Determinants of implementing of pet robots in nursing homes for dementia care

Background: Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of implementing pet robots for dementia care in nursing homes, from the perspectives of healthcare professionals and organisational leaders. Methods: A descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), was conducted. We conducted semi-structured interviews with healthcare professionals and organisational leaders from nursing homes. Data was transcribed and analysed using Framework Analysis, based on the CFIR as an a priori framework. Results: A total of 22 participants from eight nursing homes were included. Determinants were mapped to constructs from all five CFIR domains. Determinants relating to the characteristics of pet robots include their design, realisticness and interactivity, affordability, cleanability, perceived evidence strength and comparative advantages to live pets. Determinants relating to external influences (outer setting) include national regulatory guidelines, funding and networks with other organisations. With regards to characteristics of nursing homes (inner setting), determinants include the relevance of pet robots in relation to the needs of residents with dementia, alignment with care processes, infection control mandates and their relative priority. In the domain ‘characteristics of individuals’, determinants were associated with individuals’ beliefs on the role of technology, desires to enhance residents’ quality of life, and differential attitudes on the use of robots. Finally, in the domain ‘implementation process’, assessments and care planning were identified as determinants. Conclusions: Overall, while sentiments around determinants within CFIR domains of pet robots’ characteristics, outer setting and implementation process were similar, participants’ opinions on the determinants within the ‘inner setting’ and ‘characteristics of individuals’ were more varied. This could be due to different organisational structures, disciplinary differences and personal experiences of using pet robots. Many determinants in different domains were interrelated. Findings provide a springboard for identifying and designing implementation strategies to guide the translation of pet robots from research into real-world practice

Adolescent Overweight and Obesity in Ireland—Trends and Sociodemographic Associations Between 1990 and 2020

Background: Overweight and obesity in adolescence is a growing issue and can have a range of both short- and long-term consequences on health. Objectives: To analyse trends in adolescent weight status in Ireland across a 30-year period and to examine the influence of sociodemographic factors on overweight/obesity in Irish adolescents over time. Methods: Body composition and body mass index weight status of Irish adolescents were compared using data from three nationally representative, cross-sectional Irish national food consumption surveys from 1990, 2006 and 2020. Adjusted analysis of associations between socio-demographic factors with the risk of adolescent overweight/obesity at each time point were examined. Results: The prevalence of Irish adolescents with overweight/obesity has increased significantly in recent years, with 24% of adolescents living with overweight/obesity in 2020 compared to 18% in 2006 and 13% in 1990 (p \u3c 0.001). Of note is a substantial increase in the prevalence of obesity, with 8% of adolescents living with obesity in 2020 compared to 3% in 2006 and 0.5% in 1990 (p \u3c 0.001). A lower affluence social class was associated with 3.95 increased odds of adolescent overweight/obesity (95%CI 2.06-7.61) (p \u3c 0.001) in 2020 only, with 41% of adolescents from the lowest affluence social class affected by overweight/obesity. Parental education level was inversely associated with the risk of adolescent overweight/obesity in 2006 and 2020, with a stronger effect in 2020. Conclusion: There is an increasing prevalence of adolescents living with overweight/obesity in Ireland, with evidence of a growing socioeconomic gradient of overweight/obesity where adolescents affected by socioeconomic disadvantage are most at risk

Introducing and Familiarising Older Adults Living with Dementia and Their Caregivers to Virtual Reality.

Virtual Reality (VR) is increasingly being applied in dementia care across a range of applications and domains including health and wellbeing. Despite the commercial availability of VR, informants of design are not always aware of its functionality and capabilities, to meaningfully contribute to VR design. In designing VR applications for people living with dementia, it is recommended that older adults living with dementia and their support persons be involved in the design process using participatory approaches, thereby giving them a voice on the design of technology from the outset. A VR technology probe is a useful means of familiarising older adults living with dementia and their informal caregivers with the knowledge and understanding of interactive VR to employ technology that supports them to maintain their social health. This paper charts the implementation and evaluation of a VR technology probe, VR FOUNDations. To explore their experiences, nine older adults living with dementia and their nine informal caregivers trialled VR FOUNDations and completed semi-structured interviews after its use. Overall, older adults living with dementia and their informal caregivers perceived VR FOUNDations to achieve its aim of increasing understanding and inspiring future design decisions. The findings also identified promising positive experiences using a VR technology probe which may be indicative of its applicability to social health and wellbeing domains. This paper advocates for the structured design and implementation of VR technology probes as a pre-requisite to the participatory design of VR applications for the health and wellbeing of people living with dementia. The use of such technology probes may afford older adults living with dementia and their informal caregivers the best opportunity to contribute to design decisions and participate in technology design to support their health and wellbeing

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Older Adults’ Experiences and Perceptions of Immersive Virtual Reality: Systematic Review and Thematic Synthesis

BackgroundImmersive virtual reality (IVR) can be defined as a fully computer-generated environment shown on a head-mounted display. Existing research suggests that key features of IVR can assist older adults in their everyday lives, providing opportunities for health promotion and tackling social isolation and loneliness. There has been a surge in qualitative studies exploring older adults’ experiences and perceptions of IVR. However, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR technologies. ObjectiveThis study aimed to systematically review and synthesize qualitative studies exploring older adults’ experiences and perceptions of IVR. MethodsA systematic review and thematic synthesis were conducted following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. In total, 2 reviewers completed title and abstract screening, full-text screening, data extraction, and quality appraisal. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves 3 key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes, and going beyond these data to form analytical themes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach. ResultsOverall, 13 studies were included in the final synthesis, including 224 participants across 9 countries and 5 continents. Confidence in the evidence ranged from high to moderate. Three descriptive themes were generated: practical aspects of IVR use, experiencing unique features of IVR, and perceptions of IVR. The findings from the descriptive themes suggested that there are several improvements that need to be made to existing IVR devices to facilitate older adults’ use of this technology. However, older adults’ responses to IVR were generally positive. Three analytical themes were generated: tolerating the bad to experience the good, buying in to IVR (don’t judge a book by its cover), and “it proves to me I can do it.” The analytical themes illustrated that older adults were willing to tolerate discomforts that accompany existing IVR technologies to experience features such as immersive social networking. There was a discrepancy between older adults’ perceptions of IVR before use—which were generally negative—and after use—which were generally positive—and IVR provided a platform for older adults to access certain activities and environments more easily than in the real world because of limitations caused by aging. ConclusionsThis review offers insights into older adults’ experiences and perceptions of IVR and suggests how a few improvements to its existing hardware and software as well as how it is first presented could offer new opportunities for older adults to take part in meaningful activities tailored to their needs and preferences. Trial RegistrationPROSPERO CRD42020200774; https://tinyurl.com/8f48w2vt International Registered Report Identifier (IRRID)RR2-10.1177/1609406921100968

Determinants of implementing pet robots in nursing homes for dementia care

Background: Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their  potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of  implementing pet robots for dementia care in nursing homes, from the perspectives of healthcare professionals and  organisational leaders. Methods: A descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), was conducted. We conducted semi-structured interviews with healthcare professionals  and organisational leaders from nursing homes. Data was transcribed and analysed using Framework Analysis, based  on the CFIR as an a priori framework. Results: A total of 22 participants from eight nursing homes were included. Determinants were mapped to constructs from all fve CFIR domains. Determinants relating to the characteristics of pet robots include their design,  realisticness and interactivity, afordability, cleanability, perceived evidence strength and comparative advantages to live pets. Determinants relating to external infuences (outer setting) include national regulatory guidelines, funding  and networks with other organisations. With regards to characteristics of nursing homes (inner setting), determinants  include the relevance of pet robots in relation to the needs of residents with dementia, alignment with care processes, infection control mandates and their relative priority. In the domain characteristics of individuals, determinants  were associated with individuals beliefs on the role of technology, desires to enhance residents  quality of life, and  diferential attitudes on the use of robots. Finally, in the domain implementation process assessments and care planning were identifed as determinants. Conclusions: Overall, while sentiments around determinants within CFIR domains of pet robots characteristics, outer setting and implementation process were similar, participants opinions on the determinants within the ‘inner setting"  and characteristics of individuals’ were more varied. This could be due to diferent organisational structures, disciplinary diferences and personal experiences of using pet robots. Many determinants in diferent domains were interrelated. Findings provide a springboard for identifying and designing implementation strategies to guide the translation  of pet robots from research into real-world practice. </p

Key Stakeholders’ Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis

BackgroundTechnology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. ObjectiveThe aim of this QES was to explore key stakeholders’ experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. MethodsQES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders’ experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). ResultsA total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. ConclusionsThis review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology

Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers

People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiver’s experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same. People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis. The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness. The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers. People living with dementia and their caregivers consider social connectedness a vital aspect of living well with dementia.People living with dementia experience social connectedness across personal, community and societal domains.Supportive, non-judgemental or reciprocal relationships, fostering technology, and personal and contextual factors facilitate social connectedness for people living with dementia.Dementia-related barriers and periods of disruption and change can negatively impact the social connectedness of people living with dementia.People living with dementia and their caregivers consider multi-user virtual reality a promising technology to promote and maintain their social connectedness. People living with dementia and their caregivers consider social connectedness a vital aspect of living well with dementia. People living with dementia experience social connectedness across personal, community and societal domains. Supportive, non-judgemental or reciprocal relationships, fostering technology, and personal and contextual factors facilitate social connectedness for people living with dementia. Dementia-related barriers and periods of disruption and change can negatively impact the social connectedness of people living with dementia. People living with dementia and their caregivers consider multi-user virtual reality a promising technology to promote and maintain their social connectedness.</p

Application of a composite scoring protocol to identify factors that contribute to the risk of overweight and obesity in Irish children

BACKGROUND: Investigations into the main drivers of childhood obesity are vital to implement effective interventions to halt the global rise in levels. The use of a composite score may help to identify children most at risk of overweight/obesity. OBJECTIVES: To investigate the cumulative impact of factors associated with overweight/obesity risk in children. METHODS: Data were analysed from the Irish National Children's Food Survey II which included 600 children, aged 5–12‐years. The risk factors examined included social class, parental, early life, lifestyle, and dietary components. A composite score was calculated which ranged from 0 (no risk factors for overweight/obesity) to 4 (4 risk factors for overweight/obesity). RESULTS: In model 1 (%BF) the four factors associated with overweight/obesity risk were having a parent with overweight/obesity (odds ratio 3.1; 95% confidence interval 1.9–4.8), having a high birth weight of ≥4 kg (2.5; 1.6–3.9), being from a low social class (2.3; 1.4–3.8) and low physical activity (1.9; 1.2–2.8). Children who scored 3–4 points on the composite score had a 10‐fold (10.0; 4.2–23.9) increased risk of overweight/obesity compared to those with 0 points, a sevenfold (7.2; 3.9–13.5) increased risk compared to those with 1 point and a threefold (2.6; 1.4–4.8) increased risk compared to those with 2 points, with similar results observed in model 2 (BMI). CONCLUSION: The use of a composite score is a beneficial means of identifying children at risk of overweight/obesity and may prove useful in the development of effective interventions to tackle childhood obesity

The prevalence of overweight and obesity in Irish children between 1990 and 2019

Objective: The present study aimed to examine the temporal prevalence of overweight and obesity in Irish children through different methodologies and evaluate the change in rates between 1990 and 2019. Design: Anthropometric data from three Irish national food consumption surveys were used to examine the change in the prevalence of BMI and waist circumference-derived overweight and obesity levels. Setting: Three cross-sectional food consumption surveys from the Republic of Ireland: the Irish National Nutrition Survey (1990), the National Children’s Food Survey (2005) and The Second National Children’s Food Survey (2019). Participants: A demographically representative sample of Irish children aged 5–12 years: 1990 (n 148), 2005 (n 594) and 2019 (n 596). Results: Twelve percentage of children had overweight/obesity in 1990, which was significantly higher in 2005 at 25 % and significantly lower in 2019 at 16 % (P = 0·003). In 2019, more girls had overweight/obesity in comparison with boys (19 v. 14 %), whilst children from the lowest social class group had the highest levels of overweight/obesity (P = 0·019). Overall, the proportion of children with abdominal overweight/obesity was significantly lower in 2019 in comparison with 2005 (P ≤ 0·001). Conclusions: Evidence from the most recent national survey suggests that overweight and obesity levels are plateauing and in some cases reducing in children in Ireland. Despite this, rates remain high, with the highest prevalence in 2019 observed in girls and in those from the lowest social class group. Thus, overweight/obesity prevention and intervention policies are necessary and should be continued