bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effectiveness of Tai Chi Exercise in Improving Balance and Preventing Falls Among Older Adults
Authors: Kittichittipanich Boonsri , Kusoom Wichitra 
Published: December 2019

Background:
Accidental falls in older adults cause serious health problems, therefore, Tai Chi exercise (TC) is important to help older adults regain body balance and prevent falls.

Objective:
This study aimed to assess: 1) the effect of a 12-week TC intervention on lower extremity strength and body balance in older adults, 2) recent falls within 12 weeks, and 3) participants’ satisfaction toward TC exercise.

Methods:
A quasi-experimental study was conducted, and the participants were older adults, aged 60 and above. One hundred participants were selected by a purposive sampling technique and were divided into 2 groups: the experimental group (n=50) performing the TC exercise, and the control group (n=50) not performing TC. The lower-extremity strength was measured by using a dynamometer, and the body balance was measured by using a timed single leg stance procedure.

Results:
The findings revealed that lower-extremity strength was not significantly different in three time periods: pre-TC, after 6 weeks, and after 12 weeks within the experimental group and also after 12 weeks between the experimental group and control group. The body balance within the experimental group in the three time periods was significantly different (p<.001). Multiple pair comparisons by using the Bonferroni test indicated that phase 3 (a 12-week) was significantly higher than phase 1, and phase 2 (p<.05).
However, the effect of a 12-week TC intervention on the body balance of the experimental group was significantly higher than that of the control group (p<.001). The number of recent falls and near falls within 12 weeks in the control group was 14%, with 10% falls occurring outdoors and 4% occurring indoors, whereas the experimental group did not report any falls and showed satisfaction towards the TC exercise.

Conclusion:
The findings of the study confirm that TC exercise improves body balance and helps reduce the risk of falls in older adults, while the group of older adults who did not undergo TC exercise suffered an increased risk of falls. These results should be applied and implemented among older adults and other groups of populations in different geographic locations and other clinical settings who are at the risk of falls. Also, the study on TC exercise should be extended to 6-12 months so that concrete results from improving lower-limb strength and body balance can be observed.
Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study
Authors: Rogero-Blanco Eloisa , Lopez-Rodriguez Juan A , Sanz-Cuesta Teresa , Aza-Pascual-Salcedo Mercedes , Bujalance-Zafra M Jose , Cura-Gonzalez Isabel ,   MultiPAP Group
Published: December 2019

Background
Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner.

Objective
This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person’s Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START).

Methods
This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria.

Results
PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP.

Conclusions
There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.
A Mobile Phone–Based Gait Assessment App for the Elderly: Development and Evaluation
Authors: Zhong Runting , Rau Pei-Luen Patrick 
Published: December 2019

Background
Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life.

Objective
This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users.

Methods
The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions.

Results
Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring.

Conclusions
This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone–based gait assessment app. The feedback of the participants would help to design more elderly-friendly products.
A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial
Authors: Broers Eva Rosalinde , Kop Willem Johan , Denollet Johan , Widdershoven Jos , Wetzels Mart , Ayoola Idowu , Piera-Jimenez Jordi , Habibovic Mirela 
Published: December 2019

Background
Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes.

Objective
This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated.

Methods
Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies.

Results
The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean −1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07).

Conclusions
The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change.

Trial Registration
ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281
Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial
Authors: Cliffe Bethany , Croker Abigail , Denne Megan , Smith Jacqueline , Stallard Paul 
Published: December 2019

Background
Insomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated, and the effects of digital cognitive behavioral therapy (CBT) for insomnia (CBTi) on the mental health of adolescents with significant mental health problems are unknown.

Objective
This open study aimed to assess the feasibility of adding supported Web-based CBT for insomnia to the usual care of young people aged 14 to 17 years attending specialist child and adolescent mental health services (CAMHS).

Methods
A total of 39 adolescents with insomnia aged 14 to 17 years attending specialist CAMHS were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence-based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator [SCI], Insomnia Severity Scale, and Web- or app-based sleep diaries), anxiety (Revised Child Anxiety and Depression Scale [RCADS]), and depression (Mood and Feelings Questionnaire [MFQ]) were completed at baseline and post intervention. Postuse interviews assessed satisfaction with digital CBTi.

Results
Average baseline sleep efficiency was very poor (53%), with participants spending an average of 9.6 hours in bed but only 5.1 hours asleep. All participants scored less than 17 on the SCI, with 92% (36/39) participants scoring 15 or greater on the Insomnia Severity Scale, suggesting clinical insomnia. Of the 39 participants, 36 (92%) scored 27 or greater on the MFQ for major depression and 20 (51%) had clinically elevated symptoms of anxiety. The majority of participants (38/49, 78%) were not having any treatment for their insomnia, with the remaining 25% (12/49) receiving medication. Sleepio was acceptable, with 77% (30/39) of the participants activating their account and 54% (21/39) completing the program. Satisfaction was high, with 84% (16/19) of the participants finding Sleepio helpful, 95% (18/19) indicating that they would recommend it to a friend, and 37% (7/19) expressing a definite preference for a digital intervention. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (P=.005) and sleep quality (P=.001) and on measures of sleep (SCI: P=.001 and Insomnia Severity Index: P=.001), low mood (MFQ: P=.03), and anxiety (RCADS: P=.005).

Conclusions
Our study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and no follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health.

International Registered Report Identifier (IRRID)
RR2-10.2196/11324
A Patient-Centered Information System (myED) for Emergency Care Journeys: Design, Development, and Initial Adoption
Authors: Westphal Monika , Yom-Tov Galit Bracha , Parush Avi , Carmeli Nitzan , Shaulov Alina , Shapira Chen , Rafaeli Anat 
Published: December 2019

Background
Medical care is highly complex in that it addresses patient-centered health goals that require the coordination of multiple care providers. Emergency department (ED) patients currently lack a sense of predictability about ED procedures. This increases frustration and aggression. Herein, we describe a system for providing real-time information to ED patients regarding the procedures in their ED medical journey.

Objective
This study aimed to develop a system that provides patients with dynamically updated information about the specific procedures and expected waiting times in their personal ED journey, and to report initial evaluations of this system.

Methods
To develop the myED system, we extracted information from hospital databases and translated it using process mining and user interface design into a language that is accessible and comprehensible to patients. We evaluated the system using a mixed methods approach that combined observations, interviews, and online records.

Results
Interviews with patients, accompanying family members, and health care providers (HCPs) confirmed patients’ needs for information about their personal ED journey. The system developed enables patients to access this information on their personal mobile phones through a responsive website. In the third month after deployment, 492 of 1614 (30.48%) patients used myED. Patients’ understanding of their ED journey improved significantly (F8,299=2.519; P=.01), and patients showed positive reactions to the system. We identified future challenges, including achieving quick engagement without delaying medical care. Salient reasons for poor system adoption were patients’ medical state and technological illiteracy. HCPs confirmed the potential of myED and identified means that could improve patient experience and staff cooperation.

Conclusions
Our iterative work with ED patients, HCPs, and a multidisciplinary team of developers yielded a system that provides personal information to patients about their ED journey in a secure, effective, and user-friendly way. MyED communicates this information through mobile technology. This improves health care by addressing patients’ psychological needs for information and understanding, which are often overlooked. We continue to test and refine the system and expect to find positive effects of myED on patients’ ED experience and hospital operations.
Development of a National Caregiver Health Survey for Hematopoietic Stem Cell Transplant: Qualitative Study of Cognitive Interviews and Verbal Probing
Authors: Kedroske Jacob , Koblick Sarah , Chaar Dima , Mazzoli Amanda , O'Brien Maureen , Yahng Lilian , Vue Rebecca , Chappell Grant , Shin Ji Youn , Hanauer David A , Choi Sung Won 
Published: December 2019

Background
Roadmap 1.0 is a mobile health app that was previously developed for caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT). Formative research targeted toward its end users (caregivers) can help inform app design and development, allowing additional components to be incorporated into the app, which can then be tested in a future randomized controlled trial.

Objective
This study aimed to create a methodologically rigorous national survey that would help inform the development of Roadmap 2.0.

Methods
We conducted a prospective, qualitative research study that took place between November 18, 2018, and February 7, 2019, in a blood and marrow transplant unit within a large academic medical institution in the midwestern part of the United States. Cognitive interviews, including think-aloud and verbal probing techniques, were conducted in 10 adult caregivers (≥18 years) of patients who had undergone HSCT.

Results
Most participants were female (9/10, 90%), white (9/10, 90%), married (9/10, 90%), employed at least part time (6/10, 60%), caregivers of adult patients (7/10, 70%), and had some college education (9/10, 90%) and an annual household income of $60,000 or higher (6/10, 60%). All but one interview was audio-recorded, with permission. Overall, participants were engaged in the cognitive interview process of the draft survey, which included 7 topics. The interviews highlighted areas wherein survey items could be further refined, such as offering more response choices (eg, “NA”) or clarifying the type of transplant (eg, autologous or allogeneic) or context of transplant care (eg, pre-HSCT, during HSCT, post-HSCT, inpatient, and outpatient). Apart from these findings, the items in demographics, caregiving experiences, technology, positive activities, and mood were generally interpreted as intended. On the basis of the transcript data and field notes by the interviewer, items within self-efficacy (Caregiver Self-Efficacy Scale) and coping (Brief Coping Orientation to Problems Experienced inventory) questionnaires generated more confusion among interviewer and participants, reflecting difficulties in interpreting the meaning of some survey items.

Conclusions
This study incorporated the four cognitive aspects of survey methodology that describe the question-answering process—(1) comprehension, (2) information retrieval, (3) judgment and decision making, and (4) responding—by using the think-aloud and probing techniques in cognitive interviews. We conclude that this methodologically rigorous process informed revisions and improved our final questionnaire design.

International Registered Report Identifier (IRRID)
RR2-10.2196/resprot.49188
Acceptance and Use of Information Technology: Understanding Information Systems for Indonesia’s Humanitarian Relief Operations
Authors: Dwiputranti Made Irma , Oktora Raden Adriyani , Okdinawati Liane , Fauzan Mohamad Nurkamal 
Published: December 2019

Disaster management includes distributing logistical assistance to disaster victims. The implementation of this distribution must occur at the right time, at an appropriate location, on target and be appropriate to the needs of the victims. This research aims to design an information system to improve the performance of disaster relief operations by managing the information while monitoring and evaluating humanitarian relief operations.Consequently, understanding the primary determinants of user acceptance behavior has become a vital aspect in the successful implementation of the information system. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a tool to investigate and give a better understanding of the factors that affect the potential users’ acceptance and use of an information system. This research used 131 different informants from different groups of potential users to measure performance expectancy, effort expectancy, social influence, and facilitating conditions. The results have shown strong relationships between four aspects of the measurements for the acceptance of all parties involved in humanitarian relief operations.
ANTIDEPRESSANT-LIKE ACTIVITY OF TRANS-ANETHOLE IN UNSTRESSED MICE AND STRESSED MICE
Authors: DINESH DHINGRA  , SUDHA  
Published: December 2019

Objectives: The present study was undertaken to investigate the antidepressant potential of trans-anethole in unstressed and stressed male mice.
Methods: Swiss albino male mice were exposed to chronic unpredictable mild stress for 21 successive days. Simultaneously, trans-anethole (12.5 mg/kg, 25 mg/kg, and 50 mg/kg) and fluoxetine (20 mg/kg) per se were administered for 21 successive days to separate groups of unstressed and stressed mice. The effect of drugs on depressive-like behavior of mice was tested by tail suspension test (TST) and sucrose preference test.
Results: Trans-anethole (25 mg/kg) and fluoxetine significantly decreased the immobility period of unstressed and stressed mice in TST as compared to their respective control. These drugs significantly restored the reduced sucrose preference (%) in stressed mice. Trans-anethole did not show any significant effect on locomotor activity of mice. Antidepressant-like activity of trans-anethole (25 mg/kg) was found to be comparable to fluoxetine. Trans-anethole and fluoxetine significantly inhibited brain monoamine oxidase-A (MAO-A) activity, decreased plasma nitrite, brain malondialdehyde, and increased brain reduced glutathione levels and catalase activity in unstressed and stressed mice. The drugs significantly reversed stress-induced increase in plasma corticosterone levels.
Conclusion: Trans-anethole produced significant antidepressant-like activity in unstressed and stressed mice, possibly through inhibition of brain MAO-A activity and alleviation of oxidative stress. Reversal of stress-induced increase in plasma corticosterone levels might also be responsible for antidepressant-like activity of trans-anethole in stressed mice.
CHEMICAL CONSTITUENTS AND PHARMACOLOGICAL ACTIVITIES OF LANTANA CAMARA – A REVIEW
Authors: ALI ESMAIL AL-SNAFI  
Published: December 2019

Objective: The review was designed to investigate the traditional uses, chemical constituents and pharmacological effects of Lantana camara.
Methods: In the current review, databases including Web Science, Pub Med, Scopus and Science Direct, were searched to investigate the chemical constituents and pharmacological effects of Lantana camara.
Results: The plant contained alkaloids, glycosides, steroids, saponins, flavanoids, coumarins, tannins, carbohydrates, hydroxy anthraquinones, anthraquinone glycosides, proteins, phytosteroids, fixed oils, fats, and triterpinoids. Previous pharmacological studies revealed that Lantana camara possessed antimicrobial, antiparasitic, anxiolytic, gastrointestinal, hypoglycemic, cardiovascular, antioxidant, anticancer, antiinflammatory, analgesic, wound healing, antiurolithiatic, hepatoprotective, reproductive, anti–hemorrhoidal, thrombin inhibition and many other effects.
Conclusion: Lantana camara represents a promising medicinal plant with a wide range of pharmacological activities that could be utilized in several medical applications because of its effectiveness and safety.