Less sedentary time (ST) and more light physical activity (LPA) are associated with improved health outcomes among breast cancer survivors. However, less is known about whether interventions designed to increase moderate-to-vigorous physical activity (MVPA) also influence time spent sedentary and in LPA. This study explored the overall and component-specific effects of the Fit2Thrive technology-supported MVPA intervention on ST and LPA in breast cancer survivors. Physically inactive breast cancer survivors (n = 269; Mage = 52.5; SD = 9.9) received a core intervention (Fitbit and Fit2Thrive smartphone app) and were randomized to five components ("on" vs. "off"): Support Calls, Deluxe App, Fitbit Buddy, Online Gym, and Text Messages for 12 weeks. Mixed-effects models examined accelerometer-assessed ST and LPA changes, overall, and by intervention component at 12 and 24 weeks. We also examined relationships between changes in MVPA with ST and LPA, and moderating effects of demographic and disease characteristics on component effects. Compared to baseline, ST significantly decreased at 12 weeks (β = -14.2 min/day; p < 0.01); reductions were maintained at 24 weeks (β = -11.0 min/day; p < 0.01). LPA significantly increased at 24 weeks (β = 7.4 min/day; p = 0.04), but not at 12 weeks. No component effects were significant. Greater increases in MVPA were associated with greater ST decreases and LPA increases. Time since diagnosis moderated effects of the Deluxe App on ST and LPA. Participation in an mHealth MVPA promotion trial was associated with modest reductions in ST and increases in LPA, while also increasing MVPA. Findings suggest the core intervention may have been sufficient to support favorable changes across movement behaviors. Future research should investigate how to enhance effects while maximizing MVPA and health outcomes. Participation in an mHealth MVPA promotion trial may also result in reduced ST and increased LPA.
We evaluated whether offering access to a multicomponent mHealth app improves quality of life (QoL) and psychosocial outcomes among breast cancer survivors under pragmatic, nonprescriptive conditions. In this single-center, randomized, controlled trial at Hospital Clínic de Barcelona, women age ≥18 years, disease-free after breast cancer treatment, were recruited (December 2020-December 2021) and randomly assigned 1:1 to usual follow-up plus app access or usual follow-up alone. The app provided CTCAE v4.03-aligned symptom tracking with self-care guidance, educational content, an events calendar, and gamified smartphone-based step counting; no protocolized clinician monitoring or feedback was provided. Outcomes were assessed at baseline and 3, 6, 9, and 12 months using European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (QLQ)-C30/BR23, Hospital Anxiety and Depression Scale (HADS), and Three-Item Loneliness Scale (TILS). The primary end point was the difference in QLQ-C30 Global Health Status/QoL at 3 months. Analyses followed intention-to-treat using mixed models for repeated measures adjusted for baseline values. Of 124 women assessed, 121 were randomized (intervention n = 60; control n = 61). Patient-reported outcome measures were available for 106 of 121 (87.6%) at 3 months and 95 of 121 (78.5%) at 12 months. At 3 months, there was no significant difference in Global Health Status/QoL (adjusted mean difference [Intervention-Control], -2.24 [95% CI, -9.29 to 4.81]; P = .53); estimates at later time points were similarly imprecise. No significant between-group difference were observed for QLQ-BR23 domains, HADS anxiety/depression, or TILS. Exploratory subgroup analyses suggested possible heterogeneity in TILS by hormonal-treatment category; this was descriptive and hypothesis-generating only. App engagement was the highest in months 0-3 (48/60 [80.0%] with any use) and declined thereafter; 12 of 60 (20.0%) never used the app. In a pragmatic, nonprescriptive survivorship trial, offering access to a multicomponent mHealth app without closed-loop clinical integration did not show a statistically significant between-group differences in QoL or psychosocial outcomes; confidence intervals were compatible with meaningful harm and did not exclude small benefit depending on the threshold used to define clinical relevance.
Background/Objectives: Maternal mortality remains disproportionately high in low- and middle-income countries, where ineffective referral systems and a lack of infrastructure contribute to delays in emergency obstetric care. In sub-Saharan Africa, referrals are largely conducted via paper, often resulting in lost documents and limited follow-up. Mobile health (mHealth) offers a promising solution by enabling real-time, bidirectional communication. This study aimed to examine how the Mobile Obstetric Referral Emergency System (MORES), a WhatsApp-based referral platform piloted in 20 rural health facilities and two district hospitals in Bong County, Libera, influences healthcare providers' communication, collaboration, and relationships. Methods: A mixed-methods design was used. Ninety one (N = 91) providers completed demographic and Trust and Teamwork surveys. Of the 91 providers, 35 providers from rural health facilities and 56 providers from district hospitals participated in a 10-question survey and individual interviews. Results: Survey results indicated high levels of mutual respect, confidence, and teamwork perceived by both the rural health facility and district hospital providers. Qualitative data further expanded on the quantitative results showing the MORES intervention enhanced the timeliness and accuracy of referrals, supported problem-solving between facilities, and fostered shared goals, mutual respect, and knowledge exchange. Conclusions: Providers perceived the MORES to be associated with increased collaboration and continuity of care, as well as a feasible, low-cost, and sustainable intervention to improve obstetric referral systems in low-resource settings.
Wearable human activity recognition has become an important component of intelligent fitness tracking, but deploying accurate recognition models on resource-constrained edge devices remains challenging. Existing deep learning methods often rely on recurrent structures, attention mechanisms, or complex hybrid architectures, which increase computational cost and limit real-time deployment. This study proposes DeM-FCN, a lightweight and purely convolutional framework for smart dumbbell-based resistance-training activity recognition. The model integrates a physics-aware input representation, Gaussian noise regularization, stacked one-dimensional convolutional blocks, Global Max Pooling, and a cost-sensitive focal loss to improve subject-independent recognition. The input representation extends raw inertial measurements by introducing trigonometric encoding of Euler angles and acceleration and gyroscope magnitude features, allowing the model to capture both orientation-related motion patterns and orientation-insensitive motion intensity. The proposed model was evaluated using Leave-One-Subject-Out cross-validation on a custom smart dumbbell dataset containing four resistance-training exercises collected from 15 subjects. DeM-FCN achieved an accuracy of 0.966, macro F1-score of 0.916, and macro AUC of 0.982, while maintaining only 73.7 K parameters, 14.84 M FLOPs, and a model size of 0.29 MB. Additional evaluations on PAMAP2 and MHEALTH suggested that the convolutional backbone retained useful class-ranking ability on public IMU-based HAR datasets, while the reduced macro F1-scores indicated that hard-label daily activity recognition remains more challenging than constrained resistance-training recognition due to broader activity diversity, sensor-domain differences, and missing modality information. A refined ablation study confirmed that trigonometric encoding and magnitude features provide complementary benefits, with magnitude features contributing more strongly to cross-subject robustness. The results suggest that DeM-FCN provides a favorable accuracy-efficiency trade-off for wearable resistance-training recognition and offers a practical foundation for edge-oriented fitness monitoring.
Introduction: Obstructive sleep apnoea usually co-occurs with hypertension and is managed using various therapeutic modalities. Continuous positive airway pressure (CPAP) appears to be one of the promising interventions. This review aims to narratively assess its effectiveness by comparing its effect with usual and standard care. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were consulted to enhance transparency in reporting the search and selection process; however, this review does not meet the full criteria for a systematic review because screening, data extraction, and synthesis were not conducted according to full systematic review methodology. Five electronic databases (APA PsycINFO, Web of Science, Embase, AMED, and Medline) were searched. Only randomised controlled trials were considered eligible and were assessed for risk of bias using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes were calculated using an online tool developed by the Campbell Collaboration, George Mason University, version 27 November 2023. They were interpreted as trivial (<0.1), small (0.1-0.3), moderate (0.3-0.5), or large (>0.5) effects, respectively. Results: This study includes 2944 subjects, 63.3% of whom were male. Their ages range from 23 to 69.7 years. The effect sizes for systolic blood pressure ranged from small to large (d = -0.2, 95% CI -0.69 to 0.28, to d = 0.7, 95% CI -0.15 to 1.55), and for diastolic blood pressure from d = 0.1, 95% CI -0.3 to 0.57, to d = 1.4, 95% CI -0.97 to 2.08 magnitude of effects was observed for both systolic and diastolic blood pressure at different times of the day. Standard care, such as medication and telemedicine, does not confer superior effects over usual care. This intervention showed evidence of sustained effects; however, further evidence is required. Conclusions: CPAP may be effective for both systolic and diastolic blood pressure in patients with obstructive sleep apnoea at different times of day. Its effect may be sustained. The effective dose of CPAP on hypertension remains unclear. Future studies should consider using a more robust design, such as a systematic review and meta-analysis, to obtain pooled estimates rather than individual effect sizes.
Individuals with type 2 diabetes mellitus (T2D) are at increased cardiovascular risk. Although exercise is an important strategy for reducing cardiometabolic risk, accessible and scalable intervention delivery strategies, such as synchronous telehealth programs, remain underexplored. This randomized clinical trial (RED Study; NCT05362071) investigated the effects of a 12-week synchronous telehealth exercise program on clinical, functional, and psychosocial outcomes in adults with T2D. Thirty-three participants (55.8 ± 10.1 years) were randomized to an intervention group (INT; n = 17), which performed supervised combined aerobic and resistance exercise via video calls (2-3 sessions/week), or a control group (CON; n = 16). Glycated hemoglobin (HbA1c) was the primary outcome. Secondary outcomes included capillary blood glucose, blood pressure, functional performance, and psychosocial parameters. Assessments were conducted at baseline and post-intervention by blinded evaluators, and analyses were conducted using linear mixed-effects models in an intention-to-treat analysis. No significant interaction effect was observed for HbA1c (p > 0.05). However, significant group × time interactions favored the INT for functional performance outcomes, including the 30 s Chair Stand (p = 0.02), Arm Curl (p < 0.001), Timed Up and Go (p = 0.01), and 2-Minute Step Test (p = 0.01), as well as sleep quality (p < 0.001). Depressive symptoms decreased over time (p = 0.03) in both groups. Additionally, the INT showed reductions in post-session capillary blood glucose across mesocycles 1, 2, and 4 (p = 0.03). The synchronous telehealth exercise program was not superior to the control condition in reducing HbA1c; however, it improved functional performance, enhanced sleep quality, and promoted acute reductions in glycemic levels in individuals with T2D.
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been shown to increase bystander CPR rates and improve outcomes after out-of-hospital cardiac arrest (OHCA). However, dispatchers cannot directly visualize the scene, which may limit the effectiveness of telephone instructions. Telemedicine-assisted CPR (TA-CPR), incorporating real-time video communication, has been proposed to address this limitation and potentially improve bystander CPR performance. Evidence regarding its effectiveness in real-world EMS systems remains limited. This study aimed to compare bystander CPR rates between TA-CPR and DA-CPR. We conducted a pilot pragmatic cluster-randomized controlled trial involving adult patients with suspected non-traumatic OHCA. Monthly block randomization assigned CPR instruction protocols to either a TA-CPR protocol or a DA-CPR protocol. The primary outcome was bystander CPR rate. Secondary outcomes included ongoing bystander CPR at EMS arrival and protocol compliance. A total of 108 patients were included, with 55 managed using TA-CPR and 53 using DA-CPR. Patients in the TA-CPR group were younger (mean age 63.5 ± 16.2 vs. 68.9 ± 14.6 years), and a higher proportion presented with an initial shockable rhythm (20.0% vs. 9.4%). Bystander CPR occurred in 87.3% of TA-CPR cases and 92.5% of DA-CPR cases, with no statistically significant difference (p = 0.53). Ongoing bystander CPR at EMS arrival was also similar between groups (76.4% vs. 84.9%; p = 0.33). Protocol compliance was significantly lower in the TA-CPR group than in the DA-CPR group (69.1% vs. 92.5%; p < 0.01). TA-CPR did not increase bystander CPR rates compared with conventional DA-CPR in this real-world EMS setting.
Remote postoperative wound assessment may help improve follow-up after laparoscopic surgery in resource-limited settings. This study evaluated the feasibility and patient satisfaction of smartphone-based postoperative wound assessment following general and bariatric laparoscopic surgery. We conducted a prospective cohort study from June 2022 to June 2023 at a public sector teaching hospital. Consecutive adult patients undergoing elective laparoscopic general or bariatric procedures were invited to participate. Consenting patients submitted wound photographs and clinical queries to their surgeon within 14 days of discharge using an encrypted messaging platform. The primary outcome was patient satisfaction measured using the Patient Satisfaction Questionnaire Short Form (PSQ-18). Secondary outcomes included the proportion of patients requiring escalation to in-person review and the type of remote intervention provided. A total of 113 patients were enrolled. Of these, 21 (18.6%) required escalation to in-person review. Among the 92 patients managed remotely, 52 (46.0%) received reassurance only and 40 (35.4%) required medication prescription or adjustment. The mean PSQ-18 score for the cohort was 79.66 ± 11.24 (range 18-90). Satisfaction was comparable across procedure types. Smartphone-based postoperative wound assessment appears feasible and acceptable in this setting, with most postoperative concerns managed remotely and favourable patient satisfaction. Further controlled studies are needed to assess safety, diagnostic accuracy, and cost-effectiveness.
The present review aims to 1) provide a comprehensive overview of remote patient monitoring (RPM) across the existing research literature involving people with MS (pwMS) and 2) provide updated information on the availability of these technologies. A systematic literature search was conducted in PubMed, Embase, Web of Science and Scopus. Studies were included if they evaluated adult pwMS, applied RPM over at least 1 week, and reported objective outcomes. Included studies were categorised as evaluating apps, wearables or combinations of the two. A total of 77 studies involving 9463 pwMS were included. Participants had a mean age of 46 years, 69.7% were female, and most presented with mild to moderate disability (EDSS 2-3.5). Wearables were used in 37 studies, 33 employed apps and 4 combined both. Wearables were most commonly wrist-worn, primarily assessing step count and gait, while mobile apps focused on motor function, cognition and quality of life. Most wearables and apps remain restricted to research use, with only few being commercially available. Application of RPM in MS is promising, offering broad possibilities for monitoring health status, but is limited by device heterogeneity and restricted availability. Future efforts should prioritise standardised, multi-domain RPM solutions that ensure data security and broad clinical applicability. Remote patient monitoring offers significant opportunities for remote assessment and long-term tracking in pwMS.Across identified studies, participants were were predominantly younger or middle-aged (mean age 45 years), suggesting that potential challenges for older patients remain underexplored.Most studies included participants with EDSS scores between 2.5 and 4.0, limiting conclusions about the suitability of wearable monitoring for individuals with more severe gait impairments.Only a small number of the wearables and apps identified in the reviewed studies are currently commercially available, as many remain limited to research use and/or have been discontinued.
Universal telehealth aims to support access to timely coordinated chronic disease care. Large-scale evidence on the extent to which this occurs to guide telehealth policy is limited. To examine temporal changes in uptake and timeliness of general practitioner chronic disease management (GP-CDM) services in Australia following universal telehealth introduction (March 2020) and removal of subsidized telephone (but not video) GP-CDM services (July 2021). Whole-of-population cohort study of linked national claims and death data, 2018-2022. Interrupted time-series analyses quantified temporal changes in GP-CDM service uptake and timeliness following telehealth policy changes. From 2018 to 2022, each month an average of 568 858 GP-CDM services were delivered, with 25-43 users and 44-76 services per 1000 population aged 45-<85 per month. After universal telehealth introduction, GP-CDM uptake remained stable, with similar trends pre- and early-pandemic. Monthly uptake decreased substantially following the removal of telephone GP-CDM services [decrease of 4.0 users (95%CI -6.3, -1.7) and 6.9 services (-10.5, -3.3) per 1000 population]. In the first month of telehealth, 38.7% of people using GP-CDM services used telehealth (37% telephone, 1.7% video), declining to 2.2-5.4%/month after removal of telephone GP-CDM services. Small improvements in GP-CDM timeliness stalled once telephone services were no longer available. Patterns were similar across population subgroups. Telehealth policies in Australia sustained access to chronic disease care during the pandemic. Limiting access to these services to video alone was associated with a greater than expected decline in use had the pandemic and introduction of telehealth not occurred.
Survivors of critical illness commonly experience post-intensive care syndrome (PICS), including cognitive, mental health, physical, quality-of-life, and social impairments after discharge. Telemedicine may improve access to post-ICU recovery clinic care, but its feasibility and effect on recovery outcomes remain unclear. We evaluated the feasibility of a multidisciplinary telemedicine post-ICU recovery clinic and collecting 6-month outcome data. We conducted a two-site pilot feasibility randomized controlled trial at an academic medical center and regional community medical center in the southeastern United States. Adults admitted to medical or surgical ICUs with sepsis and/or acute respiratory distress syndrome were randomized 1:1 to telemedicine ICU recovery clinic visits or standard care. The intervention included two multidisciplinary visits at 3 weeks and 3 months after hospital discharge; participants accessed visits via a secure web-based personal health portal, where they videoconferenced simultaneously with an ICU clinician, pharmacist, and psychologist. Participants in the standard of care group received usual post-discharge care. Feasibility outcomes included enrollment, retention, attendance, clinician fidelity, and participant ratings of acceptability, appropriateness, and feasibility. Exploratory outcomes included cognitive, mental health (i.e., depression, anxiety, PTSD), and physical health (i.e., activities of daily living, independent activities of daily living) composite scores measured at 1 week and 6 months after hospital discharge. Of 1,108 screened patients, 91 were randomized (telemedicine, n = 46; standard care, n = 45). Among 83 participants completing the 1-week assessment, median age was 56 years, 51% were male, and 91% were White. In the telemedicine arm, 23 participants (57.5%) attended at least one visit; attendance was 55% at 3 weeks and 42.5% at 3 months among eligible participants. Primary 6-month outcome assessment was completed by 31 participants in each group (67%). Clinician participation fidelity was high, and telemedicine attendees reported favorable acceptability, appropriateness, and feasibility ratings. Exploratory analyses of PICS composite outcomes did not differ significantly between groups. A multidisciplinary telemedicine post-ICU recovery clinic and associated trial procedures were feasible, with high clinician fidelity and favorable participant ratings. Larger trials are needed to explore engagement strategies and evaluate effectiveness on long-term recovery outcomes, prioritizing inclusion of more diverse and historically underrepresented populations. NCT03926533 (posted 4/24/2019).
Background: Digital health technologies have expanded access to home fetal heart rate (FHR) monitoring devices, enabling fetal surveillance outside clinical settings. However, evidence on women's awareness, acceptance, and experiences with these devices remains limited. Objective: To assess awareness, adoption, user experience, perceived reassurance, and attitudes toward home FHR monitoring among pregnant and postpartum women. Methods: A cross-sectional online survey was conducted using a structured questionnaire distributed via Google Forms. Eligible participants were women aged ≥18 years who were currently pregnant or had been pregnant within the previous two years. The survey evaluated awareness and use of home FHR monitoring devices, usage patterns, sources of recommendation and instruction, emotional responses, perceived reassurance, mobile application integration, and overall attitudes. Descriptive statistics and exploratory subgroup analyses were performed. Results: A total of 225 women completed the survey; 166 (73.8%) reported using a home FHR monitoring device during pregnancy. Most users reported positive emotional experiences, with calmness as the most common response. Home monitoring was generally perceived as reassuring, and many participants felt calmer on days of device use. Gynecologists were the primary source of device recommendations and usage instructions. Participants highlighted the importance of professional guidance, clear instructions, and mobile application support. Primiparous women had significantly higher adoption rates than multiparous women (p < 0.001). Conclusions: Home FHR monitoring was widely accepted and commonly perceived as reassuring. These devices may support patient-centered prenatal care when accompanied by appropriate professional guidance. Further prospective studies are needed to assess their clinical utility, safety, and integration into prenatal care pathways.
Background: Telemedicine is increasingly used in inflammatory bowel disease (IBD), but its effects on quality of life (QoL) and psychological outcomes remain unclear. Objectives: This study aimed to evaluate the impact of 6-month telemonitoring on QoL, disease activity, treatment adherence, psychological well-being, patient satisfaction, and healthcare utilization. Methods: This randomized, open-label, single-center study conducted in Russia (July 2023-December 2024) included adults with ulcerative colitis or Crohn's disease, who were assigned 1:1 to telemonitoring or standard care. The intervention involved monthly remote assessments and access to a web-based platform containing educational information, disease activity assessment, and a chat with a gastroenterologist. The primary outcome was health-related QoL (SIBDQ). Exploratory outcomes included general QoL (WHOQOL-26), psychological well-being (HADS), alexithymia (TAS-26), visceral sensitivity (VSI), treatment adherence (GMAS), patient satisfaction (PSQ-18), achievement of clinical remission, and healthcare utilization. Results: Sixty-eight patients completed the study (32 intervention, 36 control). Telemonitoring was associated with lower anxiety levels (β = -1.76, p = 0.021), reduced visceral sensitivity (β = -5.08, p = 0.039), and higher medication adherence (β = 1.75, p = 0.008). No significant associations were observed for SIBDQ, WHOQOL-26 domains, depressive symptoms, alexithymia, achievement of clinical remission, or patient satisfaction with care (p > 0.05). Patients in the telemonitoring group also required fewer outpatient visits (p < 0.001), with no difference in hospitalizations. Within-group analysis demonstrated improvements in QoL, treatment adherence, visceral sensitivity, and disease activity in the telemonitoring group, but not in the controls. Conclusions: Six-month telemonitoring in IBD was associated with lower anxiety, reduced visceral sensitivity, improved treatment adherence, and fewer outpatient visits. The health-related QoL assessed by the SIBDQ did not differ compared to standard care. No clear clinical disadvantage compared with standard care was detected during the study period.
Tuberculosis (TB) has been a major health issue of concern globally, where timely diagnosis has been a major factor in spreading the disease and causing death, especially in underprivileged environments. The aim of the presented study was to construct and analyze an Information and Communication Technology (ICT)-enabled model of engaging communities in the effort of increasing the rates of early TB detection by means of increased community engagement and simplified diagnostic routes. It was a prospective, quasi-experimental study that was carried out in twelve community health centers in three districts over a period of eighteen months where ICT-enabled intervention sites (n = 6) were compared with the conventional screening sites (n = 6). ICT framework also incorporated a mobile health application to the community health worker, automated short message service (SMS) to monitor the symptoms, cloud-based case management, and geographic information system (GIS) to monitor the hotspots. One thousand eight hundred four hundred and seventy seven presumptive TB cases were registered where 923 were ICT-enabled and 924 were control sites. Findings indicated that ICT-enabled sites recorded much higher rates of case detection (78.4% vs. 52.1, p < 0.001), median time to diagnosis was lower (12.3 ± 4.2 days vs. 28.7 ± 8.9 days, p < 0.001), and higher rates of treatment initiation within 48 h were recorded (89.2% vs. 61.4, p < 0.001). The efficiency of community health workers increased by 43.6 and there was 2.8 fold greater number of household contacts screened by the worker per monthly. ICT-enabled model had better performance with regard to the facilitance of early TB detection using enhanced community engagement, which is a cost-effective and scalable solution to TB control programs fortification.
Patient safety has undergone significant evolution over the past two decades, driven by a shift towards systemsbased approaches, the adoption of technological solutions, and a growing global commitment to improving healthcare outcomes. Early milestones (2000- 2010) saw the establishment of key safety protocols, including the "To Err is Human" report and the World Health Organisation's global initiatives. The following decade (2011-2020) marked the widespread integration of electronic health records and simulation-based training. The coronavirus disease-2019 pandemic presented unique challenges, including healthcare resource shortages and increased errors, but also accelerated innovations, such as telehealth and clinical decision-support tools. More recently, artificial intelligence has emerged as a powerful tool for enhancing patient safety, offering predictive capabilities and personalised care. However, barriers such as organisational resistance, resource constraints and inconsistent data-collection remain. Looking ahead, fostering a culture of safety, collaboration and continuous innovation is essential to address systemic gaps, and to ensure safer healthcare practices globally.
Persistent mobility limitations after inpatient rehabilitation are common in older adults with cognitive impairment (CI). Home-based exercise interventions can improve locomotor capacity during this vulnerable period; however, evidence that they improve real-world mobility is scarce. To investigate the effects of a home-based exercise programme combined with physical activity (PA) promotion on real-world digital mobility outcomes (DMOs). Single-centre, double-blind, randomised, placebo-controlled trial. Community. 104 community-dwelling older adults with CI (82.3 ± 6.0 years; 75% women; Mini-Mental State Examination score 23.2 ± 2.4) recently discharged from inpatient geriatric rehabilitation. The intervention group received a 12-week home-based exercise programme combined with behavioural change techniques to promote PA; the control group received a 12-week non-specific home-based placebo motor activity programme. DMOs related to walking amount, pattern and pace were measured over 48 h at baseline, post-intervention and after a 12-week follow-up using a single body-fixed sensor and validated processing algorithms. Post-intervention, small statistically significant improvements favouring the intervention group were observed in walking pattern and pace outcomes, including longer walking bout (WB) duration, higher walking speed and longer stride length in shorter (10-30 s) WBs, and higher 90th percentile walking speed in WBs >10 s. These improvements were not sustained at the 12-week follow-up. No between-group differences were found for walking amount. The post-discharge home-based exercise programme combined with PA promotion showed small, short-term improvements in selected real-world walking pattern and pace outcomes in older adults with CI after inpatient rehabilitation; however, these effects were no longer evident at follow-up, and walking amount did not increase.
Parkinson disease (PD) is a degenerative disorder of the brain and afflicts approximately 6 in 10 people aged 50 years or older. PD patients have motor and speech problems, so regular visits to and monitoring of the patients are hard. It is necessary to detect the presence of PD promptly and accurately, since early treatment will contribute greatly to enhancing patients' lives. As the number of aging people increases, there is a great demand for noninvasive, reliable, and remote diagnosis. In the current work, we studied 31 patients with PD and healthy subjects, their voice recordings, to create an automatic classification system. A Light Gradient Boosting Machine (LightGBM) classifier was adapted and boosted using metaheuristic-based feature selection (FS), namely the Pelican Optimization Algorithm (PAO). Hyperparameter optimization was made to optimize predictive performance. The models have been assessed on typical classification measures, i.e., accuracy, sensitivity, specificity, precision, and AUC. We classified using the baseline LightGBM classifier, with an accuracy of 95%. The resulting model had a better prediction accuracy of 97% after using PAO-based FS and hyperparameter optimization. More than that, the model was also sensitive, specific, precise, and had a high area under the curve, which validates its effectiveness at classifying PD. The paper shows that FS and hyperparameter tuning are effective approaches when applied to voice data and combined with LightGBM to detect PD as early as possible. The results point to the promise of noninvasive diagnostic systems based on the use of telemedicine to allow early intervention and enhance the lives of people with PD.
Background/Objective: Conventional cardiotocography (CTG) is an essential tool for fetal surveillance but remains inaccessible in many low-resource settings. Emerging low-cost, wireless mobile CTG systems designed for home-based use may enhance global access to fetal monitoring. Nevertheless, their concordance with conventional CTG in the interpretation of FHR patterns remains insufficiently validated. This study aimed to evaluate agreement in the readability and interpretability of FHR baseline patterns and accelerations/decelerations between mobile and conventional CTG. Methods: A prospective study was conducted in pregnant women undergoing antepartum surveillance to evaluate agreement in the interpretation of FHR tracings simultaneously obtained from mobile and conventional CTG. Each paired tracing was independently and blindly assessed by two physician reviewer groups. Results: A total of 404 women underwent simultaneous assessment with both modalities. Agreement in baseline FHR interpretation was excellent between reviewer groups and modalities (ICC > 0.95). Interpretation of accelerations and decelerations also demonstrated very good agreement (κ = 0.8-0.9), whereas agreement for FHR variability and uterine contractions was moderate. Both reviewer groups assigned slightly but significantly higher quality scores and satisfaction scores to conventional CTG compared with mobile CTG. Conclusions: Mobile CTG demonstrates excellent agreement with conventional CTG in the assessment of FHR baseline and accelerations/decelerations. However, the overall quality and user satisfaction associated with mobile CTG were slightly lower than those observed with conventional CTG. Because of its advantages, including lower cost, portability, and user-friendly design, mobile CTG may serve as a feasible alternative for antepartum surveillance in low-resource settings worldwide.
Pediatric dermatology has historically seen a shortage of dermatologists relative to demand, leading to limited access for patients, which is amplified in underserved communities. Telemedicine has emerged as an attractive means to supplement clinical care and a tool that may assist in overcoming many of the barriers present in pediatric dermatology. Studies have found that teledermatology increases access to care, decreases wait-times and provides cost savings for patients and health care systems, all while maintaining high patient and provider satisfaction. Despite limitations, telemedicine remains a powerful resource with the ability to expand access to pediatric dermatologists.
Background: Over the past two decades, teleophthalmology has become an effective approach for glaucoma screening and follow-up, with its adoption markedly accelerated by the COVID-19 pandemic. Objectives: The aim of the present study was to explore and analyze the attitudes of ophthalmologists in Bulgaria toward the application of teleglaucoma, digital communication, and artificial intelligence in clinical practice. Methods: A cross-sectional survey study was conducted among 113 ophthalmologists between September 2024 and March 2025, representing 10.5% of all licensed ophthalmologists in Bulgaria (n = 1074). Results: Age, professional experience, and specialization influenced the level of involvement in managing glaucoma patients. The level of awareness regarding the term 'teleophthalmology' was higher among respondents with a specialization in ophthalmology and those holding a doctoral degree (p = 0.001). Among the ophthalmologists surveyed, 35.4% (n = 40) provided teleophthalmology services, while an additional 19.5% (n = 22) reported no prior provision of such services but planned to do so in the future. The most preferred method for conducting teleophthalmology consultations was telephone communication (n = 27; 67.5%), followed by communication via Skype, Viber, or Messenger (n = 23; 57.5%). Physicians with longer professional experience more frequently conducted remote consultations with patients they already knew (p = 0.006). A substantial proportion of respondents (85.0%, n = 96) expressed willingness to participate in training related to contemporary trends and the provision of remote medical services. More than half of respondents expressed positive attitudes toward the use of artificial intelligence in ophthalmology, although practical implementation remained limited. Conclusions: The present study outlined the current landscape of attitudes among ophthalmologists in Bulgaria toward teleglaucoma, digital communication, and the use of artificial intelligence in clinical practice. The findings indicated a moderately positive yet cautious stance-remote services were perceived primarily as complementary tools, particularly for the follow-up of previously known patients and for real-time collaboration between specialists.