Falls are common causes of disability, reduced disability-adjusted life years and death in older adults. Balance deficits and cognitive impairment are common causes of falls. Dual-task training is a new strategy that can potentially improve balance and cognitive function, leading to decreased falls. The effectiveness and cost-effectiveness of self-administered dual-task (sDT) training to improve balance and prevent falls is not known. We developed sDT training combining physical and cognitive tasks to improve balance and reduce falls. The proposed randomised controlled trial (RCT) with economic evaluation is to test the effectiveness and cost-effectiveness of the sDT compared with self-administered single-task training (sST) in this population.

In this RCT, we will recruit 190 community-dwelling older adults with a history of at least one fall over the last 6 months from 11 elderly centres. The older adults will be randomly assigned to the sDT (n=95) and sST groups (n=95). Each group will be offered in six training workshops to teach the participants either sDT or sST depending on the group allocation. Each workshop will last an hour and will be held once every 2 weeks for 3 months. Besides, the participants will be instructed to repeat the exercises at home two times weekly for 3 months. Following the intervention phase, the participants will continue unsupervised home-based exercises for 6 months. Assessments will be performed before, after and 6 months after completing the intervention. A fall calendar and cost diary will be provided to each older adult to record the number of falls and fall-related costs during and after the intervention to assess fall incidence and cost-effectiveness. Effectiveness will be assessed using a negative binomial regression model following the intention-to-treat principle for falls and a linear mixed model for the additional measure and cost-effectiveness using a Markov model.

This study has ethical approval from the PolyU Institutional Review Board for conducting research on human subjects (Ref: HSEARS20210322005). The results will be disseminated through seminars for individuals and health practitioners, international conferences and published in peer-reviewed journals.

NCT05533333.

To investigate demographic, clinical characteristics, treatment patterns and healthcare resource utilisation (HCRU) among patients with portopulmonary hypertension (PoPH).

Retrospective analysis of a real-world cross-sectional survey, the pulmonary arterial hypertension (PAH) Disease Specific Programme.

Secondary care settings in the USA.

Pulmonologists (n=22), cardiologists (n=17) and internists (n=7) who saw ≥2 patients with PAH/month provided data on 90 PoPH patients. Mean age of patients was 56.8 years, 51.1% were male, 76.7% were white/Caucasian.

Demographic characteristics, initial presentation/diagnosis, disease trajectory, symptoms, comorbidities, treatment patterns and HCRU.

The most common diagnostic tests were echocardiogram (62.2%), right heart catheterisation (56.7%) and electrocardiogram (48.9%). Dyspnea on exertion (64.4%), dyspnea following exertion (51.1%) and fatigue (48.9%) were the most common symptoms prior to PAH diagnosis as well as the most bothersome. Overall, 13.3% patients had mild disease before treatment vs 42.2% at time of survey. Most (60.0%) had stable disease (21.1% were improving and 18.8% were deteriorating at the time of the survey). Most common recent symptoms were dyspnea on exertion (51.1%), fatigue (37.8%) and dyspnea following exertion (32.2%). Patients had a mean of 1.8 comorbidities. In total, 80.0% of PoPH patients were receiving PAH-specific treatment; 41.7%, 22.2% and 12.5% received monotherapy, dual therapy and triple therapy, respectively. Patients had seen their physician 4.1 times in the past 12 months (3.5 visits specifically for PAH), while 31.1% had been hospitalised for PAH. Most (70.0%) patients were managed in a multidisciplinary team, and 8.9% of patients relied on a caregiver.

This study highlights the high symptomatic burden coupled with mostly moderate-to-severe disease status and a high hospitalisation rate despite the majority of PoPH patients being on therapy. Therefore, new treatment options in PoPH are in great need.

Existing patient-reported outcome measures (PROMs) do not meet accepted international criteria for measuring health outcomes of hypospadias treatment. This protocol describes the qualitative development (phase I) of a novel PROM to evaluate outcomes of hypospadias treatments.

Participants aged 7 years and older with hypospadias and caregivers of children under 8 years seeking treatment at Boston Children’s Hospital, Children’s Hospital of Eastern Ontario (CHEO), Children’s Hospital of Philadelphia (CHOP) and McMaster Children’s Hospital), will be invited to participate in concept elicitation and cognitive interviews. Concept elicitation interviews will be in-depth and semi-structured to understand concepts important to patients seeking treatment for hypospadias. Cognitive interviews will be performed concurrently to ensure that the scale items, instructions and response options are relevant, understandable and comprehensive. Cognitive interviews will be complemented by expert input. Concept elicitation and cognitive interview transcripts will be coded line-by-line. Participant quotes will be categorised into top-level domains, themes and subthemes. The primary outcome of this research will be to develop a conceptual model representing the patient experience of hypospadias and a novel PROM.

Ethics approval was obtained from Boston Children’s Hospital’s Institutional Review Board (HHS Registration: IRB00000352; Protocol number IRB-P00042425). CHOP, McMaster and CHEO have reliance agreements with Boston Children’s Hospital. Findings from this research will be disseminated at national and international conferences and published in relevant peer-reviewed journals for the target audience.

Caregiving has been widely recognised as a potential risk factor for caregivers’ psychological well-being in previous studies. The objective of this study is to examine the association between multiple factors of the caregiving process and the depression risk of caregivers, as well as the mediating effect of caregiver burden in these associations.

Cross-sectional study.

The Hong Kong Polytechnic University in Hong Kong Special Administrative Region, China.

597 family caregivers of persons with disabilities in December 2020 under the Hong Kong governmental initiative, ‘Persons with Disabilities and Rehabilitation Program’.

Indications of depression were assessed through the application of the World Health Organization-Five Well-being Index (1998 version).

A structural equation model (SEM) was applied using Analysis of Moment Structure (AMOS) 28.0 to identify the association between a series of caregiving-related factors and depression risk, as well as test the mediating role of caregiver burden in these associations. 50% of care recipients needed assistance in all four care need categories, with daily living care being the most prominent (72.4%). Caregivers dedicated around 79.6 hours (SD: 52.2) per week on caregiving duties. Nearly 44% of the caregivers had at least one diagnosed disease. Only 5% of caregivers considered that they had a poor caregiving ability, whereas 87.2% of them reported heightened caregiving pressure during the COVID-19 pandemic. In this study, the average caregiver burden score was 6.6 (SD: 3.3), and the average depression score was 6.7 (SD: 5.1). The results of the SEM model showed that care needs of care recipients (ß (95% CI): –0.201 (–0.355, –0.083), p=0.001), weekly caregiving hours (ß (95% CI): –0.126 (–0.215, –0.067), p=0.001) and presence of emotional issues (ß (95% CI): –0.329 (–0.538, –0.184), p=0.001) were positively associated with depression risk of caregivers, fully mediated by caregiver burden. Additionally, caregivers’ health status had both direct (ß (95% CI): –0.234 (–0.388, –0.101), p=0.001) and indirect (ß (95% CI): –0.126 (–0.215, –0.067), p=0.001) effects on depression, indicating that caregiver burden partially mediated this pathway (proportion mediation is 35%). A higher self-evaluation of caregiving ability was related to a lower risk of depression (ß (95% CI): 0.281 (0.169, 0.396), p=0.001), and caregiver burden did not mediate this pathway.

Care needs of care recipients, weekly caregiving hours, caregivers’ health status and presence of emotional issues during the COVID-19 pandemic were adversely associated with an increased depression risk for caregivers, and these were either fully or partially mediated by caregiver burden. Additionally, caregivers’ lower self-evaluation of their caregiving ability was an independent factor that directly contributes to an increased depression risk.