We evaluated the uptake of an at-home syphilis testing option through TakeMeHome, a free HIV/STI self-testing programme, and assessed the correlates of selecting the new testing option in this cross-sectional evaluation. Data consisted of self-test orders placed between January and July 2025 in jurisdictions that introduced an at-home syphilis self-testing option through TakeMeHome and previously did not offer STI testing through the programme. Poisson regression models with robust standard errors were used to estimate the associations between participant race/ethnicity, gender identity, last HIV/STI test date, status as a previous TakeMeHome tester, and age and the outcome of ordering an add-on at-home syphilis test. In jurisdictions that did not previously offer an STI testing option, 1234 at-home tests were ordered over the follow-up period, with 907 (74%) orders for an at-home HIV test with an at-home syphilis test. Cisgender women were more likely to be interested in and eligible for the syphilis test compared with cisgender men, after adjustment for race/ethnicity, last HIV/STI test date, being a previous TakeMeHome tester, jurisdiction and age (adjusted PR: 1.22, 95% CI 1.13 to 1.33, p<0.0005). There was high interest in and uptake of the new at-home syphilis testing option in jurisdictions that previously did not offer at-home STI testing through TakeMeHome.
Exercises that involve increasing the speed of movements are beneficial for individuals with Parkinson disease (PD) and have the potential to reduce bradykinesia. High-speed bodyweight resistance training is accessible and versatile and can be performed anytime and anywhere, including at home. Furthermore, it is important to consider home exercises that enable treatment continuity and reduce barriers such as transportation difficulties and participation in physical exercise programs. However, we have not identified any studies that have conducted home-based high-speed bodyweight resistance training in individuals with PD. This protocol aims to investigate the effects of remotely supervised home-based high-speed bodyweight resistance training in reducing bradykinesia and improving mobility, muscle power, dynamic balance, and quality of life in individuals with PD. A randomized controlled trial will be performed with 1:1 allocation, blinded assessments, and an intention-to-treat analysis. Altogether, 46 individuals with PD, aged ≥50 years, who have bradykinesia and a sedentary or insufficiently active lifestyle, will be included. Participants will be randomly assigned to either (1) an experimental group (high-speed bodyweight resistance training) or (2) a control group (bodyweight intervention; usual speed). Both groups will perform a home-based, remotely supervised intervention, consisting of 60-minute individual sessions, 3 times per week over 12 weeks, with a trained physiotherapist. The primary outcome is bradykinesia of the lower limbs. The secondary outcomes are mobility, muscle power, dynamic balance, and quality of life. The effects of the training will be analyzed from the collected data by using the intention-to-treat analysis. Between-group differences will be measured by 2-way repeated measures ANOVA, considering the baseline, posttraining follow-up (primary time point), and 4-week follow-up (secondary time point). Recruitment was conducted from October 2024 to October 2025 (n=46). Data collection is currently in the follow-up phase. The results are expected to be analyzed and submitted for publication by May 2026. The results of this trial will likely provide valuable new information on the effects of remotely supervised home-based high-speed bodyweight resistance training in reducing bradykinesia and improving mobility, muscle power, dynamic balance, and quality of life in individuals with PD. If confirmed, these findings may support the feasibility and effectiveness of an accessible home-based intervention delivered through telerehabilitation, potentially reducing barriers to rehabilitation. ClinicalTrials.gov NCT06646523; https://clinicaltrials.gov/study/NCT06646523. DERR1-10.2196/84689.
The main aim of this study is to investigate the connection between a high workload and health-related quality of life among in-home care workers in northern Sweden during the COVID-19 pandemic. We also investigate whether social support and control at work can prevent poor health due to high workload. A cross-sectional survey was conducted during the pandemic, with 629 (response rate 33 per cent) of an estimated 1,900 in-home care workers responding. Results were compared with a nearly identical survey conducted prior to the pandemic in which 1,154 (response rate 58 per cent) of an estimated 2000 in-home care workers responded. Psychosocial factors were measured using QPSNordic and health-related quality of life using EuroQol 5 Dimensions (EQ-5D). EQ-5D responses were translated into quality-adjusted life year (QALY) scores. Propensity scores were used with absolute risk differences. During the pandemic, staff with high workload had a statistically significantly (6.2%) lower QALY score (confidence interval 2.2%-10.3%) compared to staff with a normal workload. This was also the case for the usual activities and the anxiety/depression dimensions of EQ-5D. These risk differences were greater, but not statistically significant, during the pandemic than before. The combination of a normal workload and a high degree of control over one's work appeared to protect against a low QALY score, while social support at work did not seem to be protective. High workload is related to poorer health-related quality of life. This is mainly attributable to anxiety/depression. In-home care organisations need to manage workload better to prevent poor health among staff during strained situations such as a pandemic. The results of our study indicate that in-home care organisations should increase their readiness to promote opportunities for staff to maintain a high degree of control over their work, in order to counteract variations in workload that ultimately appear to have a negative impact on HRQoL.
Optimal cardiovascular health during pregnancy and postpartum is critical for reducing maternal morbidity and mortality. Although lifestyle interventions effectively promote cardiovascular health, strategies are needed to reach the maternal populations with the highest prevalence of cardiovascular disease risk factors. Evidence-based home visiting programs, though not initially developed to address cardiovascular health, offer a promising platform for reaching pregnant and postpartum women at high risk for later cardiovascular disease. This study explored home visitor perspectives on integrating cardiovascular health content into home visitation. Guided by the Social Ecological Model, semi-structured interviews (n = 10) and focus groups (n = 8) were conducted with home visitors, supervisors, and program managers (N = 33) from agencies in California and Rhode Island. Thematic analysis identified broad support for including heart health content, with participants emphasizing the value of culturally relevant, engaging, and flexible curricula that could be tailored to family needs. Organizational challenges included staff burden, training gaps, and funding for intervention sustainability. At the community level, strong relationships with healthcare providers and aligned messaging across systems were identified as key facilitators. Findings provide practical insights for the design and implementation of cardiovascular health interventions within home visiting and highlight the importance of addressing multi-level factors to support successful integration.
This study aimed to examine the satisfaction with, and feasibility and acceptability of, a virtual home safety assessment implemented for people living with dementia and their caregivers by a trained Occupational Therapist (OT). Seventeen assessments were conducted. Nine caregivers and one patient completed a satisfaction survey. Ten caregivers and the OT assessor completed semi-structured interviews, which were analyzed using qualitative content analysis. Survey respondents reported high levels of satisfaction with the virtual assessment; the majority (90%) reported being comfortable with the virtual modality. Caregivers perceived that their assistance was required to conduct the assessment virtually, and care recipients responded well to technology. In comparison to in-person visits, the virtual assessment was considered easier for people living with dementia, easier to access, and equivalent to an in-person visit. Virtual home assessments are easy to implement, feasible, acceptable, and an effective way to identify and manage safety risks. Given the health system pressures that have led to long wait times for in-home safety assessments, virtual administration can build capacity for home safety assessments, allowing more patients to be assessed sooner, particularly in rural and underserviced areas where travel distances impede timely access to assessment.
Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population. To identify the rates and types of patient safety events within a US national pediatric population receiving HHC. This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC. Days of HHC receipt. Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index. This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology. In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.
Family caregivers play a critical role in preventing pressure injuries among patients receiving home care. This quasi-experimental pre- and post-test study evaluated the effect of teach-back training on caregivers' knowledge of pressure injury prevention in 2024 within the neurology department of a teaching hospital in Iran. A total of 110 family caregivers of patients requiring home care participated. A specialized wound care research nurse delivered structured education using the teach-back method. Caregivers' knowledge was measured before the intervention and 1 month after hospital discharge using a 23-item Family Caregivers' Knowledge Regarding Pressure Injuries Questionnaire. There was a statistically significant improvement in the mean knowledge score after the intervention. Findings indicate that teach-back is a practical, low-cost, and effective educational strategy for improving caregiver knowledge related to pressure injury prevention in home care settings. The results support integrating teach-back into caregiver education programs and highlight the need for additional studies to further evaluate its impact on caregiver competence and patient outcomes.
U.S. home healthcare agencies provide essential care to homebound patients, primarily older adults at high risk for infection. The COVID-19 pandemic intensified existing infection prevention and control challenges, particularly among marginalized communities. This qualitative study explored unique infection prevention and control challenges faced by agencies and differences in responses among those serving vulnerable populations. Ten agencies representing diverse geographic regions, ownership models, and patient characteristics participated; 25 staff across varied roles completed semi-structured interviews examining infection prevention and control policies, care coordination, and patient/caregiver communication during COVID-19. Thematic analysis identified four major themes: Into the Fray; Changing Relationships to Patients; Solutions Aimed at Care Provision Continuity; and Alleviating Fear and Providing Information. Staff experienced fear and stress from uncertainty and essential worker pressures, with urban infection prevention, quality, and education personnel particularly affected. Urban staff faced parking challenges and exposure risks in multi-generational homes; many rural staff contended with long drives and regional/county protocols that complicated patient access. Wearing full PPE in inclement weather further strained staff. Patient/caregiver hesitancy made trust building essential. Telehealth, education, remote work, and local partnerships supported care continuity, with corporately resourced agencies adapting more rapidly. Findings highlight the need for centralized guidance, telehealth investment, and stronger staff well-being supports in future public health crises.
Nursing homes (NHs) are key to supporting older adults' quality of life (QoL). With many QoL instruments available, selecting an appropriate tool is challenging. This study inventories instruments used with NH residents, and examines whether they conceptualize QoL as a multidimensional construct. A systematic review was conducted to identify QoL instruments used in NHs. Five databases were searched in March 2025 using terms related to "elderly", "nursing home", "questionnaire", "psychometrics", and "quality of life". Empirical English- or Dutch-language studies were eligible, with no geographic or date restrictions. Reference and citation searches were added. Quality was assessed using COSMIN Risk of Bias checklist, and questionnaire characteristics and QoL subdomains were analyzed using a QoL concept map. A total of 15,516 records were identified (MEDLINE n = 4,536; Web of Science n = 4,738; CINAHL n = 1,395; Scopus n = 3,395; Embase n = 1452), of which 6,680 duplicates were removed. After screening 8,836 titles and abstracts, 370 full texts were assessed, yielding 28 eligible studies. Most questionnaires were setting-specific, QoL-focused, and designed for self-report. Across all instruments, 157 unique themes were mapped onto seven QoL dimensions; 'context and environment' and 'social relationships' were most common, whereas 'relationship with staff' and 'physical health' were addressed less often. This study provides an overview of conceptual and practical diversity in QoL tools for NH residents. It highlights the absence of a standardized, comprehensive tool tailored to both residents and the NH context.
Sleep quality declines with age and is a known contributor to multiple chronic health conditions, including Alzheimer disease. Emerging evidence suggests that certain electroencephalography (EEG) neural signatures measured during sleep may be predictive of cognitive decline in older adults. Sleep EEG signals are traditionally measured using bulky, rigid, and uncomfortable equipment in an unfamiliar laboratory setting, which can negatively impact sleep signals. Due to these limitations, sleep EEG data acquisition is typically limited to a single night. This study aimed to validate our recently developed portable, skin-like EEG monitoring patch for 7 nights in the home environment in a pilot sample of young and older adults by evaluating usability and acceptance, and replicating age-related differences in sleep architecture observed in the polysomnography literature. Eighteen young adults and 18 cognitively unimpaired older adults without sleep disorders were enrolled (data from 11 young adults and 12 older adults were included in the analyses) in a 7-night study during which they wore novel, gel-free, wireless, ultrathin, skin-conforming, sleep monitoring, fabric-based patches. These patches were self-applied to the forehead and face for optimal usability and comfort. The patches incorporate laser-cut mesh electrodes with low-profile electronics (including a rechargeable battery and amplifier) and transmit EEG signals to a participant-controlled, Bluetooth-enabled, tablet-based data acquisition app. An automated algorithm was used to stage sleep and assess microarchitecture features from the EEG commonly impacted for each participant. Averages across nights were computed for these sleep features for each participant. Young and older adults reported that the sleep patch was easy to use and comfortable to wear. There was no loss of signal power over 7 nights of wear across participants (retained-data signal-to-noise ratio over the 7-d period: young adult, mean 20.69, SD 12.78, maximum 52.13, minimum 5.19; older adult, mean 22.10, SD 9.39, maximum 49.96, minimum 13.79). Most datasets not retained were lost due to poor reference electrode adhesion on the nose (75/101, 74% of lost datasets in young adults and 57/88, 65% in older adults). Trained sleep technologists verified that the retained datasets were of sufficient quality to be scored without difficulty. Expected age-group differences in sleep features were observed, including age-related reductions in stage N3 sleep (young adult, mean 18.55, SD 6.70; older adult, mean 10.40, SD 6.43; Mann-Whitney U=42.0; P=.01) and reduced sleep spindle density (young adult, mean 2.92, SD 2.24; older adult, mean 0.94, SD 1.33; Mann-Whitney U=45.0; P=.006). This study demonstrates that our novel, comfortable, wearable patch can reliably measure physiological sleep data over multiple nights at home in adults across the lifespan, thereby making multinight sleep assessment in cognitive aging studies and clinical research more accessible than traditional polysomnography. In future studies, the small, lightweight system, which is highly scalable, can be shipped inexpensively to participants' homes, making this technology and research accessible to individuals who may have difficulty traveling or who are hesitant to travel to a laboratory or clinic.
Working-From-Home (WFH) practices expanded rapidly during the COVID-19 pandemic and continue to be a point of discussion today with debates increasingly focused on productivity rather than the underlying reasons for WFH or flexibility. This study investigates why individuals value WFH and hybrid work arrangements in the United States. The specific period of study was during the COVID-19 pandemic. Understanding these motivations can inform constructive negotiations and effective policies that enhance productivity while supporting employees' work-life balance and caregiving responsibilities. Despite extensive discussion of whether employers should permit WFH, the diverse reasons employees seek flexibility remain understudied. Using data from a nationally representative online survey conducted in late 2021, we employ a best-worst scaling experiment to rank motivations for remote work. Results show the most valued reason for WFH is balancing work with caregiving, followed by reducing commuting time and costs, limiting exposure to illness, and preferring the home environment. A latent class model identifies four heterogeneous preference segments: (1) caregiving and commuting, (2) productivity and comfort, (3) multitasking and health safety, and (4) diffuse preferences without a dominant motivation. Additionally, seemingly unrelated regression analysis links WFH preferences with behavioral changes in grooming, attire, and personal care routines. These findings highlight the heterogeneity in workers' motivations for flexibility and suggest that one-size-fits-all approaches may be inefficient. By revealing the underlying drivers of WFH preferences, this study offers nuanced insights for organizations seeking to design flexible work policies that balance productivity objectives with employee well-being.
The Balancing Incentive Program (BIP), legislated in the 2010 Affordable Care Act, offered states financial incentives to increase access to Medicaid home-based and community-based services (HCBS). Despite the major infrastructure changes required by BIP, no evaluation to date has quantified the increase in spending attributable to BIP, which is of concern to Medicaid HCBS policymakers, providers, and consumers. This is the first causal estimate of BIP's effects, including the timing of implementation in each state, compared with a counterfactual. Using state-level expenditure data, we estimated the change in HCBS spending as a percentage of LTSS spending in 17 BIP participant states compared with a counterfactual or synthetic control calculated as a weighted average of the outcome in 17 BIP eligible, nonparticipant states. Synthetic control weights were estimated using pre-BIP characteristics. To assess how BIP effects evolved over time, we estimated cumulative change in the outcome in multiple post-BIP years (2013, 2016, and 2019). Our primary analysis indicates that cumulatively from FY 2013 to 2019, BIP states increased their HCBS spending as a percentage of LTSS spending by an average of 5.2 percentage points (95% CI: 0.0, 9.8), compared with the synthetic control. Although many state-run programs have sought to increase HCBS access, our study's causal estimate of BIP effects in 17 states, compared with 17 states that did not, represents a more substantial growth than findings of prior studies.
The introduction of the healthcare program has brought about a Copernican revolution by separating care from the place where it is provided. This system, which combines constraints and outpatient care, calls into question healthcare practices, particularly during home visits. Qualitative research conducted among thirteen healthcare professionals in outpatient psychiatry in the Hauts-de-France region explores the necessary adaptations to relational strategies in this context. It highlights the emergence of a key skill, flexible rigidity, in establishing and maintaining the therapeutic alliance.
Patient-centric, at-home, dried blood collection can increase compliance, reduce cohort size, decrease shipping costs, and open the door for broader applications of affinity proteomics. Dried blood samples from 16 individuals, collected by Tasso M20 "smart" devices, were analyzed by the SomaScan Assay using conditions modified for this new matrix. These assay results were compared to plasma and serum from the same donors. The cross-section of proteins that can be measured in both plasma and dried blood was determined. Complete blood counts (CBCs) were also taken from these donors. We generated models to predict these counts based on SomaScan Assay measurements. Over 800 proteins can be measured in both plasma and DBS. These proteins are actively secreted by cells or found on cellular surfaces. The remainder of the SomaScan Assay menu contains information on the cellular component of whole blood. Models generated from DBS data can more accurately predict complete blood counts than those generated from plasma.
This study aims to assess whether single-agent pharmacotherapy directed at the patient-prioritised, highest-scoring PERSONS symptom (target symptom) produces concurrent improvements in both the target symptom and overall symptom burden in advanced-cancer patients. Consecutive adults receiving palliative care specialist between April 2023 and February 2024 were enrolled if ≥1 PERSONS item scored ≥ 7/10. At baseline (T0), clinicians identified the target symptom and initiated one guideline-concordant drug for its control. Follow-up (T1) occurred after 14 days (median). Outcomes were change in target-symptom severity and change in total PERSONS score. Paired t-tests compared T0 and T1; Pearson's r examined correlations. 81 patients (median age 71years; 55.6% female; 81.5% metastatic disease) completed both assessments. Target-symptom severity fell from 7.63 ± 1.02 to 3.78 ± 1.35 (mean reduction 3.85 points; 95% CI 3.45 to 4.25; p<0.0001). The total PERSONS score decreased from 21.94 ± 4.56 to 13.46 ± 5.12 (mean reduction 8.48 points; 95% CI 7.54 to 9.42; p<0.0001). Target-symptom severity correlated moderately with non-target PERSONS score at T0 (r = 0.55) and strongly at T1 (r = 0.65; both p<0.0001). Pain was the predominant target symptom (45.7 %). Focusing on a single, evidence-based drug on the patient-defined dominant symptom halved target-symptom intensity and reduced global symptom burden by 39% within 2 weeks. These findings support a pragmatic 'less-is-more' paradigm that may minimise polypharmacy while delivering broad symptomatic benefit in advanced cancer.
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Acute limb ischemia may impair functional status and hinder return home after hospitalization, even in patients who survive to discharge. However, the associations among discharge destination, clinical characteristics, and outcomes have not been fully evaluated. Using a multicenter registry, we analyzed 769 patients with acute limb ischemia who underwent revascularization between July 2011 and March 2025 and survived to discharge. Non-home discharge was defined as transfer to another hospital or nursing facility. Multivariable logistic regression incorporating baseline and procedural variables was performed to identify determinants of non-home discharge. One-year mortality after discharge was compared between the home and non-home discharge groups. Non-home discharge occurred in 287 (37.3 %) patients. Multivariable analysis demonstrated that advanced age, non-ambulatory status, frailty, prior cerebrovascular disease, hypoalbuminemia, and receipt of public assistance were independently associated with non-home discharge, as was severe ischemia (Rutherford category IIb/III). Procedural factors, including the need for surgical revascularization and inadequate distal perfusion (final Tibial Infrapopliteal Perfusion Index grade 0-1) were also associated with non-home discharge. When stratified by cumulative risk burden (0-2, 3-5, ≥6 factors), the incidence of non-home discharge increased stepwise (18%, 50%, and 92%, respectively; p < 0.001). One-year mortality was significantly higher among patients with non-home discharge than among those discharged home (21.2% vs. 7.6%; log-rank p < 0.001). More than one-third of patients with acute limb ischemia were unable to return home after revascularization. Discharge destination was independently associated with baseline vulnerability, disease severity, and procedural factors, and was linked to increased 1-year mortality.
Older adults undergoing total joint arthroplasty (TJA) are particularly vulnerable to postoperative functional decline, yet the impact of anesthetic technique on recovery remains uncertain. This study examined whether spinal anesthesia (SA), compared with general anesthesia (GA), is associated with early functional decline and non-home discharge in geriatric patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA). We performed a retrospective cohort study using the 2021-2023 American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥75 years undergoing THA or TKA were included. The primary outcome was functional status decline, defined as any reduction in activities of daily living independence from preoperative status to hospital discharge. The secondary outcome was discharge disposition, categorized as home versus non-home. Multivariable logistic regression was used to estimate adjusted ORs (aORs) for associations between anesthetic type and outcomes. The cohort included 62 338 cases (GA: 30 296; SA: 32 042). GA was associated with higher rates of functional decline (38.5% vs 30.2%; p<0.001) and non-home discharge (22.6% vs 11.0%; p<0.001). After adjustment, GA remained independently associated with increased odds of functional decline (aOR 1.32; 95% CI 1.28 to 1.37; p<0.001) and non-home discharge (aOR 1.70; 95% CI 1.63 to 1.78; p<0.001). Findings were consistent across THA and TKA subgroups. In patients aged 75 years or older undergoing elective total joint arthroplasty, general anesthesia was associated with significantly higher odds of early functional decline and discharge to a non-home setting compared with spinal anesthesia. These findings suggest that anesthetic choice may be a modifiable perioperative factor for optimizing recovery in geriatric total hip arthroplasty patients.