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The All of Us Research Program enrolls diverse US participants which provide a unique opportunity to better understand the problem of opioid use. This study aims to estimate the prevalence of opioid use and its association with sociodemographic characteristics from survey data and electronic health record (EHR). A total of 214,206 participants were included in this study who competed survey modules and shared EHR data. Adjusted logistic regressions were used to explore the associations between sociodemographic characteristics and opioid use. The lifetime prevalence of street opioids was 4%, and the nonmedical use of prescription opioids was 9%. Men had higher odds of lifetime opioid use (aOR: 1.4 to 3.1) but reduced odds of current nonmedical use of prescription opioids (aOR: 0.6). Participants from other racial and ethnic groups were at reduced odds of lifetime use (aOR: 0.2 to 0.9) but increased odds of current use (aOR: 1.9 to 9.9) compared with non-Hispanic White participants. Foreign-born participants were at reduced risks of opioid use and diagnosed with opioid use disorders (OUD) compared with US-born participants (aOR: 0.36 to 0.67). Men, Younger, White, and US-born participants are more likely to have OUD. All of Us research data can be used as an indicator of national trends for monitoring the prevalence of receiving prescription opioids, diagnosis of OUD, and non-medical use of opioids in the US. The program employs a longitudinal design for routinely collecting health-related data including EHR data, that will contribute to the literature by providing important clinical information related to opioids over time. Additionally, this data will enhance the estimates of the prevalence of OUD among diverse populations, including groups that are underrepresented in the national survey data.

When Ronan the Accuser seizes control of the Kree Empire and launches an attack against Earth, the Avengers must face the threat, while the shape-shifting Skrulls, hiding among the human population, reveal themselves to wage war.

INTRODUCTION Digital technologies can increase the accessibility of evidence‐based caregiver programs. METHODS A 6‐month, phase I, exploratory, randomized‐controlled trial of two dementia caregiver support platforms, GamePlan4Care (GP4C) and Resources4Care (R4C), each enrolling 120 community‐based family caregivers. Outcome measures included burden, positive aspects of caregiving, social support, and depression. RESULTS Caregivers showed significant follow‐up improvements in burden (GP4C: effect size [ES] = 0.50, p < 0.001; R4C: ES = 0.47, p < 0.001), positive aspects of caregiving (GP4C: ES = 0.26, p = 0.022; R4C: ES = 0.23, p = 0.030), social support (GP4C: ES = 0.21, p = 0.035), and distress (GP4C: ES = 0.30, p = 0.010). Caregivers engaged more in GP4C (GP4C: mean 5.5 h, SD = 0.61; R4C: mean 1.9 h, SD = 0.20) and set more goals for the safety domain (mean 8.9 goals, SD = 7.60). DISCUSSION GP4C was not superior to R4C; however, both platforms demonstrated improved outcomes. Findings highlight a health system's successful development and implementation of online dementia caregiver platforms. Improving digital technology for caregivers requires studies with larger populations and longitudinal outcomes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04540198 Highlights Online platforms can be useful in the goal of supporting family caregivers with educational and skills‐training material to reduce the negative consequences of caregiving and to improve positive feelings of caregiving. Rules‐based conditional logic was successfully integrated into a Web‐based platform to tailor evidence‐based strategies to an individual's unique caregiving context and needs. Health systems are in an ideal position to adopt online technologies that provide education, skills training, and support for family caregivers of persons living with dementia.

Despite the variability and complexity of geriatric conditions, few COVID-19 reports of clinical characteristic prognostication provide data specific to oldest-old adults (over age 85), and instead generally report broadly as 65 and older. To examine metabolic syndrome criteria in adults across 25 hospitals with variation in chronological age. This cohort study examined 39,564 hospitalizations of patients aged 18 or older with COVID-19 who received inpatient care between March 13, 2020, and February 28, 2022. ICU admission and/or in-hospital mortality. Metabolic syndrome criteria and patient demographics were examined as risk factors. The main outcomes were admission to ICU and hospital mortality. Oldest old patients (≥ 85 years) hospitalized with COVID-19 accounted for 7.0% (2758/39,564) of all adult hospitalizations. They had shorter ICU length of stay, similar overall hospitalization duration, and higher rates of discharge destinations providing healthcare services (i.e., home health, skilled nursing facility) compared to independent care. Chronic conditions varied by age group, with lower proportions of diabetes and uncontrolled diabetes in the oldest-old cohort compared with young-old (65-74 years) and middle-old (75-84 years) groups. Evaluations of the effect of metabolic syndrome and patient demographics (i.e., age, sex, race) on ICU admission demonstrate minimal change in the magnitude of effect for metabolic syndrome on ICU admission across the different models. Metabolic syndrome measures are important individual predictors of COVID-19 outcomes. Building on prior examinations that metabolic syndrome is associated with death and ARDS across all ages, this analysis supports that metabolic syndrome criteria may be more relevant than chronological age as risk factors for poor outcomes attributed to COVID-19.

The negative consequences of caregiving can be mitigated by providing caregivers with support programs that increase their dementia care skills and provide emotional and tangible support. Web-based technology can increase the availability of evidence-based caregiver interventions. GamePlan4Care (GP4C) is a web-based adaptation of the Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention, redesigned and reformatted for web-based delivery. The goal of GP4C is to create a web-based family caregiver support platform that facilitates self-directed exposure to evidence-based skills training and support for caregivers of persons living with dementia. This multidimensional approach of using technology enhanced with live support has the potential for improved scalability and sustainability. In preparation for a randomized clinical trial of the new intervention, the GP4C platform underwent user interface/user experience (UI/UX) testing with caregivers as part of an iterative design process. UI/UX testing of caregivers' reactions to technical and content-related aspects of the platform was conducted with 31 caregivers recruited through partnerships with community-based organizations in central Texas. Usability testing consisted of performing system tasks, answering open-ended questions on the tasks, and providing feedback on their experience with the platform. Two researchers used an inductive thematic approach to data analysis using transcripts of individual audio and screen-recorded sessions with each participant. The analysis consisted of 3 phases: data familiarization, coding, and theme formulation. In total, 18 participants tested technical-related aspects of the GP4C platform, and 13 participants tested content-related aspects. The average age of participants was 62 (SD 12.2, range 31-86). A majority of participants were female (27/31, 87.1%) and White or Caucasian (26/31, 83.1%) while almost one-third were Hispanic (10/31, 32.3%). The thematic analysis revealed 3 themes: supportive resources as a common theme, active engagement for technical aspects of the platform, and a comprehensive approach for content aspects of the platform. Participants also suggested changes in navigation and content. Findings from the usability testing sessions indicate that the platform provided engaging, useful content that the caregiver would continue to use, resonated with their caregiving experience, helped the caregivers think through their choices and emotions, and could be used to help communicate with the person living with dementia. Caregivers appreciated the personalization based on what they had already completed and the concept of having a Dementia Care Navigator when they needed additional help. Caregivers also provided multiple suggestions on how to improve the system, including changes for easier navigation and inclusiveness. This positive feedback indicates that with a few changes, the platform would be beneficial to meet the needs and provide resources for caregivers of persons living with dementia. The process of involving end users in usability testing during the development stage ensures that the finished tool will better meet users' expectations and current needs.

INTRODUCTION Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare. METHODS Community‐dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site‐specific recruitment strategies to enroll health system patients. RESULTS Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American. DISCUSSION Health systems can successfully enroll diverse dyads in a pragmatic clinical trial.

ObjectiveTo identify the needs of caregivers of hospitalised adults with dementia in the hospital and during care transitions.DesignPragmatic qualitative inquiry with semi-structured interviews.SettingMichael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, USA.Participants12 family caregivers (family member (n=11); friend (n=1)) and 15 health professionals (hospital medicine physicians (n=4), inpatient nurse case managers (n=2), social workers (n=4), outpatient geriatrics providers (n=2), a primary care provider (n=1), geriatric psychiatrists (n=2)) were interviewed. Caregivers were recruited while their care recipient was hospitalised and were interviewed at least 2 weeks after the care recipient was discharged from the hospital. Health professionals were eligible for the study if they provided care to patients with dementia in the inpatient or outpatient setting.ResultsFour recommendations emerged from the analysis: (1) engage caregivers as partners in the care team, (2) provide dementia-specific information and training, (3) connect caregivers to home and community-based services and (4) provide care navigation and support for the caregiver posthospitalisation.ConclusionsHospital care transitions are challenging for caregivers of hospitalised adults living with dementia. Care transition interventions designed to support caregivers with tailored, dementia-specific information and services are needed.

Abstract Background and Objectives This study aims to identify patterns of caregiving intensity and assess associations between caregiving intensity and multidimensional physical health indicators and health behaviors among spousal caregivers of persons with Alzheimer’s disease and related dementia. Research Design and Methods Using data from 152 spousal caregivers aged 65 and older, the intensity of their caregiving experience was measured as the number and frequency of health- and medical-related helping activities for their care recipient. Multidimensional health indicators included self-reported fatigue, sleep disturbance, physical functioning, pain interference, general health, and the number of chronic conditions from the electronic health records. Self-reported health promotion behaviors were assessed as health responsibility, physical activity, nutrition, interpersonal relations, and stress management. Results Two distinct caregiving intensity patterns, high-intensity (37.5%) and low-intensity (62.5%) caregiving, were identified with cluster analysis. Caregivers in the high-intensity caregiving cluster reported feeling more tired (t = 2.25, p < .05), experiencing more sleep disturbance (t = 3.06, p < .01), and performing less physical activity (t = 2.05, p < .05) compared with caregivers in the low-intensity group. Discussion and Implications Future studies are needed to develop effective interventions to address caregiving intensity and its consequences on the health of spousal caregivers of persons with dementia.

This cross-sectional study analyzes data from Silver Alert activations in Texas from 2017 to 2022 to identify temporal, geographic, and wandering characteristics of missing adults with dementia.