe's work to present evidence for health policy - and decision-makers in a clear and understandable form. It presents the needs of older people, the different trajectories of illnesses they suffer, evidence of underassessment of pain and other symptoms, their need to be involved in decision-making, evidence for effecive palliative care solutions, and issues for the future

    Public Reporting and Transparency

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    Provides a short history of efforts to report information on health system performance; identifies policy issues to consider when advancing such efforts; and offers lessons from the experience of public reporting efforts to date

    Achieving Green and Healthy Homes and Communities in America

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    In the Fall of 2010, the National Coalition to End Childhood Lead Poisioning contracted with the National Academy to develop and execute an online dialogue that would examine ways to increase the health, safety, and energy efficiency of low- to moderate-income homes. Since 1999, the National Coalition had worked to improve low- to moderate-income housing through the support and execution of home interventions that addressed multiple issues within a home at one time; an approach that often did not align with other traditional, single-issue housing assistance programs. By 2010, the National Coalition had taken on the leadership of the Green and Healthy Homes Initiative, a public-private partnership focused on integrating funding streams to improve low- to middle-income homes across the country.With plans to expand the GHHI's operations, the National Coalition partnered with the National Academy to conduct the National Dialogue on Green and Healthy Homes, a collaborative online dailogue in which participants were asked to identify challenges to, and innovative practices for, improving the health, safety and energy-efficiency of low- to moderate- income homes. The Dialogue was live from November 4-November 22, 2010, and collected 100 hundred ideas and 362 comments from 320 registered users. Over the course of its two and a half week duration, the Dialogue received more than 2,500 visits from over 1,100 people in 48 states and territories. Key FindingsBy reviewing the feedback received in the Dialogue, the Panel was able to make a number of recommendations on how the green and healthy homes community of practice could increase the health, safety and energy efficiency of homes across the country. These recommendations included: Conduct an evaluation of current housing standards to determine if they meet the Nation's health, safety, and energy efficiency needs; Develop a tiered performance standard for healthy, safe and energy efficient homes; Group government funding streams to better align programs with the comprehensive intervention approach; Develop a long-term funding strategy to support efforts after Recovery Act funding ends; and Educate government decisionmakers and the public on the importance of developing green and healthy homes and communities, and the work that supports that development

    Utility of accelerometers to measure physical activity in children attending an obesity treatment intervention

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    Objectives. To investigate the use of accelerometers to monitor change in physical activity in a childhood obesity treatment intervention. Methods. 28 children aged 7–13 taking part in “Families for Health” were asked to wear an accelerometer (Actigraph) for 7-days, and complete an accompanying activity diary, at baseline, 3-months and 9-months. Interviews with 12 parents asked about research measurements. Results. Over 90% of children provided 4 days of accelerometer data, and around half of children provided 7 days. Adequately completed diaries were collected from 60% of children. Children partake in a wide range of physical activity which uniaxial monitors may undermonitor (cycling, nonmotorised scootering) or overmonitor (trampolining). Two different cutoffs (4 METS or 3200 counts⋅min-1) for minutes spent in moderate and vigorous physical activity (MVPA) yielded very different results, although reached the same conclusion regarding a lack of change in MVPA after the intervention. Some children were unwilling to wear accelerometers at school and during sport because they felt they put them at risk of stigma and bullying. Conclusion. Accelerometers are acceptable to a majority of children, although their use at school is problematic for some, but they may underestimate children's physical activity
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