Search Results (147)

Background/Objectives: There is a need for randomized clinical trials with higher quality, especially for older people at high risk of falls, with interventions that consider individual needs, comprehensiveness of care, and connection with primary health care. We designed a randomized controlled trial to examine the effects of a case management intervention combined with a physical exercise protocol on risk factors for falls, falls data, adherence, satisfaction, costs, and implementation in community-dwelling older adults with high risk of falls. Methods: A minimum of 60 community-dwelling older people with high falls risk will participate in the randomized controlled assessor-blinded trial (MAGIC—v. 2). The trial will be conducted in a regional health department of São Paulo state (Brazil), which includes 6 cities. Participants will be randomized to the Intervention Group (case management intervention based on all individual risk factors for falls identified by a multidimensional assessment, over 16 weeks, once a week, by telephone calls). Both groups will perform a physical exercise protocol based on falls prevention for 16 weeks (twice a week) in Health Units. The assessment will be performed at baseline, after 16 weeks of intervention, after 6-month follow-up, and after 12-month follow-up. Primary outcome measures include falls data and potentially modifiable risk factors for falls. Discussion: This study has the potential to facilitate the future implementation of the intervention based on case management with a focus on fall prevention in the health sectors. Trial registration: Brazilian Registry of Clinical Trials (ReBEC). Full article

Purpose: We aimed to evaluate the safety and feasibility of a remote electrocardiogram (ECG) monitoring-based cardiac rehabilitation (CR) program during an early postoperative period in patients who underwent cardiac surgery. Methods: Five days after cardiac surgery, patients were referred to a CR department and participated in a low-intensity inpatient CR program while wearing an ECG monitoring device. Prior to discharge, the patients underwent a cardiopulmonary exercise test (CPET) and squat endurance test to determine the suitable intensity and target heart rate (HR) for home-based CR (HBCR). During 2 weeks of the HBCR period after discharge, patients participated in aerobic and resistance exercises. Electrocardiogram data were transmitted to a cloud, where researchers closely monitored them through a website and provided feedback to the patients via telephone calls. Grip strength (GS), 6 min walk distance (6 MWD), EuroQol-5 dimension (EQ-5D), short-form 36-item health survey (SF-36), and Korean Activity Scale/Index (KASI) were measured at three different time points: 5 d post-surgery (T1), pre-discharge (T2), and 2 weeks after discharge (T3). Squat endurance tests and CPET were performed only at T2 and T3. Result: Sixteen patients completed the study, seven (44%) of whom underwent coronary artery bypass graft surgery (CABG). During the study period between T2 and T3, peak VO₂ improved from 12.39 ± 0.57 to 17.93 ± 1.25 mL/kg/min (p < 0.01). The squat endurance test improved from 16.69 ± 2.31 to 21.81 ± 2.31 (p < 0.01). In a comparison of values of time points between T1 and T3, the GS improved from 28.30 ± 1.66 to 30.40 ± 1.70 kg (p = 0.02) and 6 MWD increased from 249.33 ± 20.92 to 387.02 ± 22.77 m (p < 0.01). The EQ-5D and SF-36 improved from 0.59 ± 0.03 to 0.82 ± 0.03 (p < 0.01) and from 83.99 ± 3.40 to 122.82 ± 6.06 (p < 0.01), and KASI improved from 5.44 ± 0.58 to 26.11 ± 2.70 (p < 0.01). In a subgroup analysis, the CABG group demonstrated a greater increase in 6 MWD (102.29 m, p < 0.01) than the non-CABG group. At the end of the study, 75% of the patients expressed satisfaction with the early CR program guided by remote ECG monitoring. Conclusions: Our findings suggest that early remote ECG monitoring-based CR programs are safe and feasible for patients who have undergone cardiac surgery. Additionally, the program improved aerobic capacity, functional status, and quality of life. Full article

Background/Objectives: Depression impairs the quality of life in older adults and represents a significant public health issue. Cognitive reserve may act as a protective factor against depressive symptoms in older adults. Additionally, interaction with pets may serve as another potential protective factor against these symptoms. Thus, this study aimed to evaluate whether higher cognitive reserve could predict a reduction in depressive symptoms in older adults and to investigate the moderating role of pet companionship in this relationship. Methods: The following instruments were used: a Sociodemographic Data Sheet, the Modified Telephone Interview for Cognitive Status (TICS-M), the Cognitive Reserve Index Questionnaire (CRIq), and the Geriatric Depression Scale (GDS-15). Data were collected via video calls through WhatsApp and analyzed using a moderation analysis with PROCESS for SPSS. Results: The final sample consisted of 215 older adults with a mean age of 69.13 years (SD = 6.89). Among the participants, 53% owned pets and 47% did not. The overall model revealed a significant association between the predictor variables and the outcome (F(3, 211) = 4.24, p < 0.01). For the group without pets, the effect was not significant (β = −0.1082, p = 0.2916), but for the group with pets, the effect was substantial and negative on the GDS (β = −0.1936, p < 0.05). Conclusions: We concluded that the relationship between cognitive reserve and depressive symptoms is moderated by the presence of pets in individuals’ lives. These findings highlight the role of pets in protecting against depressive symptoms in older adults. Future studies should explore this relationship with more diverse samples. Full article

Background: Digital health, especially in Primary Health Care (PHC), has been expanding rapidly, encompassing various technologies to improve care. This study aims to evaluate the integration of digital technologies in PHC, identifying barriers and facilitators in a Brazilian capital in an urban context. Methods: A survey with a questionnaire based on a validated model was used, involving physicians and nurses from Basic Health Units. The analysis included descriptive statistics and association tests in the SPSS software, with a significance level of 5%. Results: The findings show the presence of computers and the use of e-SUS/Electronic Citizen Record in all units, highlighting WhatsApp^®, telephone calls, and other digital media as the main used tools. It was observed that there was limited digital infrastructure, a lack of adequate training for professionals or specific protocols for the organization of digital actions and statistical associations with the performance of digital health actions. Conclusions: It is recommended to strengthen policies for professional qualification and investments in infrastructure, aiming at the continuity and improvement of the use of Information and Communication Technologies in PHC. These findings offer comparable insights for similar contexts in Brazil in urban PHC settings and countries with equivalent socioeconomic contexts and analogous public health systems. Full article

Identification of emotions exhibited in utterances is useful for many applications, e.g., assisting with handling telephone calls or psychological diagnoses. This paper reviews methods to identify emotions from speech signals. We examine the information in speech that helps to estimate emotion, from points of view involving both production and perception. As machine approaches to recognize emotion in speech often have much in common with other speech tasks, such as automatic speaker verification and speech recognition, we compare such processes. Many methods of emotion recognition have been found in research on pattern recognition in other areas, e.g., image and text recognition, especially in recent methods for machine learning. We show that speech is very different compared to most other signals that can be recognized, and that emotion identification is different from other speech applications. This review is primarily aimed at non-experts (more algorithmic detail is present in the cited literature), but this presentation has much discussion for experts as well. Full article

This paper addresses the challenge of optimizing end-to-end neural diarization systems for conversational telephone speech, focusing on diverse acoustic features beyond traditional Mel-filterbanks. We present a methodological framework for integrating and analyzing different feature types as input to the well-known End-to-End Neural Diarization with Encoder Decoder Attractors (EEND-EDA) model, focusing on Emphasized Channel Attention, Propagation and Aggregation in Time Delay Neural Network (ECAPA-TDNN) embeddings and Geneva Minimalistic Acoustic Parameter Sets (GeMAPS). Our approach combines systematic feature analysis with adaptation strategies, including speaker-count restriction and regularization techniques. Moreover, through comprehensive ablation studies of GeMAPS features, we identify optimal acoustic parameters and temporal contexts for diarization tasks, achieving a reduced feature set that maintains performance while decreasing computational complexity. Experiments on the CallHome corpus demonstrate that our optimized ECAPA-TDNN with Mel-filterbank combination reduces Diarization Error Rate by 29% relative to baseline systems. Our evaluation framework extends beyond traditional metrics, revealing that different feature combinations exhibit distinct strengths in specific diarization aspects. Full article

With the improvement of the internet and the widespread adoption of digital communication devices such as smartphones, VoIP has largely replaced traditional telephone systems. Many companies are deploying VoIP systems due to their scalability and low cost. In this paper, we address the issue of remote clients or traveling employees being unable to contact business partners due to specific phone numbers. We propose a reference phone number mechanism that combines a set of related business partners’ phone numbers to enhance call availability. To ensure the confidentiality of calls, we also designed an algorithm to integrate key exchange protocols into the proposed mechanism. The mechanism can flexibly customize the required security protocols. A performance analysis was conducted by deploying the proposed mechanism in a medium-sized company. The results prove that the mechanism is feasible and the effect is satisfactory. Full article

The dispatching telephone functionality acts as a pivotal interconnection between the power grid dispatch business and telecommunications business, playing a vital role in ensuring the efficient conduct of grid dispatch activities. Nonetheless, the current power grid dispatch system and communication program-controlled exchange system are disjointed, leading to a cumbersome process for the dispatching telephone functionality that severely impacts grid dispatch efficiency. To better tackle the above challenges, in this paper, we introduce an innovative intelligent call technology designed to facilitate data interchange and information integration between the power grid dispatch system and the communication program-controlled exchange system. By leveraging the K-Nearest Neighbors (KNN) algorithm, the technology enables automated querying of operational information with heightened efficiency and precision, thereby optimizing the operations of the dispatching telephone functionality. Subsequently, a prototype software application is developed to conduct experimental testing of intelligent call technology. The findings demonstrate that the method proposed in this paper successfully reduces the time expenditure associated with the dispatching telephone functionality, enhancing the productivity of dispatchers in routine operations and emergency response, thus ensuring the secure and stable operation of the power grid. Full article

Background: Post-COVID-19 Syndrome or long COVID (LC) is a novel public health crisis and, when persistent (>2 years), is a long-term condition. Post-exertional symptom exacerbation (PESE) is a characteristic symptom of LC and can be improved in a structured pacing rehabilitation programme. Aims: To evaluate the effect of an 8-week structured World Health Organisation (WHO) Borg CR-10 pacing protocol on PESE episodes, LC symptoms, and quality of life in a cohort of individuals with long-term LC. Methods: Participants received weekly telephone calls with a clinician to discuss their activity phase, considering their PESE symptoms that week. They completed the Leeds PESE questionnaire (LPQ), C19-YRS (Yorkshire Rehabilitation Scale), and EQ-5D-5L at the beginning of the programme (0 weeks), the end of programme (8 weeks), and at final follow-up (12 weeks). Results: Thirty-one participants (duration of LC symptoms: 29 months) completed the programme. The PESE episodes decreased in number each week (15% fewer each week, 95% CI: 11% to 20%, p < 0.001) and were of shorter duration and milder severity each week. The changes in C19YRS symptom severity and functional disability (0–12 weeks) were statistically significant but not clinically significant. The EQ5D-5L index score change was not statistically significant. Conclusions: A structured pacing protocol effectively reduced PESE episode frequency, duration, and severity but did not produce clinically significant changes in LC symptoms, reflecting the long-term nature of the condition in this cohort. Full article

Objectives: To summarize the impact of various telerehabilitation interventions on motor function, balance, gait, activities of daily living (ADLs), and quality of life (QoL) among patients with stroke and to determine the existing telerehabilitation interventions for delivering physiotherapy sessions in clinical practice. Methods: Six electronic databases were searched to identify relevant quantitative systematic reviews (SRs). Due to substantial heterogeneity, the data were analysed narratively. Results: A total of 28 systematic reviews (n = 245 primary studies) were included that examined various telerehabilitation interventions after stroke. Motor function was the most studied outcome domain across the reviews (20 SRs), followed by ADL (18 SRs), and balance (14 SRs) domains. For primary outcomes, our findings highlight moderate- to high-quality evidence showing either a significant effect or no significant difference between telerehabilitation and other interventions. There was insufficient evidence to draw a conclusion regarding feasibility outcomes, including participant satisfaction, adherence to treatment, and cost. Most reviews under this umbrella included patients with stroke in the subacute or chronic phase (12 SRs). Simple and complex telerehabilitation interventions such as telephone calls, videoconferencing, smartphone- or tablet-based mobile health applications, messaging, virtual reality, robot-assisted devices, and 3D animation videos, either alone or in combination with other interventions, were included across reviews. Conclusions: Various telerehabilitation interventions have shown either a significant effect or no significant difference compared to other interventions in improving upper and lower limb motor function, balance, gait, ADLs, and QoL, regardless of whether simple or complex approaches were used. Further research is needed to support the delivery of rehabilitation services through telerehabilitation intervention following a stroke. Full article

Background/Objectives: Evidence suggests that older adults who survived COVID-19 were exposed to greater functional dependence in their daily living activities. This study aims to examine the prevalence of functional dependence and associated factors among Brazilian older people with functional dependence 12 months after COVID-19 infection. Methods: A cross-sectional study was carried out involving people aged 60 years or older in the state of Paraná, Brazil. One year after notification or hospital discharge due to COVID-19, between June 2021 and March 2022, participants responded to a questionnaire via telephone call about sociodemographic data and data on functionality using the Measure of Functional Independence (FIM). The outcome variable “assessment of functional capacity” was divided into functional dependence (FIM Total < 104) and functional independence (FIM Total ≥ 104). Results: A total of 768 older adults participated, with an average age of 68.03 ± 6.8 years (range between 60 and 100). A majority of them were female (50.3%), white (46%), with low education (37.4%), had a partner (56.3%), did not live alone (72.4%), and had their own home (52.2%). The prevalence of functional dependence was 7.2%. On average, participants scored 5.4 points lower on FIM one year after COVID-19 infection compared with those in the acute phase of COVID-19 (125.5 vs. 120.1; p < 0.001). Functional dependence was higher (p < 0.05) among women when compared to men (aOR = 2.28); in people who changed their work situation due to COVID-19 when compared to those with no change (aOR = 5.27); in people with fair/poor/bad self-reported health compared to those with excellent/good health (aOR = 2.97); in people with cardiovascular symptoms compared to those without cardiovascular symptoms (aOR = 3.37); and among the most severe cases of the disease (treatment in ICU) compared to mild cases (outpatient treatment) (aOR = 10.5). Conclusions: Most participants presented functional independence 12 months after COVID-19 infection. Cases of functional dependence were influenced by multidimensional factors, including physical health, economic, and psychosocial aspects. Full article

Background/Objectives: Obesity is a growing public health challenge due to its high prevalence and associated comorbidities. Bariatric surgery is the most effective treatment for achieving sustained weight reduction when more conservative treatments have failed. This study evaluates the impact of a nurse-led telecare follow-up programme in the immediate postoperative period for patients who have undergone bariatric surgery. Methods: A quasi-experimental study was carried out in two hospitals in southern Spain. We included 161 patients who met the inclusion criteria: a body mass index (BMI) ≥ 40 kg/m² or a BMI ≥ 35 kg/m² with associated comorbidities, and the failure of non-surgical treatments. Patients were divided into two groups: the intervention group (IG), which received follow-up telephone calls from a specialised nurse during the first 30 days post-surgery, and the control group (CG), which received standard care. The nurse, who was available 24 h a day, answered questions and dealt with queries over the phone or referred patients to the emergency department if necessary. Several variables were recorded, including the number of telephone consultations, reasons for consultation, number of emergency visits, readmissions, and surgical reinterventions. Results and Conclusions: The IG showed a significant reduction in ED visits (4.9% vs. 30% in CG), and consultations were mainly related to diet and drainage. The nurse telecare intervention significantly improved postoperative recovery by reducing complications and optimising the safety and quality of postoperative care. These results reinforce the importance of personalised follow-up in improving clinical outcomes in bariatric patients. Full article

Introduction: Patients with head injuries usually return to their home environments after completing rehabilitation, which is an additional challenge in the case of functional, motor or cognitive impairment. In order to identify the problems that such patients face and to objectify their problems with integration, we used the Community Integration Questionnaire-Revised (CIQ-R). At the same time, the validity of the translation of the questionnaire into Slovenian was checked. Methods: The CIQ-R was translated, and patients were telephoned twice, 14 days apart. In addition, they were assessed using the Functional Independence Measure (FIM) during the first call. The reliability of the CIQ-R in terms of internal consistency was assessed using Cronbach’s alpha and Guttman’s lambda-2. The reliability in terms of repeated measures was assessed using intraclass correlation (ICC). The association between FIM and CIQ-R scores was assessed using Pearson’s correlation. Results: Internal consistency of the CIQ-R was high (α = 0.8, λ = 0.85), and there was a very high re-test stability of the overall CIQ-R score (ICC = 0.95). The cognitive component of the FIM in the home environment was linearly associated with the CIQ-R score (r = 0.8, p ≤ 0.001). Conclusions: The translation of the CIQ-R questionnaire into Slovenian was successfully validated, and we proved its potential suitability for clinical use. Full article

Helping people with intellectual and visual disabilities engage in activity and mobility is considered crucially important to promote constructive occupation and a basic form of physical exercise (i.e., objectives that are essential for the individuals’ wellbeing and in line with their rights). This study assessed two new programs aimed at helping eight participants with intellectual and visual disabilities (four in each program) to independently move through specific indoor destinations, collect and transport objects, and access stimulation events (e.g., music) with the support of technology systems involving a smartphone linked to mini cameras and speakers. The second program was more advanced than the first and (a) required the participants to discriminate the objects used and transport two (rather than one) of them before any stimulation event, and (b) included telephone calls to and stories from preferred communication partners among the stimulation events. Each program was implemented using a single-case research design (i.e., a non-concurrent multiple baseline design across participants). The results showed that both programs were effective in enabling the participants to collect, transport, and put away objects and access stimulation independently during 20-min sessions. Based on the results, both programs might be considered useful tools to help people with intellectual and visual disabilities manage independent activity and mobility. Full article

Background: Headache is a prevalent and disabling non-respiratory symptom of COVID-19, posing a persistent challenge in post-COVID syndrome. This study aimed to determine the prevalence, phenotypes, risk factors and biomarkers associated with COVID-related headaches. Methods: A retrospective analysis of 634 hospitalized COVID-19 patients was conducted, with 295 participants being followed up 12–15 months post-discharge via telephone call. Initial laboratory workups, including complete blood count and various biochemical parameters, were compared between headache and non-headache groups. Results: One-third of hospitalized patients experienced headaches, predominantly younger individuals (p < 0.001) and women (p = 0.002). Non-dominant headaches were characterized as dull (56.9%) and holocranial (26.5%), while dominant headaches were unilateral (31.3%) with photophobia (34.3%) and nausea (56.3%). Persistent headaches were unilateral (40%) and pulsating (38%) with phonophobia (74%). Decreased CD4 T cells independently predicted COVID-associated headaches, with elevated IL-6 levels noted in the dominant-headache group (p = 0.040). Remarkably, 50% of patients reported persistent headaches 12–15 months post-infection. Dexamethasone administration significantly reduced the likelihood of long-COVID headaches (52% vs. 73%, p = 0.029). Conclusions: Headache was present in one-third of patients with heterogenous phenotypes: tension headache in the non-dominant group, and migraine in the dominant and persistent headache groups. Persistent headache remains a challenge, with dexamethasone showing potential in reducing its incidence, emphasizing the need for tailored approaches in managing long-COVID headaches. Full article