Search Results (737)

As global populations age, there is increasing demand for effective, person-centered healthcare solutions that support older adults to age in place. Home healthcare has emerged as a crucial strategy to address the complex health and social needs of older adults while reducing reliance on institutional care. This umbrella review aimed to synthesize evidence from existing systematic reviews and meta-analyses on home healthcare services and interventions targeting older adults. A comprehensive search was conducted across five databases and gray literature sources, including Google Scholar, for reviews published between 2000 and 2025. The review followed the Joanna Briggs Institute methodology and PRISMA statement. Twenty reviews met the inclusion criteria, encompassing a total of over 3.1 million participants. Interventions were grouped into four categories: integrated and multidisciplinary care, preventive and supportive home visits, technological and digital interventions, and physical, transitional, and environmental support. Results indicated that many interventions led to improved health outcomes, including enhanced functional ability, reduced hospital readmissions, and increased satisfaction. However, effectiveness varies depending on the intervention type, delivery model, and population. Challenges such as caregiver burden, digital exclusion, and implementation in diverse settings were noted. This review highlights the promise of home healthcare interventions and underscores the need for context-sensitive, equitable, and scalable models to support aging populations. Full article

Background/Objectives: This study evaluates the effects of a personalized exercise program on symptoms (pain, fatigue, sleep, cognitive function, physical function), resilience, and health-related quality of life (HRQOL) and compares the effectiveness of in-person versus telehealth delivery. Methods: A secondary data analysis was conducted on two 12-week randomized control pilot studies for solid tumor cancer survivors. One study involved in-person home visits with telephone follow-ups. The second utilized weekly exercise recommendations via a smartphone app. Both studies had control participants who received the standard care. Symptoms, resilience, and HRQOL were measured at baseline and after 12 weeks. Paired t-tests were conducted for intervention effects and ANCOVA for group differences, adjusting for age and education. Results: The analysis included 75 program completers: 15 in-person (iHBE), 38 telehealth (TEHE), and 22 who received standard care. Those receiving exercise interventions reported improvements in physical (t = 3.0, p < 0.01) and mental fatigability (t = 3.1, p < 0.01) at program completion compared to baseline. Comparing the mean changes between participants receiving exercise interventions in-person and via telehealth, there were no significant differences between the two delivery methods except perceived visuo-perceptual cognitive difficulty (F = 3.55, p = 0.027), where telehealth showed a slight advantage. Conclusions: The study provides initial evidence of the effectiveness of a telehealth personalized exercise on fatigability and cognitive difficulty, suggesting it is a potential viable alternative to in-person intervention. Further research with a larger cohort is essential to ascertain the effects of these interventional modalities on cancer-related health outcomes. Full article

Much U.S. research supports the effectiveness of parenting education delivered via the home visiting method. Home visitors are essential to reaching fathers in this context, but not all have favorable attitudes toward father engagement or feel confident working with fathers. Given that father involvement is important for a wide range of child and adolescent outcomes and that fathers benefit from parenting education, it is important to better understand the forces that shape home visitors’ attitudes toward fathers, and thus their subsequent efforts to include them in publicly funded programming. Using survey data from 95 home visitors in Tennessee, this study explores whether home visitors’ beliefs about fathers and attitudes toward father engagement vary as a function of home visitor or agency characteristics. Results suggest training in social work, reporting father-friendly organizational attitudes and behaviors at one’s agency, and reporting supervisor support specifically for father engagement relate to various favorable fathering attitudes. Home visitors’ strategies to engage fathers in home visiting are presented, including strategies for before, during, and after the home visit. Overall, family service agency administrators are in key positions to make decisions that can improve agency father-friendliness, home visitor attitudes toward fathers, and subsequent outcomes for fathers, mothers, and children. Full article

Background: The mechanisms linking loneliness to frailty in older adults with diabetes remain unclear. Guided by the Loneliness–Health Outcomes Model, this study is the first to simultaneously validate the dual mechanisms (mediation and moderation) of social support in the loneliness–frailty relationship among older Chinese adults with diabetes. Methods: A cross-sectional study enrolled 442 community-dwelling adults aged ≥60 years with type 2 diabetes in Beijing. Standardized scales assessed loneliness (UCLA Loneliness Scale), frailty (Tilburg Frailty Indicator), and social support (SSRS). Analyses included Pearson’s correlations, hierarchical regression, and PROCESS macro to evaluate mediating/moderating effects, after adjusting for demographics and comorbidities. Results: The frailty prevalence was 55.2%. Loneliness was positively correlated with frailty (r = 0.327, p < 0.01), while social support showed inverse associations with both loneliness (r = −0.496) and frailty (r = −0.315) (p < 0.01). Social support partially mediated loneliness’s effect on frailty (indirect effect: 30.86%; 95% CI: 0.028–0.087) and moderated this relationship (interaction β = −0.003, p = 0.011). High-risk clusters (e.g., aged ≥80 years, widowed, and isolated individuals) exhibited combined “high loneliness–low support–high frailty” profiles. Conclusions: Social support reduces the frailty risk through dual mechanisms. These findings advocate for tiered clinical interventions: (1) targeted home-visit systems and resource allocation for high-risk subgroups (e.g., solo-living elders aged ≥80 years); and (2) the integration of social support screening into routine diabetes care to identify individuals below the protective threshold (SSRS < 45.47). These findings advance psychosocially informed strategies for diabetes management in aging populations. Full article

Background/Objectives: Imposed sleep restriction leads to increased feelings of appetite and hedonic eating behaviors (or food rewards). No study to date has assessed home-based measures of sleep with appetite and food rewards exclusively in Black emerging adults (ages 18–28 years), despite higher risks of short sleep and obesity in this population. We examined associations between 6-month changes in sleep with changes in appetite and food reward in Black emerging adults. Methods: Fifteen Black emerging adults (12 females; age, 21 ± 2.5 years; body mass index, 25.7 ± 4.5 kg/m²; body fat, 25.8 ± 11.9%) completed two identical 7-day measurement bursts at baseline and 6 months. Sleep (duration, efficiency, and architecture) was captured via 7 days of actigraphy and 2 nights of in-home polysomnography. During a laboratory visit, participants completed appetite measures (desire to eat, hunger, fullness, and prospective food consumption) via visual analog scales before and for 3 h following standard breakfast intake. The food reward for the fat and sweet categories of food was measured before lunch with the Leeds Food Preference Questionnaire. Results: Fasting fullness scores decreased from baseline to 6 months (−8.9 mm, p < 0.01) despite increases in body weight (2.6 kg, p < 0.01) and waist circumference (2.4 cm, p = 0.03). Increases in actigraph-measured sleep duration were associated with decreases in fasting desire to eat (r = −0.58, p = 0.04). Increases in actigraph-measured sleep efficiency were also associated with decreases in explicit liking for sweet foods (r = −0.60, p = 0.03). Conclusions: Our findings suggest that improvements in sleep duration and sleep efficiency may lead to decreased feelings of appetite and food reward in Black emerging adults. Full article

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

Bacterial vaginosis (BV) affects 30% of women annually, but many face barriers to in-person care. Here we present real-world outcomes of remote BV diagnosis and management through self-collected vaginal microbiome (VMB) testing and telemedicine visits, focusing on symptom resolution, recurrence, and overall microbial shifts. Among the 1159 study participants, 75.5% experienced symptom resolution at four weeks when managed with our algorithm-guided treatment protocol. At a median follow-up of 4.4 months after the initial visit, 30.0% of patients experienced recurrent BV, which is lower than the typical recurrence rates seen in historical in-person cohorts. Across the entire cohort, metagenomic data demonstrated a significant increase in Lactobacillus abundance (mean of 32.9% to 48.4%, p < 0.0001) and a corresponding decrease in BV-associated taxa such as Gardnerella, Prevotella, and Fannyhessea. A PERMANOVA of pairwise Bray–Curtis distances showed significant separation between pre-and post-treatment samples (pseudo-F = 37.6, p < 0.0001), driven by an increase in Lactobacillus-dominated samples. Treatment adherence was high (a total of 78% reported perfect or near-perfect adherence), and adverse events were generally mild (in total, 22% reported vaginal irritation, and 13% reported abnormal discharge). These results demonstrate that Evvy’s at-home metagenomic platform, paired with telemedicine and a smart treatment algorithm, delivers robust clinical and microbial outcomes. This work offers a novel approach to managing bacterial vaginosis, a challenging condition characterized by persistently high recurrence rates. Full article

Background: Advanced home care is becoming increasingly common for cancer patients and serves as a viable alternative to inpatient hospital care. The transition to home care is driven by both the rising costs of healthcare and evidence indicating better quality of care. This study aims to compare the costs of hospital-at-home treatment and in-hospital care for patients undergoing allo-HSCT. Methods: The cost analysis was conducted as a case–control study comparing the costs of allo-HSCT at home (HaH) to the costs of allo-HSCT for patients receiving in-hospital care (INH). The cost evaluation was conducted from the hospital’s perspective, which means that costs incurred outside the hospital setting were not included. Post-procedural costs for the first year after allo-HSCT included all readmissions and outpatient visits at Oslo University Hospital. Results: The cost for the peritransplant period could be reduced by up to 33% by treating allo-HSCT recipients at home instead of in the hospital. During the study period, 24% of the allo-HSCT recipients were treated at home, but our data from 2021 and 2022 indicate that at least a third of the patients scheduled for allo-HSCT are candidates for HaH. Conclusions: The findings demonstrate that patients in advanced home care experience significantly lower total costs compared to those receiving in-hospital treatment. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article

Background: As e-commerce expands and delivery services diversifies, understanding the factors that shape consumer preferences becomes critical to designing efficient and sustainable urban logistics. This study examines how perceived walkability influences consumers’ preferences for shopping channels (in-store or online) and delivery methods (home delivery versus pickup points). Method: The analysis is based on structural equation modeling and utilizes survey data collected from 444 residents of Belo Horizonte, Brazil. Results: The findings emphasize the importance of walkability in supporting weekday store visits, encouraging pickup for online purchases and fostering complementarity between different modes of purchase and delivery services. Perceived walkability positively affects the preference to buy in physical stores and increases the likelihood of using pickup points. Educated men, particularly those living in walkable areas, are the most likely to adopt pickup services. In contrast, affluent individuals and women are less likely to forgo home delivery in favor of pickup points. Conclusions: The results highlight the role of perceived walkability in encouraging in-person pickup as a sustainable alternative to home delivery, providing practical guidance for retailers, urban planners, and logistics firms seeking to align consumer convenience with sustainable delivery strategies. Full article

School social work practice in the South African context is a growing field; however, there is limited research regarding the roles and responsibilities of school social workers, particularly in the Gauteng province. This province is unique in that school social workers are employed by multiple institutions, including individual schools and the education and social development departments. This study aimed to explore and describe the roles and responsibilities of school social workers in the Gauteng province, recognizing them as critical specialists in addressing learners’ psychosocial needs within school settings. An explorative qualitative design was used in this study. Data were collected from 22 purposively selected participants, comprising school social workers, supervisors, and provincial managers of school social work programs. Semi-structured interviews were conducted to collect data, and thematic analysis was employed to identify themes. The findings revealed context-specific roles of school social workers, including the creation of conducive teaching and learning environments, advocacy for social justice and child protection, conducting interviews and psychosocial assessments, providing counseling and trauma debriefing, conducting home visits and offering family services, removing abused learners from harmful environments, including their respective homes, and providing parental skills training and support. As a conclusion, this study highlights the need for standardized national and provincial guidelines to formalize and support school social work practice. It is recommended that the identified roles be incorporated into future practice frameworks. Furthermore, it is suggested that a uniform assessment tool be developed to promote consistency and guide school social workers in the initial evaluation processes. Full article

Objectives: This study aimed to describe the profile and identify the clinical and sociodemographic factors associated with emergency department (ED) use among patients aged ≥65 years. Methods: This was a retrospective cross-sectional study of patients aged ≥65 years who were seen in the emergency department of the Hospital de Mérida (Spain) in 2019, the year before the Coronavirus Disease 2019 (COVID-19) pandemic. Descriptive statistics were calculated for dependent variables such as hours of ED stay, total number of visits, reasons for discharge, and diagnostic specialty, disaggregated by gender, season, age group, day type (work or holiday), shift, and population area (rural or urban). Results: Significant differences in ED hours were found according to gender (p < 0.001), season (p = 0.024), age group (p < 0.001), attention shift (p < 0.001), and population area (p = 0.003). Discharge to home was the most common destination (63.5%), followed by hospital admission (25.7%). Admissions for gastrointestinal surgery and neurology were predominant in men, and admissions for internal medicine and trauma were predominant in women. Patients aged 65–79 years were admitted to internal medicine, and those over 80 years were admitted to cardiology. Among patients who presented to the hospital’s emergency department and required admission, 51.5% were men aged ≥ 75 years, rising to 53.3% among those aged 65 to 74 years. The clinical areas were related to cardiology (27.67%) and pneumology (20.63%). Conclusions: Demands for ED care in those over 65 years of age are associated with sociodemographic and clinical characteristics, which can be used to better plan and manage resources and improve user satisfaction. Full article

Transcranial direct current stimulation (tDCS) is a safe, well-tolerated method of non-invasively eliciting cortical neuromodulation. It has gained recent interest, especially for its positive clinical outcomes in neurodegenerative diseases such as multiple sclerosis (MS). However, its simultaneous (during tDCS) and cumulative effects (following repeated tDCS sessions) on the regional brain activity during rest need further investigation, especially in MS. This study aims to elucidate tDCS’ underpinnings, alongside its therapeutic impact in MS patients, using concurrent tDCS-MRI methods. In total, 20 MS patients (age = 48 ± 12 years; 8 males) and 28 healthy controls (HCs; age = 36 ± 15 years; 12 males) were recruited. They participated in a tDCS-MRI session, during which resting-state functional MRI (rs-fMRI) was used to measure the levels of the fractional amplitude of low-frequency fluctuations (fALFFs), which is an index of regional neuronal activity, before and during left anodal dorsolateral prefrontal cortex (DLPFC) tDCS (2.0 mA for 15 min). MS patients were then asked to return for an identical tDCS-MRI visit (follow-up) after 20 identical at-home tDCS sessions. Simultaneous tDCS-induced changes in fALFF are seen across cortical and subcortical areas in both HC and MS patients, with some regions showing increased and others decreased brain activity. In HCs, fALFF increased in the right pre- and post-central gyrus whilst it decreased in subcortical regions. Conversely, MS patients initially displayed increases in more posterior cortical regions but decreases in the superior and temporal cortical regions. At follow-up, MS patients showed reversed patterns, emphasizing significant cumulative effects of tDCS treatment upon brain excitation. Such long-lasting changes are further supported by greater pre-tDCS fALFFs measured at follow-up compared to baseline, especially around the cuneus. The results were significant after correcting for multiple comparisons (p-FDR < 0.05). Our study shows that tDCS has both simultaneous and cumulative effects on neuronal activity measured with rs-fMRI, especially involving major brain areas distant from the site of stimulation, and it is responsible for fatigue and cognitive and motor skills. Full article

This qualitative study explored the motivations for, and resilience of, family caregivers visiting family members with dementia in residential care homes (RCHs) in Hong Kong during the COVID-19 pandemic. Data for this qualitative descriptive study was obtained through audio-recorded, semi-structured, in-depth interviews with 25 family caregivers of individuals with dementia in RCHs. Following transcription, a thematic analysis was performed on the verbatim data. Three main themes emerged: (a) virtue of respect and filial piety; (b) family expectations and hopes; and (c) from red flags to resilience and rebuilding stronger relational bonds. The findings elucidate family caregiver motivations and resilience during RCH visits, offering crucial insights for healthcare policymakers. This can inform the design of care services and support to bolster the resilience of both caregivers and their relatives with dementia amidst ongoing global health-system pressures. Full article

The aim of our study was to test the application of a new vision training device, the EYE ROLL, for home-based eye movement training in athletes. Sixty-seven participants were randomly divided into three groups: a control group (no training); an eye movement training group with no device; and a group using the new EYE ROLL device. The results of 51 participants were used for statistical analyses after a 4-week period. Before and after the 4-week period, participants underwent the same assessment procedures: a comprehensive vision examination and saccadic eye movement recording. Before training, for both 10° and 5° stimuli, all subjects showed statistically significantly larger and faster rightward saccades compared to leftward saccades. After four weeks, the control group showed increased horizontal saccadic asymmetry and a decrease in leftward saccade amplitude. However, both velocities showed asymmetry in both visits. There were larger changes in saccadic parameters for leftward saccades, but no clear changes in saccadic response asymmetry after training. There were no consistent differences between the training groups. The EYE ROLL is a novel device that may serve as a substitute training tool for saccadic enhancement and may improve the symmetry of horizontal saccadic movements after four weeks of home-based training. Full article