Bruk av skjermbaserte medier blant eldre under covid-19-pandemien : en HUNT studie

Bakgrunn: Eldre er spesielt sårbare for alvorlig sykdom og død ved covid-19 og har blitt oppfordret til selvisolering under koronapandemien. Skjermbaserte medier og telefon har blitt fremhevet som viktige hjelpemidler for å unngå ensomhet, opprettholde kontakten med venner og familie samt sikre oppfølging av nødvendig helsehjelp. Det har imidlertid manglet kunnskap om hvordan eldre har brukt skjermbaserte medier under pandemien. Hensikt: Formålet med studien var å undersøke hvordan eldre over 70 år har benyttet skjermbaserte medier til underholdning, informasjon og kontakt med venner, sosialt nettverk og helsepersonell. Videre ønsket vi å se på hvordan kjønn og alder påvirket bruken. Metode: I januar 2021 sendte vi et spørreskjema i posten til 12 772 personer som var 70 år eller eldre da de deltok i den fjerde runden av Helseundersøkelsen i Nord-Trøndelag (HUNT 4) i perioden 2017–19. Deltakerne ble bedt om å angi hvor mye tid per dag de hadde brukt på henholdsvis underholdning, kontakt med venner eller nettverk og innhenting av kunnskap eller informasjon på skjermbaserte medier. Resultat: Totalt 9391 personer (73,5 prosent) (72–106 år) svarte på spørreundersøkelsen. Av disse brukte 83,9 prosent skjermbaserte medier til å holde kontakten med venner og sosialt nettverk. Åtte prosent svarte at de hadde hatt kontakt med helsepersonell på skjermbaserte medier. Flere kvinner enn menn og flere under 80 år enn over holdt kontakten med andre via skjerm. Konklusjon: En stor andel eldre har brukt skjermbaserte medier under pandemien. Studien avdekket at det har vært lite kontakt mellom eldre og helsepersonell via telefon eller skjerm. Slik kontakt bør styrkes, samtidig som det må settes søkelys på de i den eldste delen av befolkningen som ikke benytter seg av kommunikasjonsteknologi.publishedVersio

Transscleral Optical Spectroscopy of Uveal Melanoma in Enucleated Human Eyes

PURPOSE. The aims of this study were to use transscleral optical spectroscopy to analyze normal and tumor-infiltrated areas of enucleated human eyes, and to characterize the spectral properties of uveal melanomas in relation to various morphological features. METHODS. Nine consecutive eyes enucleated for uveal melanoma were examined by transscleral spectroscopy, using a fiber-optic probe that exerted a fixed pressure on the scleral surface. Spectroscopic measurements, covering the wavelength range of 400-1100 nm, were sequentially performed over the uveal melanoma and on the opposite (normal) side of each eye. The eyes were then processed for histological and immunohistochemical analyses. Comparisons between spectral and morphological parameters were performed by Spearman's rank correlation coefficient and unpaired t-test. RESULTS. The average reflection intensity obtained from the normal side of the eyes was higher than that from the tumors. The spectral imprint of hemoglobin was lower and that of water was considerably stronger when compared with the tumor side. The diffuse reflection spectra from the melanomas showed a strong correlation with the degree of tumor pigmentation (Spearman's rho = -0.87, P < 0.0001). A weaker correlation was observed between the amount of hemoglobin-related absorption and the density of intratumoral blood vessels (Spearman's rho = -0.25, P = 0.023). The mean diffuse reflection intensity obtained from the spindle cell melanomas was significantly higher than that from the mixed and epithelioid cell melanomas (P < 0.0001). CONCLUSIONS. Although future in vivo studies are required, these data suggest that transscleral optical spectroscopy is a feasible method for identification and morphological assessment of choroidal tumors. (Invest Ophthalmol Vis Sci. 2012;53:5379-5385) DOI: 10.1167/iovs.12-984

Human alpha-lactalbumin made lethal to tumor cells (HAMLET) kills human glioblastoma cells in brain xenografts by an apoptosis-like mechanism and prolongs survival.

Malignant brain tumors present a major therapeutic challenge because no selective or efficient treatment is available. Here, we demonstrate that intratumoral administration of human α-lactalbumin made lethal to tumor cells (HAMLET) prolongs survival in a human glioblastoma (GBM) xenograft model, by selective induction of tumor cell apoptosis. HAMLET is a protein-lipid complex that is formed from α-lactalbumin when the protein changes its tertiary conformation and binds oleic acid as a cofactor. HAMLET induces apoptosis in a wide range of tumor cells in vitro, but the therapeutic effect in vivo has not been examined. In this study, invasively growing human GBM tumors were established in nude rats (Han:rnu/rnu Rowett, n = 20) by transplantation of human GBM biopsy spheroids. After 7 days, HAMLET was administered by intracerebral convection-enhanced delivery for 24 h into the tumor area; and α-lactalbumin, the native, folded variant of the same protein, was used as a control. HAMLET reduced the intracranial tumor volume and delayed the onset of pressure symptoms in the tumor-bearing rats. After 8 weeks, all α-lactalbumin-treated rats had developed pressure symptoms, but the HAMLET-treated rats remained asymptomatic. Magnetic resonance imaging scans revealed large differences in tumor volume (456 versus 63 mm3). HAMLET caused apoptosis in vivo in the tumor but not in adjacent intact brain tissue or in nontransformed human astrocytes, and no toxic side effects were observed. The results identify HAMLET as a new candidate in cancer therapy and suggest that HAMLET should be additionally explored as a novel approach to controlling GBM progression

Staff's perspectives on the organization of homecare services to people with dementia—A qualitative study

Abstract Aims The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. Design This study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data. Methods A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. Results Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service

Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms : a cluster randomized controlled trial

Objective To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia. Methods In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks. Results A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1–2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6–2.7; p = 0.002) in favor of the TIME intervention was found. Conclusion The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally

Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms : a cluster randomized controlled trial

Objective To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia. Methods In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks. Results A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1–2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6–2.7; p = 0.002) in favor of the TIME intervention was found. Conclusion The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally. Lichtwarck, Bjørn, et al. "Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms: a cluster randomized controlled trial." The American Journal of Geriatric Psychiatry 26.1 (2018): 25-38. © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license

TIME – Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms : protocol for an effectiveness-implementation cluster randomized hybrid trial

Background: Nearly all persons with dementia will experience neuropsychiatric symptoms (NPS) during the course of their disease. Clinicians and researchers emphasize the need for an evidence-informed standardized approach to managing NPS that integrates pharmacological and nonpharmacological treatments for real-world implementation. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) represents such an approach and is a multicomponent intervention based on the theoretical framework of cognitive behavioural therapy. Methods/design: The trial is a 3-month cluster randomized trial conducted in 30 nursing homes including 168 participants with dementia and a high level of agitation. Each nursing home defined as a cluster will be randomized to receive either the TIME intervention (the intervention group) or a brief education-only intervention regarding dementia and NPS (the control group). TIME is a manual-based, multicomponent programme that includes a rigorous assessment, one or more case conferences and the treatment and evaluation of NPS. Patient-level measurements are taken at baseline (prior to randomization) and 8 and 12 weeks later. The primary outcome measure is the change in agitation, as defined by the Neuropsychiatric Inventory-Nursing Home Version, at 8 weeks from baseline. Secondary outcome measures include change in agitation at 12 weeks from baseline, and change from baseline at 8 and 12 weeks in other NPS, quality of life, and the use of psychotropic and analgesic medications. Mixed methods will be used to follow, measure and explore the implementation process and the effect of the intervention at the individual staff level and the organization level. Combining measurements of clinical effectiveness and implementation outcomes define this trial as an effectiveness-implementation hybrid trial. Discussion: Measuring the implementation and effect of complex interventions aimed at reducing NPS in nursing homes is challenging. In this study protocol, we describe a multicomponent program, TIME, and discuss how an effectiveness-implementation cluster randomized hybrid trial can meet these challenges. Trial registration: ClinicalTrials.gov identifier NCT02655003. Registered 6 January 2016. Keywords: dementia, neuropsychiatric symptoms, behavioural and psychological symptoms of dementia (BPSD), psychosocial interventions, nursing home, case conferenc

A machine learning classifier for detection of physical activity types and postures during free-living

Introduction: Accelerometer-based measurements of physical activity types are commonly used to replace self-reports. To advance the field, it is desirable that such measurements allow accurate detection of key daily physical activity types. This study aimed to evaluate the performance of a machine learning classifier for detecting sitting, standing, lying, walking, running, and cycling based on a dual versus single accelerometer setups during free-living. Methods: Twenty-two adults (mean age [SD, range] 38.7 [14.4, 25–68] years) were wearing two Axivity AX3 accelerometers positioned on the low back and thigh along with a GoPro camera positioned on the chest to record lower body movements during free-living. The labeled videos were used as ground truth for training an eXtreme Gradient Boosting classifier using window lengths of 1, 3, and 5 s. Performance of the classifier was evaluated using leave-one-out cross-validation. Results: Total recording time was ∼38 hr. Based on 5-s windowing, the overall accuracy was 96% for the dual accelerometer setup and 93% and 84% for the single thigh and back accelerometer setups, respectively. The decreased accuracy for the single accelerometer setup was due to a poor precision in detecting lying based on the thigh accelerometer recording (77%) and standing based on the back accelerometer recording (64%). Conclusion: Key daily physical activity types can be accurately detected during free-living based on dual accelerometer recording, using an eXtreme Gradient Boosting classifier. The overall accuracy decreases marginally when predictions are based on single thigh accelerometer recording, but detection of lying is poor

A Machine Learning Classifier for Detection of Physical Activity Types and Postures During Free-Living

Accelerometer-based measurements of physical activity types are commonly used to replace self-reports. To advance the field, it is desirable that such measurements allow accurate detection of key daily physical activity types. This study aimed to evaluate the performance of a machine learning classifier for detecting sitting, standing, lying, walking, running, and cycling based on a dual versus single accelerometer setups during free-living. Methods: Twenty-two adults (mean age [SD, range] 38.7 [14.4, 25–68] years) were wearing two Axivity AX3 accelerometers positioned on the low back and thigh along with a GoPro camera positioned on the chest to record lower body movements during free-living. The labeled videos were used as ground truth for training an eXtreme Gradient Boosting classifier using window lengths of 1, 3, and 5 s. Performance of the classifier was evaluated using leave-one-out cross-validation. Results: Total recording time was ∼38 hr. Based on 5-s windowing, the overall accuracy was 96% for the dual accelerometer setup and 93% and 84% for the single thigh and back accelerometer setups, respectively. The decreased accuracy for the single accelerometer setup was due to a poor precision in detecting lying based on the thigh accelerometer recording (77%) and standing based on the back accelerometer recording (64%). Conclusion: Key daily physical activity types can be accurately detected during free-living based on dual accelerometer recording, using an eXtreme Gradient Boosting classifier. The overall accuracy decreases marginally when predictions are based on single thigh accelerometer recording, but detection of lying is poor