Adverse Psychosocial Outcomes Research Articles

Provider Consensus on Candidate Protective and Risk Factors for Adverse Psychosocial Outcomes Following Discharge From a PICU: A Modified Delphi Study.

Pediatric palliative care promotes interdisciplinary, family-centered care when children are faced with diagnoses threatening length and/or quality of life. A significant knowledge gap remains in how to best match pediatric palliative care resources to palliate the psychosocial impact of a PICU admission. This study was designed to identify drivers of adverse post-PICU psychosocial outcomes related to social determinants of health to inform pediatric palliative care services and improve post-PICU psychosocial outcomes. Modified Delphi technique to develop consensus regarding social determinants of health and clinical factors affecting post-ICU psychosocial outcomes. All Delphi rounds were via an electronically mailed survey link. First-round participants were PICU and pediatric palliative care clinicians at the study institution. Subsequent rounds invited participants from national PICU and pediatric palliative care professional online listserves. None. Consensus was defined a priori as items assigned a score greater than or equal to 4 (5-point scale) by greater than75% of respondents. One-hundred twenty-six surveys were returned and scored. Social determinants of health risk factors included child protective services involvement (91%), caregiver with intellectual disability (87%), lack of friend or family support (82%), caregiver with behavioral health diagnosis (81%), teenage caregiver (79%), transportation challenges (79%), and language/cultural barrier (76%). Clinical risk factors included new home ventilator (94%), new tracheostomy (90%), greater than or equal to 3 hospitalizations in the prior 6 months (88%), and greater than or equal to 3 hospitalizations in the prior 12 months (82%). Social determinants of health protective factors included extended family support (91%), caregivers in a committed relationship (79%), and caregiver optimism (78%). Respondents reported that pediatric palliative care services had the greatest impact on caregiver satisfaction with the healthcare system (90%) and increased family involvement with state social services programs (80%). Consensus on candidate risk and protective factors for post-ICU psychosocial challenges and candidate pediatric palliative care-sensitive variables were identified. Further research is needed to operationalize and optimize a screening tool based on these consensus items and test it prospectively.

Daily mood profiles and psychosocial adjustment in youth with newly diagnosed cancer and healthy peers.

A new cancer diagnosis leads to many daily changes in the lives of youth. We aimed to determine how short-term emotion dynamics relate to psychosocial adjustment over time in youth with newly diagnosed cancer and healthy peers. Youth with newly diagnosed cancer (n = 71, weeks since diagnosis: M = 6.56, SD = 1.94) and age-matched controls (n = 63), aged 8-17 years, reported on their daily mood across the week (T1). Two to 4 months later (T2), youth reported on perceived parental care and overprotection, anxiety, and quality of life. Primary caregivers reported on youth's externalizing and internalizing problems and on parental distress. Latent profile analysis (LPA) was conducted to identify individual daily mood profiles at T1. These profiles were used to predict adjustment at T2, controlling for sociodemographic factors and looking at differences between cancer patients and comparisons. LPA revealed 4 daily mood profiles: stable positive mood (SPM, 61.6%), stable negative mood (SNM, 4.8%), intermediate mood (27.6%), and fluctuating negative mood (FNM, 6%). No sociodemographic or cancer/comparison differences were found across mood profiles. Results showed several relations between mood profiles across the week and adjustment outcomes at T2. Overall, a SPM related to favorable adjustment outcomes, whereas a SNM related to less favorable adjustment. Compared to an FNM, SNM demonstrated less youth-reported perceived parental care (p = .02) and higher youth-reported anxiety (p = .05). Most children show healthy emotions during treatment for cancer. Close monitoring of mood during treatment is important to identify youth at risk for adverse psychosocial adjustment outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Child abuse in a sample of children and adolescents with externalizing disorders

Objectives Many children in Egypt are being subjected to different forms of abuse. Numerous studies have documented that children exposed to child abuse are more likely to experience a set of adverse psychosocial and behavioral outcomes including low self-esteem and externalizing disorders.Patients and methods A total of 100 children and adolescents were included in the study; 50 of them were the case group with externalizing behavior [attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder] recruited from the outpatient clinic of psychiatry department, Al Zahraa University Hospital, whereas the other 50 were the control group from the outpatient clinic of Pediatric Department, Al Zahraa University Hospital. They were subjected to clinical assessment, the Wechsler Intelligence Scale, Child Trauma Questionnaire, and Coopersmith Self-Esteem Inventory.Results The most prevalent diagnoses of the externalizing disorder group were ADHD (46%), CD (26%), oppositional defiant disorder (16%), and ADHD with CD (12%). Comparison between the case group (externalizing disorders) and the control group regarding different types of abuse showed that there was statistically significant difference regarding emotional abuse, severe physical abuse, sexual abuse, and physical neglect. Comparison between different types of abuse in different diagnoses showed that both ADHD and CD are significantly associated with severe physical abuse and sexual abuse. The relation between self-esteem and different types of abuse showed that all types of abuse are significantly associated with low self-esteem.Conclusion The results highlight the need for strategies aiming at reducing child abuse and improving parenting style.

Family and Child Characteristics Associated With Caregiver Challenges for Medically Complex Children.

Children with medical complexity, comprising 3% of US children, face elevated risk of adverse medical, developmental, psychosocial, and family outcomes. The purpose of this study was to examine the association between family and child characteristics and caregiver challenges via a retrospective cohort study using data from 2009/2010 National Survey of Children with Special Health Care Needs. Results revealed that most children with medical complexity have 2 or more conditions; region of residence, insurance, and health conditions significantly predict caregiver challenges; and race, ethnicity, and coinsurance status are associated with medical challenges. Results highlight important evidence on connections between family/child characteristics and caregiver challenges among children with medical complexity.

Psychosocial effects of whole-body MRI screening in adult high-risk pathogenic TP53 mutation carriers: a case-controlled study (SIGNIFY)

BackgroundGermline TP53 gene pathogenic variants (pv) cause a very high lifetime risk of developing cancer, almost 100% for women and 75% for men. In the UK, annual MRI breast screening...

Testing the feasibility of a media multitasking self-regulation intervention for students: Behaviour change, attention, and self-perception

Media multitasking has been associated with a number of adverse cognitive, psychosocial, and functional outcomes. In particular, associations between media multitasking and the executive or cognitive control processes theorised to underlie the execution of goal-directed behaviour have been shown. In response to calls for investigations considering the remedial efficacy of interventions targeting media multitasking and related cognitive effects, the present study investigates the feasibility of a self-regulation based media multitasking intervention for a student population. Through a mixed-methods study involving a between-subjects, pre/post experimental design, usage tracking, and follow-up interviews, four feasibility dimensions were investigated: demand, implementation, acceptability, and efficacy. The findings indicate, firstly, that a greater cognisance of media behaviour is key to behaviour change and goal-alignment, secondly, that such behavioural changes were perceived to enable more instances of single-tasking, goal-oriented task-execution and, as a result, engender state-level changes in attentional strategies and, thirdly, that short-term behavioural changes do not necessarily imply trait-level changes in cognitive functioning. Key implications for media-effects research in general and, more specifically, for research concerning media-related interference are discussed.

Exploring Coaches' Perceptions of Youth Sport Specialization: A Comparison of High School and Club Sport Contexts.

Previous researchers have identified sport specialization as being associated with various negative outcomes (eg, overuse injuries and adverse psychosocial outcomes). However, little is known regarding how the underlying attitudes, beliefs, and values of sport stakeholders may be shaping this trend. To examine the perceptions of coaches in the high school versus club sport setting and compare their attitudes and behaviors toward sport specialization. Cross-sectional survey. A total of 769 coaches (497 high school coaches, 272 club sport coaches). Participants completed a novel measure that surveyed their perceptions regarding various aspects of youth sport specialization. Additionally, each coach completed a questionnaire detailing his or her relevant demographic and sport background information. High school coaches and club sport coaches differed in their perceptions of sport specialization (t767 = 1.41, P < .001); club coaches (2.43 ± 0.25) were more likely than high school coaches (2.31 ± 0.21) to rate specialization as a positive, adaptive practice. The multiple linear regression equations for both the high school and club coaches indicated that no educational, experiential, or demographic factors predicted coaches' perceptions of specialization (P values > .05). Club sport coaches were more likely to possess attitudes in favor of sport specialization. Additionally, coaches' background characteristics did not predict their perceptions of specialization, suggesting that the competitive context itself (high school versus club) may be the most salient influencer of these perceptions. Athletes and sports medicine practitioners should be aware of the heightened expectation of specialized participation and resulting increased injury risk in these contexts. Pediatric sport researchers and practitioners should continue to explore how these different group perceptions manifest in participation behaviors and may link to overall athlete health, wellbeing, and development.

Keeping Your Guard Up: Hypervigilance Among Urban Residents Affected By Community And Police Violence.

Hypervigilance, a state of heightened awareness and watchfulness, is a consequence of violence that has been linked to adverse psychosocial outcomes. Although well documented in veteran populations, it remains poorly quantified in community populations that are exposed to high levels of neighborhood violence. In-person surveys of 504 adults were conducted in Chicago, Illinois, in 2018 to assess the relationships between hypervigilance and exposure to neighborhood violence, including community and police altercations. Exposure to police violence was associated with a 9.8-percentage-point increase in the hypervigilance score (on a 100-point scale)-nearly twice that associated with exposure to community violence (a 5.5-percentage-point increase). Among participants who reported having had a police stop, experiencing the stop as a traumatic event (defined as exposure to actual or threatened death or serious injury) was associated with a 20.0-percentage-point increase in the hypervigilance score. Scoring in the highest quartile of hypervigilance was associated with higher systolic blood pressure (an increase of 8.6 mmHg). Understanding hypervigilance and, importantly, its linkages with violence and health may help inform policing practices and health care responses to violence in urban communities.

The Impact of Communication Surrounding Intrauterine Congenital Anomaly Diagnoses: An Integrative Review.

Congenital anomalies are the leading cause of infant death in the United States, accounting for 20% of the annual infant mortality. Advancements in ultrasound diagnostic technology allow practitioners to diagnose fetal anomalies as early as 11 weeks' gestational age, 75% of which are detected in low-risk pregnancies. Communicating a fetal anomaly diagnosis to parents and initiating perinatal end-of-life discussions are difficult for healthcare providers and parents alike. Furthermore, poorly communicated diagnoses have had long-term negative impacts on perinatal grief intensity, which can manifest into lifelong symptoms of adverse psychosocial outcomes such as anxiety, depression, substance abuse, and suicidal ideation. The purpose of this integrative review is to examine the impact of communication in discussing an intrauterine diagnosis of a fetal congenital anomaly on perinatal grief. An integrative review was conducted following the distinct 5-stage process of problem identification, searching the literature, evaluating data, analyzing, and presenting findings. A systematic literature review using the PICO model (Population, Intervention, Comparison, Outcome) and structured after the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). This framework was completed between November 2017 and May 2018 using PubMed, CINAHL, and PsycINFO databases. Of the 931 article results, 15 satisfied search criteria. Emerging themes included parental need for appropriate time to assimilate and understand the diagnosis, freedom to explore options and alternatives, and the need for clinicians with expert communication skills. The initial conversation communicating the diagnosis of a congenital anomaly impacts expectant parents for the remainder of their lives. Healthcare professionals are in a unique position to either positively or negatively impact the intensity of perinatal grieving reactions. The application of empathetic, sensitive communication may offer solace and promote healing surrounding perinatal end-of-life discussions.

Leydig Cell Function in Male Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study.

Direct assessment of Leydig cell function in childhood cancer survivors has been limited. The objectives of this study were to describe the prevalence of and risk factors for Leydig cell failure (LCF), Leydig cell dysfunction (LCD), and associated adverse health outcomes. In this retrospective study with cross-sectional health outcomes analysis, we evaluated 1,516 participants (median age, 30.8 years) at a median of 22.0 years after cancer diagnosis. LCF was defined as serum total testosterone less than 250 ng/dL (or 8.67 nmol/L) and luteinizing hormone greater than 9.85 IU/L, and LCD by testosterone as 250 ng/dL or greater and luteinizing hormone greater than 9.85 IU/L. Polytomous logistic regression evaluated associations with demographic and treatment-related risk factors. Log-binomial regression evaluated associations with adverse physical and psychosocial outcomes. Piecewise exponential models assessed the association with all-cause mortality. The prevalence of LCF and LCD was 6.9% and 14.7%, respectively. Independent risk factors for LCF included an age of 26 years or older at assessment, testicular radiotherapy at any dose, and alkylating agents at cyclophosphamide equivalent doses of 4,000 mg/m2 or greater. The risk increased with older age, higher doses of testicular radiotherapy, and cyclophosphamide equivalent doses. LCF was significantly associated with abdominal obesity, diabetes mellitus, erectile dysfunction, muscle weakness, and all-cause mortality. LCD was associated with unilateral orchiectomy and the same risk factors as LCF; no significant associations were found with adverse physical or psychosocial outcomes. Older age, testicular radiotherapy, and exposure to alkylating agents were associated with LCF, which was associated with adverse physical and psychosexual outcomes. LCD, although having similar risk factors, was not associated with adverse health outcomes. Additional studies are needed to investigate the role of sex hormone replacement in mitigating the burden from adverse outcomes in survivors.

Hierarchy of hair loss stigma: media portrayals of cancer, alopecia areata, and ringworm in Israeli newspapers

BackgroundOver 300,000 people in Israel cope with temporary or permanent hair loss (alopecia) that results from diseases and medical treatments. For women, hair loss can be a highly traumatic event that may lead to adverse psychosocial consequences and health outcomes. Nevertheless, this phenomenon has been mostly ignored by health professionals as it is primarily considered an aesthetic—rather than as a health-related issue. Only recently the Healthcare Basket Committee approved financial assistance for the purchase of wigs by patients coping with hair loss. Given the important role that the media plays in shaping health policies related to diagnoses, treatment and support services, the current study sought to enrich our understanding of how the media portrays disease-related hair-loss.MethodsUsing framing and agenda-setting theories, this study examined the media portrayals of hair loss associated with three diseases—cancer, alopecia areata, and ringworm, depicted in Israeli newspapers in 1994–2016. The sample consisted of 470 articles about the three diseases: 306 on cancer, 36 on AA, and 128 on ringworm.ResultsTextual and visual analysis revealed the ways media marginalize this physical flaw. Cancer was framed in medical terms, and patients were portrayed as older Israeli-born people whose hair loss was absent from their experience. Ringworm was framed as a fear-inducing disease; patients were portrayed as faceless, unidentified immigrants that coped with visible hair loss. Articles on AA provided the greatest focus on the patient’s experience of hair loss, but patients were portrayed as young foreign people.ConclusionsOur results revealed a hierarchy of stigmas against hair loss, in which the media coverage marginalized this experience. The omission of hair loss by the media may explain, at least in part, why health professionals often ignore the psychosocial needs of these patients. Health insurance funding of wigs is a helpful but nevertheless insufficient solution to coping with feminine hair loss. Our findings may encourage media leaders to conduct planned media interventions to increase awareness of clinicians and health policymakers about the unique challenges faced by women coping with hair loss and promote health policy-making aimed at the well-being of these women.

Media Use and Sleep in Teenagers: What Do We Know?

The screen-based media landscape has changed markedly during the last decade, with 95% of American teens owning or having access to a smartphone. Coinciding with the rise in digital media devices, researchers have noted a high prevalence of insufficient sleep among youth. In this article, we review recent literature about adolescents’ screen use behaviors and sleep health outcomes published between 2015 and 2019. Overall, we found a high level of screen use and poor sleep health (i.e., short duration, poor quality, late timing) among adolescents. The great majority of recent observational studies demonstrated a robust inverse association between screen media device use and sleep outcomes among adolescents all over the world. Screen-based media use has also been linked to a series of adverse psychosocial and behavioral outcomes, partially if not fully mediated through impaired sleep health. Experimental data, however, offer mixed findings on the causal relationship between teen media use and sleep. In addition, there is uncertainty as to the relative roles of the proposed mechanisms underlying those relationships, whether driven by the light emitted by devices, time displacement, or the media content affecting psychological state (e.g., fear of missing out, anxiety). Current empirical research demonstrates that screen-based digital media use is closely associated with sleep duration and sleep quality among teens; however, limited data show a direct causal effect of screen-based media use on adolescent sleep health. With very few studies demonstrating easy-to-implement and effective interventions, we argue that more basic, translational, and clinical research is necessary.

La Vida Buena (The Good Life) evaluation: a quasi experimental intervention of a community health worker-led family-based childhood obesity program for Latino children 5\u20138\u2009years of age on the US-Mexico border

BackgroundDue to multiple and interacting factors, Latino children are disproportionately at risk for overweight and obesity in the United States. Childhood obesity increases the risk for adverse physical and psychosocial outcomes throughout the lifespan. Intensive behavioral interventions recommended in primary care settings may not conform to current practices, and the most vulnerable populations are often unable to access these services. Community Health Workers (CHWs) offer a promising approach to bridging the gap between vulnerable communities and culturally competent services. La Vida Buena (The Good Life) is an 8-week family-focused intervention for Latino children 5–8 years old and their parents or caregivers who are patients at a Federally-Qualified Community Health Center (FQHC). It is a culturally and linguistically appropriate curriculum, facilitated by CHWs, that targets family behaviors to foster a healthy lifestyle in order to prevent and mitigate childhood overweight and obesity.MethodsThe primary objective is to test the effectiveness of the La Vida Buena (LVB) childhood obesity program among Latino children 5–8 years old and their families as compared with a single educational session. This study uses a parallel two-arm quasi-experimental design. The intervention group receives the 8-week La Vida Buena intervention and the comparison group receives a single educational session. The primary outcome is the change in the child’s BMI z-score from baseline to 6 months.DiscussionThe implementation and evaluation of La Vida Buena may inform research and practice for linking Latino patients in FQHCs to culturally responsive community-based childhood obesity interventions. It will also contribute to the literature about CHWs as facilitators of behavior change for families underserved by health services and preventive programs. La Vida Buena can serve as a culturally and linguistically appropriate early intervention curriculum that will foster a healthy home environment for childhood obesity mitigation and prevention.Trial registrationThe trial was retrospectively registered on December 18, 2018. The ClinicalTrials.gov Identifier is NCT03781856.

Improving Outcomes in Pediatric Multiple Sclerosis: Current and Emerging Treatments.

Pediatric-onset multiple sclerosis (MS) comprises 2-5% of MS cases, and is known to be associated with high disease activity and the accumulation of disability at an earlier age than their adult-onset counterparts. Appropriate therapy leading to disease control has the potential to alter the known trajectory of adverse long-term physical, cognitive, and psychosocial outcomes in this population. Thus, optimizing treatment for children and adolescents with MS is of paramount importance. The last decade has seen a growing number of disease-modifying therapies approved for relapsing MS in adults, and available agents now include oral, injectable, and infusion therapies. Recently, the development of randomized controlled MS trials in youth has led to the first agent approved by the US FDA for the treatment of pediatric MS-fingolimod. With this, we have entered a new era of knowledge and treatment in this population and ongoing pediatric trials are expected to further inform clinical management. With the emergence of highly effective therapies targeting the inflammatory component of the disease, there has been increased interest in identifying treatment strategies that instead target mechanisms such as remyelination/repair, neuroprotection, or rehabilitation. The potential role for such emerging therapies in the treatment of pediatric MS remains an important area of study. In this review, we discuss current evidence for MS therapies in children including the treatment of acute relapses, disease-modifying therapies, and symptomatic management. We will also discuss evidence for emerging therapies, including remyelinating and neuroprotective agents.

Quality of life after hysterectomy at tertiary care hospital in upper Egypt

Background: Hysterectomy is the most common major gynaecolog- ical surgery often performed for benign lesions.Many studies have reported adverse psychosocial outcomes post-hysterectomy. This study is to evaluate psychological wellbeing, and quality of life in patients undergoing hysterectomy for non-malignant conditions, in comparison with patientsundergoing surgery other than hysterecto- my. Methods: A comparativestudy was conducted on 90con- secutive out-patients who underwent hysterectomy for non-malignant indications at least 6 months ago. The comparison group comprised of 45 consecutive out-patients whounderwent gy- naecological surgery other than hysterectomy at least 6 months ago formed the comparison group. Thestudy participants were evaluated on , Psychological General Wellbeing Index (PGWBI), and Wom- en’s Quality of Life Questionnaire (WOMQOL). Results: No statistically significant different on socio-demographic characteristics such as patient age, marital status, social and education levels .There were no significant differences in the study groups on scores of PGWBI, and WOMQOL . Both the study groups had good marital adjustment andmajority reported no depression and anxiety. Conclusion: There is no major psychiatric morbidity, decline in mar- ital adjustment and quality of life afterhysterectomy for benign condi- tions among women at Aswan university hospital in upper Egypt.

Monitoring Adverse Psychosocial Outcomes One and Two Years After the Lac-Mégantic Train Derailment Tragedy (Eastern Townships, Quebec, Canada).

In July 2013, a train carrying 72 cars of crude oil derailed in the town of Lac-Mégantic (Eastern Townships, Quebec, Canada). This disaster provoked a major conflagration, explosions, 47 deaths, the destruction of 44 buildings, the evacuation of one-third of the local population, and an unparalleled oil spill. Notwithstanding the environmental impact, many citizens of this town and in surrounding areas have suffered and continue to suffer substantial losses as a direct consequence of this catastrophe. To tailor public health interventions and to meet the psychosocial needs of the community, the Public Health Department of Eastern Townships has undertaken repeated surveys to monitor health and well-being over time. This study focuses on negative psychosocial outcomes one and two years after the tragedy. Two cross-sectional surveys (2014 and 2015) were conducted among large random samples of adults in Lac-Mégantic and surrounding areas (2014: n = 811; 2015: n = 800), and elsewhere in the region (2014: n = 7,926; 2015: n = 800). A wide range of psychosocial outcomes was assessed (ie, daily stress, main source of stress, sense of insecurity, psychological distress, excessive drinking, anxiety or mood disorders, psychosocial services use, anxiolytic drug use, gambling habits, and posttraumatic stress symptoms [PSS]). Exposure to the tragedy was assessed using residential location (ie, six-digit postal code) and intensity of exposure (ie, intense, moderate, or low exposure; from nine items capturing human, material, or subjective losses). Relationships between such exposures and adverse psychosocial outcomes were examined using chi-squares and t-tests. Distribution of outcomes was also examined over time. One year after the disaster, an important proportion of participants reported human, material, and subjective losses (64%, 23%, and 54%, respectively), whereas 17% of people experienced intense exposure. Participants from Lac-Mégantic, particularly those intensely exposed, were much more likely to report psychological distress, depressive episode, anxiety disorders, and anxiolytic drug use, relative to less-exposed ones. In 2015, 67% of the Lac-Mégantic participants (76% of intensely exposed) reported moderate to severe PSS. Surprisingly, the use of psychosocial services in Lac-Mégantic declined by 41% from 2014 to 2015. The psychosocial burden in the aftermath of the Lac-Mégantic tragedy is substantial and persistent. Public health organizations responding to large-scaling disasters should monitor long-term psychosocial consequences and advocate for community-based psychosocial support in order to help citizens in their recovery process.

Survivors of institutional abuse in long-term child care in Scotland.

The Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland. To profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes. 225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI. Data were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements. Survivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes. Evidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.

OR18-1 Leydig Cell Function in Adult Survivors of Childhood Cancer

Context: Direct assessment of Leydig cell function in adult survivors of childhood cancer has been limited. Objectives: To describe the prevalence of, and risk factors for, Leydig cell failure (LCF) and associated adverse health outcomes. Design: Retrospective cohort with cross-sectional health outcomes analysis. Patients: 1534 participants (median age 30.8 years; range 18.1-63.8) evaluated at a median of 22.0 years (range 7.5-49.8) after cancer diagnosis. Survivors with LH/FSH deficiency were excluded. Main Outcome Measure: LCF was defined as serum total testosterone < 250 ng/dL (8.67 nmol/L) combined with LH >8.6 IU/L; compensated LCF by testosterone ≥ 250 ng/dL and LH >8.6 IU/L. Polytomous logistic regression evaluated associations between demographic and treatment-related risk factors and LCF or compensated LCF. Log-binomial regression examined associations between these diagnoses and risk of diabetes mellitus, dyslipidemia, abdominal obesity, frailty, erectile dysfunction, and psychological distress. Piecewise exponential models analyzed the association between mortality and LCF/compensated LCF. Results: The prevalence of LCF and compensated LCF was 8.0% (95% confidence interval (CI) 6.7%-9.4%) and 22.8% (95% CI 20.7%-25.0%), respectively. Individuals aged 36-45.9 years (odds ratio (OR) 3.8, 95% CI 1.9-7.9) or ≥46 years (OR 4.9, 95% CI 2.2-11.1) at the time of study had a significantly higher risk of LCF than those 18-25 years old. Participants treated with direct testicular radiotherapy at doses >0-19.9 (OR 81.6, 95% CI 24.9-266.7) or ≥ 20 Gy (OR >999, 95% CI 109.9->999) had a higher risk of LCF than those not exposed to this treatment. Individuals treated with alkylating agents at cyclophosphamide equivalent doses 4000-7999 mg/m2 (OR 3.6, 95% CI 1.9-6.9) or 8000-11999 mg/m2 (OR 3.7, 95% CI 1.9-7.3) or ≥ 12000 mg/m2 (OR 8.7, 95% CI 4.7-16.4) had a higher risk of LCF than those not exposed to these agents. LCF was independently associated with abdominal obesity (prevalence ratio (PR) 1.6, 95% CI 1.2-2.1), diabetes mellitus (PR 2.9, 95% CI 1.8-4.6), erectile dysfunction (PR 1.8, 95% CI 1.4-2.5), frailty (PR 2.5, 95% CI 1.2-5.3) and mortality (PR 4.8, 95% CI 2.3-10.1). For compensated LCF, the risk factor associations were similar to those found for LCF; however, no significant associations were found with adverse physical or psychosocial outcomes. Conclusion: In adult survivors of childhood cancer, older age, direct testicular radiotherapy and high dose alkylating agents were associated with LCF, which was associated with poor general health outcomes. Further studies are needed to investigate the role of sex hormone replacement in mitigating such outcomes.

A loneliness model of hypochondriasis among older adults: The mediating role of intolerance of uncertainty and anxious symptoms

Loneliness has been described as an epidemic and is associated with a number of adverse health and psychosocial outcomes. In this study, we proposed a loneliness of model of hypochondriasis among older adults in which loneliness triggers a maladaptive threat response in which there is greater self-focus, leading to hypochondriasis through greater intolerance of uncertainty and anxious symptoms. Community-dwelling older adults (N = 280) participated in an interview survey. Results found that loneliness was associated with higher hypochondriasis even after controlling for perceived health status and relationship status. Loneliness had a serial indirect effect on hypochondriasis through higher intolerance of uncertainty and anxious symptoms. With intolerance of uncertainty and anxious symptoms in the model, the relationship between loneliness and hypochondriasis was no longer significant, suggesting full mediation. The results support a loneliness model of hypochondriasis among older adults. Health care professionals working with older adults suffering from hypochondriacal concerns may wish to consider social factors such as loneliness.

Psychosocial support during displacement due to a natural disaster: relationships with distress in a lower-middle income country.

Past studies show relationships between disaster-related displacement and adverse psychosocial health outcomes. The development of psychosocial interventions following displacement is thus increasingly prioritized. However, data from low- and middle-income countries (LMICs) are lacking. In October 2017, the population of Ambae Island in Vanuatu, a lower-middle income country, was temporarily displaced due to volcanic activity. We analyzed distress among adults displaced due to the event and differences based on the psychosocial support they received. Data on experiences during displacement, distress and psychosocial support were collected from 443 adults 2-3 wk after repatriation to Ambae Island. Four support categories were identified: Healthcare professional, Traditional/community, Not available and Not wanted. We analyzed differences in distress by sex and group using one-way ANOVA and generalized linear models. Mean distress scores were higher among women (1.90, SD=0.97) than men (1.64, SD=0.98) (p<0.004). In multivariate models, psychosocial support group was associated with distress among women (p=0.033), with higher scores among women who reported no available support compared with every other group. Both healthcare professional and traditional support networks were widely used. Women might be particularly vulnerable to distress during disaster-related displacement in LMICs, and those who report a lack of support might be at greater risk. Both healthcare professional and traditional networks provide important sources of support that are widely used and might help to ameliorate symptoms.