Changes In Health Status Research Articles

NATURAL RESTORATIVE ENVIRONMENT TERHADAP KECEMASAN PADA PASIEN CHRONIC KIDNEY DISEASES

Chronic Kidney Disease (CKD) is a condition in which kidneys don’t function properly resulting in the accumulation of metabolic remnants. Hemodialysis therapy causes common psychological disorders, is anxiety due to changes in health status, self-acceptance, life threats, stress, and depression. Natural Restorative Environment (NRE) is an intervention that can use to reduce anxiety in patients. This study aimed to analyze the effect Natural Restorative Environment on anxiety in CKD patients on hemodialysis. The method in this research was a quasi-experiment with a pretest-posttest with a control group design. The sampling technique was carried out using cross-sectional sampling, namely 48 patients each with an intervention group and control group. Before and after the intervention, patients in the intervention group and the control group pre-test and post-test about the level of anxiety during hemodialysis therapy. Data analysis used Paired t-test, Wilcoxon-test, and Mann-Whitney U-test. The results showed a decrease in anxiety levels intervention group indicated by a p-value<0.001. Natural Restorative Environment (NRE) can be reducing anxiety in patients with CKD on hemodialysis Keywords: Anxiety; Chronic Kidneys Disease; Natural Restorative Environment

Patient-Reported Outcomes at Return to Sport After Lateral Ankle Sprain Injuries: A Report From the Athletic Training Practice-Based Research Network.

Limited evidence exists regarding the assessment of single-item patient-reported outcomes when patients are medically cleared to return to sport after a lateral ankle sprain (LAS) injury. To evaluate self-reports of improvement in health status, pain, function, and disability at return to sport after an LAS. Descriptive study. Sixty-nine athletic training facilities across 24 states. A total of 637 patients (males = 53.2%) who were diagnosed with an LAS, restricted from sport after injury, and subsequently medically cleared to return to sport within 60 days were included. Descriptive statistics were used to summarize scores for health status (Global Rating of Change), pain (Numeric Pain Rating Scale), function (Global Rating of Function), and disability (Global Rating of Disability). Mann-Whitney U tests were used to compare score differences between sexes. A Kaplan-Meier analysis was performed to provide a visual depiction of sex differences in the time to return to sport. Most patients sustained an LAS injury while participating in basketball, football, or soccer and were cleared to return to sport 8 days after injury. More than two-thirds of patients reported a meaningful improvement in health status between the time of injury and return to sport. However, many noted deficits related to pain (65.1%), function (86.2%), or disability (35.8%) at return to sport. No differences were seen between males and females for pain (P = .90), function (P = .68), change in health status (P = .45), or disability (P = .21) at return to sport, although males returned to sport slightly sooner than females (P = .025). Despite self-perceived improvements in health status since the time of injury, patients typically returned to sport with deficits in pain, function, and disability after an LAS. Patients may be returning to unrestricted sport participation before they feel their bodies have fully recovered from the injury.

Nonlinear, Multicomponent Physical Exercise with Heart Rate Variability-Guided Prescription in Women with Breast Cancer during Treatment: Feasibility and Preliminary Results (ATOPE Study).

The purpose of this study was to examine the feasibility, safety, adherence, and preliminary efficacy of the ATOPE program during radiotherapy (RT) or chemotherapy (CT) for women with breast cancer. This single-blind, pretest-posttest feasibility study included 38 women with breast cancer at the beginning of their treatment. The ATOPE program consisted of 12 to 18 sessions of a multimodal physical exercise program, prescribed based on daily heart rate variability (HRV) and clinimetric assessments using the ATOPE+ mHealth system. Overall health was assessed with quality of life, autonomous balance, and body composition, whereas health-related fitness (HRF) was measured through functional capacity, physical activity levels, and upper and lower limb strength. The rates of recruitment, retention, and adherence were 52.35%, 73.68%, and 84.37%, respectively, and the satisfaction rating was 9.2 out of a possible 10 points. The perceived health status change score was 3.83 points, scored on a - 5 to 5 point scale. No adverse effects were found. Compliance results showed that the ATOPE+ mHealth system was used on 73.38% of the days, and the Fitbit bracelet (Google, Mountain View, CA, USA) was used on 84.91% of the days. Women stayed physically active 55% of days. Regarding preliminary results, for overall health, the percentage of body fat in the RT group decreased by 1.93%, whereas it increased by 5.03% in the CT group. Lower limb strength increased in the RT group, specifically knee extensor isometric strength (6.07%), isokinetic knee flexors 180°/s (1.53%) and isokinetic knee extensors 300°/s (4.53%), in contrast with the reductions found in the CT group (11.07%, 18.67%, and 14.89%, respectively). The ATOPE program, through nonlinear prescription based on daily monitoring with the ATOPE+ mHealth system, is feasible and safe for application during breast cancer treatment. The results suggest that overall health can be maintained or even improved regarding most variables. This study focused on the feasibility, safety, and completion of a physical therapist-led program at early diagnosis for adults with breast cancer. The multimodal, supervised, tailored, nonlinear physical exercise program is feasible and safe, showed a good completion rate, and was able to prevent the quality-of-life deficits that are often triggered by systemic breast cancer treatment. This study highlights the importance of daily morning assessments using the ATOPE+ mHealth system in patients with breast cancer to prescribe nonlinear physical exercise.

#6658 ORAL HEALTH STATUS IN DIABETIC AND NON-DIABETIC PATIENTS ON MAINTENANCE HEMODIALYSIS TREATMENT

Abstract Background and Aims Uremic toxins and inflammation influence the oral health in patients on maintenance hemodialysis treatment. The presence of diabetes additionally aggravates the oral status. Aims: To compare the oral health status in diabetic and non-diabetic patients on different dialysis modality treatment. Method Observational, cross-section, monocentric study was conducted in 72 hemodialysis (HD) patients divided into two groups regarding the presence of Diabetes mellitus (DM). Patients were routinely designed to hemodialysis or hemodiafiltration (HDF) during the previous year of HD treatment. Demographic characteristics as patients age, dialysis vintage, laboratory inflammatory markers as C-reactive protein (CRP), albumin and Interleukin 6 (IL-6) were measured at the start of the study. Also, uremic small and middle molecules as blood urea nitrogen (BUN), creatinine, β2-microglobilin (β2M), myoglobin, albumin, free light chains kappa (FLC-k), and free light chains lambda (FLC-λ) were analyzed. Patients were examined by a dentist specialist scoring the oral hygiene index (OHI) by Greene Vermillion as good, fair and poor. Presence of tooth fillings and extractions, caries, hyperkeratosis, periodontal disease, erosions, ulceration, erythema, pigmentations, saburral tonque and uremic fetor were notified. Gingival hyperplasia (GH) was scored (1-3) with 3 for worst score and the tooth color was scored 1-3, signing 1-yellow, 2-gray, 3-white. Data was presented as mean and standard deviation for continuous and percentages for nominal values. X squared Fisher exact and Mann-Whitney test were used for statistical analysis. P<0.05 was considered as significant. Results The patients from group 1 - with DM (N=26) didn't differ from the non-diabetic group (N= 46) in respect of gender, age and dialysis modality but had significantly shorter dialysis vintage (48.68 ± 37.45 vs. 88.13 ± 63.29, P = .02, respectively). From the inflammatory markers only Il-6 was significantly higher in diabetics (P = .03). All the analyzed uremic toxins – small and middle molecules also didn't differ between the two groups. Diabetic patients were at 3 fold risk for manifestation of fissure, 4 fold risk for pigmentations and 7 fold risk for erythema (OR 3.58; CI:1.017-12.380, p= 0.003; OR 4.12; CI:0.684-22.870; p= 0.02, OR 4.84; CI:1.343-17.498, p= 0.000), (OR 7.25; CI:1.123-46.880, p= 0.000), respectively. GH was more likely to be present in diabetic patients (35%, 54%, 11% vs 83%, 15, 0%, p= 0.000, respectively). The presence of hyperkeratosis, periodontal disease erosions, caries, extractions, tooth fillings and the tooth colour didn't differ between the groups. Diabetics were found with higher percentage of bad oral hygiene index (38% vs 20%), but the overall comparison of OHI showed no significant difference. Conclusion Oral health is significantly deteriorated in dialysis patients, especially in those with inflammation. Diabetic patients are at higher risk of developing changes in the oral health status.

Risk and protective factors related to changes in mental health among adolescents since COVID-19 in Hong Kong: a cross-sectional study

BackgroundMost research has suggested that children and adolescents had poorer mental health than pre-COVID-19 pandemic status. There have been few investigations into factors associated with pre-peri pandemic differences in young people’s mental health status. Our study aimed to investigate the association between sociodemographic factors, attitudes, and daily life experiences and these differences.MethodsWe used self-reported cross-sectional data from the Youth Sexuality Survey (YSS) by the Family Planning Association of Hong Kong, collected from secondary school students aged 10–16 between the fourth and fifth waves of the pandemic. The study outcome was pre-peri pandemic differences in mental health (better, unchanged, or poorer). Associations between the study outcome with age, sex, satisfaction with academic performance, school life, relationship with classmates and family life, and average sleeping and exercising time in the past month, were assessed through multinomial logistic regression, controlling for depressive/anxiety symptoms and change in physical health status since the pandemic.ResultsThere were 6,665 respondents. Compared with pre-pandemic, approximately 30% reported poorer mental health, whilst 20% reported better mental health. Females (OR = 1.355, 95% CI = 1.159–1.585) and those dissatisfied with their academic performance (OR = 1.468, 95% CI = 1.233–1.748) were significantly more likely to report poorer mental health with reference to unchanged status, while those satisfied with family life had improved mental health with reference to unchanged (OR = 1.261, 95% CI = 1.006–1.579) and poorer status (OR = 1.369, 95% CI = 1.085–1.728).ConclusionPolicy and community strategies that promote good family relationships are thus essential for young people’s mental health during societal challenges such as the COVID-19 pandemic.

Clinical performance, audiological outcomes, and quality of life of the Cochlear Osia ® system

ObjectiveThe Cochlear Osseointegrated Steady-State Implant Bone Anchored Hearing Device (Osia) is a surgically implanted titanium apparatus that utilizes a piezoelectric actuator under the skin to address conductive and mixed hearing loss as well as single-sided deafness. The purpose of this study is to examine the clinical, audiologic, and quality-of-life outcomes in patients who underwent Osia implantation. MethodsThis is a retrospective study analyzing 30 adult patients (age 27–86) with conductive healing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD) who were implanted with the Osia device from January 2020 to April 2023 at a single institution by the senior author. Preoperative speech score testing (CNC, AzBio in quiet, AzBio in noise) were performed in all subjects while unaided, wearing conventional air conduction hearing aids, and wearing a softband BAHA. These preoperative speech scores were then compared to post-implantation speech scores using paired t-test analysis to assess for degree of speech improvement. In order to analyze quality of life after Osia implantation, each patient filled out the Glasgow Benefit Inventory (GBI) survey. The GBI is a series of 18 questions answered using a five-point Likert scale that addresses the changes in general health status, physical health status, psychosocial health status, and social support after a medical intervention. ResultsCHL, MHL, and SSD patients had significant improvement in hearing and speech recognition scores after Osia implantation compared to preoperative unaided hearing: CNC (14 % vs 80 %, p < 0.0001), AzBio in Quiet (26 % vs 94 %, p < 0.0001), and AzBio in Noise (36 % vs 87 %, p = 0.0001). Preoperative speech scores using the softband BAHA were accurate predictors of post-implantation speech scores and can serve to determine surgical candidacy for the Osia. Post-implantation Glasgow Benefit Inventory patient surveys demonstrated significant improvement in quality of life with patients scoring an average increase of +54.1 points in heath satisfaction. ConclusionAdult patients with CHL, MHL, and SSD can receive significant improvement in speech recognition scores after implantation with the Osia device. This translates to improved quality of life, which was confirmed on the post-implantation Glasgow Benefit Inventory patient surveys.

Case mix-based changes in health status: A prospective study of elective surgery patients in Vancouver, Canada.

Hospital activity is often measured using diagnosis-related groups, or case mix groups, but this information does not represent important aspects of patients' health outcomes. This study reports on case mix-based changes in health status of elective (planned) surgery patients in Vancouver, Canada. We used a prospectively recruited cohort of consecutive patients scheduled for planned inpatient or outpatient surgery in six acute care hospitals in Vancouver. All participants completed the EQ-5D(5L) preoperatively and 6months postoperatively, collected from October 2015 to September 2020 and linked with hospital discharge data. The main outcome was whether patients' self-reported health status improved among different inpatient and outpatient case mix groups. The study included 1665 participants with completed EQ-5D(5L) preoperatively and postoperatively, representing a 44.8% participation rate across eight inpatient and outpatient surgical case mix categories. All case mix categories were associated with a statistically significant gain in health status (p < .01 or lower) as measured by the utility value and visual analogue scale score. Foot and ankle surgery patients had the lowest preoperative health status (mean utility value: 0.6103), while bariatric surgery patients reported the largest improvements in health status (mean gain in utility value: 0.1515). This study provides evidence that it was feasible to compare patient-reported outcomes across case mix categories of surgical patients in a consistent manner across a system of hospitals in one province in Canada. Reporting changes in health status of operative case mix categories identifies characteristics of patients more likely to experience significant gains in health.

Increased prevalence of depression and anxiety among adults initiating antiretroviral therapy during the COVID-19 pandemic in Shinyanga region, Tanzania

BackgroundConcerns about the interconnected relationship between HIV and mental health were heightened during the COVID-19 pandemic. This study assessed whether there were temporal changes in the mental health status of people living with HIV presenting for care in Shinyanga region, Tanzania. Specifically, we compared the prevalence of depression and anxiety before and during COVID-19, with the goal of describing the changing needs, if any, to person-centered HIV services.MethodsWe analyzed baseline data from two randomized controlled trials of adults initiating ART in Shinyanga region, Tanzania between April-December 2018 (pre-COVID-19 period, n = 530) and May 2021-March 2022 (COVID-19 period, n = 542), respectively. We compared three mental health indicators that were similarly measured in both surveys: loss of interest in things, hopelessness about the future, and uncontrolled worrying. We also examined depression and anxiety which were measured using the Hopkins Symptom Checklist-25 in the pre-COVID-19 period and the Patient Health Questionnaire-4 in the COVID-19 period, respectively, and classified as binary indicators per each scale’s threshold. We estimated prevalence differences (PD) in adverse mental health status before and during the COVID-19 pandemic, using stabilized inverse probability of treatment weighting to adjust for underlying differences in the two study populations.ResultsWe found significant temporal increases in the prevalence of feeling ‘a lot’ and ‘extreme’ loss of interest in things [‘a lot’ PD: 38, CI 34,41; ‘extreme’ PD: 9, CI 8,12)], hopelessness about the future [‘ a lot’ PD: 46, CI 43,49; ‘extreme’ PD: 4, CI 3,6], and uncontrolled worrying [‘ a lot’ PD: 34, CI 31,37; ‘extreme’ PD: 2, CI 0,4] during the COVID-19 pandemic. We also found substantially higher prevalence of depression [PD: 38, CI 34,42] and anxiety [PD: 41, CI 37,45].ConclusionsAfter applying a quasi-experimental weighting approach, the prevalence of depression and anxiety symptoms among those starting ART during COVID-19 was much higher than before the pandemic. Although depression and anxiety were measured using different, validated scales, the concurrent increases in similarly measured mental health indicators lends confidence to these findings and warrants further research to assess the possible influence of COVID-19 on mental health among adults living with HIV.Trial Registration NCT03351556, registered November 24, 2017; NCT04201353, registered December 17, 2019.

Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients.

Frequent assessment of the severity of illness for hospitalized patients is essential in clinical settings to prevent outcomes such as in-hospital mortality and unplanned admission to the intensive care unit (ICU). Classical severity scores have been developed typically using relatively few patient features. Recently, deep learning-based models demonstrated better individualized risk assessments compared to classic risk scores, thanks to the use of aggregated and more heterogeneous data sources for dynamic risk prediction. We investigated to what extent deep learning methods can capture patterns of longitudinal change in health status using time-stamped data from electronic health records. We developed a deep learning model based on embedded text from multiple data sources and recurrent neural networks to predict the risk of the composite outcome of unplanned ICU transfer and in-hospital death. The risk was assessed at regular intervals during the admission for different prediction windows. Input data included medical history, biochemical measurements, and clinical notes from a total of 852,620 patients admitted to non-intensive care units in 12 hospitals in Denmark's Capital Region and Region Zealand during 2011-2016 (with a total of 2,241,849 admissions). We subsequently explained the model using the Shapley algorithm, which provides the contribution of each feature to the model outcome. The best model used all data modalities with an assessment rate of 6 hours, a prediction window of 14 days and an area under the receiver operating characteristic curve of 0.898. The discrimination and calibration obtained with this model make it a viable clinical support tool to detect patients at higher risk of clinical deterioration, providing clinicians insights into both actionable and non-actionable patient features.

Association between reproductive span and albuminuria in Korean women

Menopause is a major turning point in women's health. During that time, the reproductive span comes to an end, comprehensive health condition changes dramatically depend on age at menopause which reflects hormonal exposure. Cumulative evidences have supported that women’s reproductive health status, including menopause and estrogen levels is related to albuminuria and chronic kidney disease (CKD). Nephro-protective effect of estradiol was reported in several studies. The exact mechanism is unknown, but estradiol is thought to have a protective effect on glomerular endothelial cell damage that can occur in numerous kidney disease.

Challenges and Opportunities for the Use of Patient-Reported Outcome Measures in Orthopaedic Pediatric and Sports Medicine Surgery.

Patient-reported outcome measures (PROMs) are essential tools in assessing treatment response, informing clinical decision making, driving healthcare policy, and providing important prognostic data regarding patient health status change. These tools become essential in orthopaedic disciplines, such as pediatrics and sports medicine, given the diversity of patient populations and procedures. However, the creation and routine administration of standard PROMs alone do not suffice to appropriately facilitate the aforementioned functions. Indeed, both the interpretation and optimal application of PROMs are essential to provide to achieve greatest clinical benefit. Contemporary developments and technologies surrounding PROMs may help augment this benefit, including the application of artificial intelligence, novel PROM structure with improved interpretability and validity, and PROM delivery methods that provide increased access to patients resulting in greater compliance and data acquisition yields. Despite these exciting innovations, several challenges remain in this realm that must be addressed to continue to advance the clinical usefulness and subsequent benefit of PROMs. This review will highlight the opportunities and challenges surrounding contemporary PROM use in the orthopaedic subspecialties of pediatrics and sports medicine.

Can a family caregiver provide an evidence‐based falls prevention intervention to the person with cognitive impairment or dementia they care for?

AbstractBackgroundFalls are a common reason that persons with cognitive impairment or dementia (PwCID) cannot remain at home. FallsTalk is a one‐month evidence‐based falls prevention program that focuses attention on the individual causes of losses of balance or falls. FallsTalk encourages new falls prevention behaviors, which have been shown to decrease falls. We adapted FallsTalk for family Caregiver (FCG) administration to a PwCID with a recent history of falls to determine if FallsTalk‐Caregiver could influence the number of new falls prevention behaviors reported by the FCG or the number of falls.MethodThirty‐four Dyads (FCG+PwCID) were trained to conduct brief daily falls prevention discussions together. Dyads were randomly assigned to receive either standardized paper (FallsTalk,n = 14) or computer‐tailored (FallsTalk‐Caregiver,n = 20) discussion suggestions based on prior concerns expressed by the FCG. All Dyads had FallsTalk training, had daily discussions together and received weekly check‐in calls. The FCGs reported weekly on the number of falls and new falls prevention behaviors (#newFPBs); as well as any changes in the PwCID’s health, care or living arrangements during the intervention period. FCGs continued to enter the number of falls and status changes weekly into a secure web‐site using a subject ID, until medical (significant health status change) or residential (no longer living at home permanently) endpoint was reached, or 52 weeks were completed. Poisson regression models compared the number of new falls prevention behaviors and weekly fall rate between groups. Fall rates were annualized for comparison with published residential care fall rates.ResultDyads receiving FallsTalk‐Caregiver reported significantly more #newFPBs (MeanPaper = 5.34 (SEM = 0.68, CI = 3.48‐5.93), MeanComputer = 8.46 (SEM = 0.76, CI = 7.48‐10.40); p = .004) during the intervention month. FallsTalk‐Caregiver PwCIDs experienced a significantly lower fall rate (MeanPaper = 0.073/week (SEM = .015, CI = 0.049‐0.109), MeanComputer = 0.040/week (SEM = .008, CI = 0.027‐0.060); p = .047). Annualized fall rates (Falls/year for Dyads with &gt; = 12 weeks) were (MeanPaper = 3.64/year, n = 13; MeanComputer = 2.08/year, n = 19.ConclusionFallsTalk‐Caregiver provides an effective means to encourage new falls prevention behaviors to prevent losses of balance and falls. Despite the diversity of the Dyad’s home environment and varied PwCID diagnoses, FCGs matched or bettered the annual fall rates achieved by professional caregivers in skilled nursing facilities (Resident Falls/year = 2.33 (Residents without a PwCID diagnosis); 4.05 (Residents with a PwCID diagnosis).

Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study

ObjectiveTo evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals with a SARS-CoV-2 infection.DesignPopulation based, longitudinal cohort.SettingGeneral population of canton of Zurich, Switzerland.Participants1106...

Changes in health-related quality of life and treatment effects in chronic heart failure: a meta-analysis

BackgroundHeart failure (HF) is associated with poor health status, and high morbi-mortality. However, it is not well established how health status changes correlate with treatment effects on clinical outcomes. Our aim was to study the association between treatment-induced changes in health-status, assessed by Kansas City Cardiomyopathy Questionnaire 23 (KCCQ-23), and clinical outcomes in chronic HF. MethodsSystematic search of phase III-IV pharmacological RCTs in chronic HF that assessed KCCQ-23 changes and clinical outcomes throughout follow-up. We studied the association between treatment induced changes in KCCQ-23 and treatment effects on clinical outcomes (HF hospitalization or cardiovascular death, HF hospitalization, cardiovascular death, and all-cause death) using weighted random-effects meta-regression. ResultsSixteen trials were included, enrolling a total of 65,608 participants. Treatment induced KCCQ-23 changes were moderately correlated with treatment effects on the combined outcome of HF hospitalization or cardiovascular mortality (regression coefficient (RC) = −0.047, 95%CI: −0.085 to −0.009; R2 = 49%), a correlation that was mainly driven by HF hospitalization (RC = −0.076, 95%CI: −0.124 to −0.029; R2 = 56%). Correlations of treatment induced KCCQ-23 changes with cardiovascular death (RC = −0.029, 95%CI: −0.073 to 0.015; R2 = 10%) and all-cause death (RC = −0.019, 95%CI: −0.057 to 0.019; R2 = 0%) were weak and non-significant. ConclusionsTreatment-induced changes in KCCQ-23 were moderately correlated with treatment-effects on HF hospitalizations but were not correlated with the effects on cardiovascular and all-cause mortality. Treatment-induced changes in patient-centered outcomes (i.e., KCCQ-23) may reflect non-fatal symptomatic changes in the clinical course of HF leading to hospitalization.

Search for ways of optimizing the educational process of physical education in a technical university in the conditions of wartime

The need to adapt the physical education course for distance learning on the Moodle platform arose with the introduction of martial law. Statement of the problem, the significance of scientific and practical problems. Students and teachers found themselves in difficult conditions. It is necessary to organize the educational process among students with maximum accessibility to learning and practicality in wartime. Target. Find a way to optimize the process of physical education in a technical university in wartime. The optimization of this process was carried out using the methods of analysis of literary sources, questionnaires and methods of mathematical statistics. Results. The study was conducted among students with the aim of studying changes in health status, lifestyle, identifying symptoms of stress with the outbreak of hostilities. The stress caused by military operations, together with the increase in time spent at the computer and low physical activity, led to a deterioration in health in 39% of the students surveyed. The most relevant topics in modern conditions have been identified and the training course has been supplemented by them: "Providing first aid for various types of injuries and wounds", "Rules for survival in a military conflict zone", "Helping the psyche in a new reality". Developed and offered to students methodological recommendations for stress relief and exit from a stressful state. In search of new ways to attract students to physical activity, they were invited to participate in mass sports and patriotic events of various levels. Conclusions. Changes in the course program, the introduction of new themes and forms into the educational process have shown their effectiveness and received a positive assessment from the students.

People with Diabetes Have Poorer Self-Rated Health (SRH) and Diabetes Moderates the Association between Age and SRH.

Diabetes is a severe chronic condition that is related to decreased physical functioning. Recently, there has been growing interest in understanding how a brief report on health such as self-rated health (SRH) could be used to track changes in health status and service needs in people with diabetes. The current research aims to investigate how SRH is affected by diabetes and how diabetes could moderate the association between age and SRH. By analyzing data from 47,507 participants, with 2869 of them clinically diagnosed with diabetes, the current study found that people with diabetes had significantly poorer SRH than people without diabetes after controlling for demographic covariates (t(2868) = -45.73, p < 0.001, 95% C.I. (-0.92, -0.85), Cohen's d = -0.85). In addition, diabetes was a significant moderator of the relationship between age and SRH (b = 0.01, p < 0.001, 95% C.I. (0.01, 0.01)). Specifically, age was more strongly related to SRH in people without diabetes (b = -0.015, p < 0.001, 95% C.I. (-0.016, -0.015)) than in people with diabetes (b = -0.007, p < 0.001, 95% C.I. (-0.010, -0.004)). Health professionals should aim to improve SRH in people with diabetes given that SRH is related to various outcomes.

A Better Way to Care for Long Term Care (LTC) residents in Times of Medical Urgency: Improving Acute Care transfers for LTC Residents.

Background: Prior to the pandemic, every day approximately 28 long term care (LTC) residents were transferred to an emergency department (ED) in Alberta. This was placing increasing strain on healthcare resources and potentially negatively impacting the health and wellness of residents (e.g., exposure to iatrogenic harms). Many residents’ conditions could be managed within LTC if appropriate supports were provided. Poor communication between LTC and EDs can also lead to long ED lengths of stay, unnecessary resource utilization, sub-optimal health outcomes, and exposure to iatrogenic harms for LTC residents. Two INTERACT® tools (tools for early identification of acute medical issues) and a new care and referral pathway were implemented to help identify and address changes in health status among LTC residents sooner, improve communication between LTC and ED providers, and reduce unnecessary ED transfers. Methods: Between October 2019 and April 2022, 40 LTC homes and 4 EDs within the Calgary zone implemented the standardized LTC-to-ED care and referral pathway supported by a centralized telephone advice and transfer system for healthcare providers, community paramedics, and two INTERACT® tools (Stop and Watch for healthcare aides; Change in Condition Cards for nursing). Using a randomized stepped-wedge design, the pathway was implemented within 9 cohorts of (4-5) LTC facilities every 3 months, supported by an implementation coach. Three-hour train the trainer implementation sessions were conducted in-person or online with over 325 health practitioners in the enrolled LTC homes using strategies adapted to consider local context and barriers, as well as considering pandemic-related challenges. Evaluation Methods: Evaluation of the intervention involved both qualitative and quantitative methods. The primary study outcome is change in transfers from LTC to ED; secondary (quantitative) outcomes include hospital admissions, utilization of the centralized telephone advice and transfer system, and community paramedic visits. Analysis of these quantitative outcomes utilized negative binomial regression to estimate the incident rate with 95% confidence intervals (per 1000 residents), while adjusting for the different cohorts. The quantitative evaluation also included an economic analysis to determine potential cost savings. Interviews with healthcare providers were conducted to provide context to their experience with the intervention and ways it can be improved. These interviews will be interpreted with the involvement of members of our project resident and family advisory council. Results: Quantitative results demonstrate a reduction in the LTC-to-ED transfer rate [1.70 (95%CI 1.61-1.79) post-intervention) vs 1.91 (95%CI 1.84-2.00) pre-intervention], along with reduction in hospital admission rates [0.94 (95%CI 0.88-1.00) vs 1.08 (95%CI 1.03-1.14)]. There was an increase in utilization of the centralized telephone advice and transfer system [0.18 (95%CI 0.16-0.22) vs. 0.13 (95%CI 0.11-0.16)], but no increase in the number of community paramedic visits [2.05 (95%CI 1.94-2.16) vs 2.50 (95%CI 2.39-2.61)]. Cost and qualitative outcome data is pending. Advice and Lessons Learned: LTC staff education and use of early warning tools for identifying a change in resident health status (INTERACT® tools) and/or utilization of a centralized telephone advice and transfer system may have played a role in reducing ED transfers. We did not observe the expected relationship between community paramedic visits and reduced LTC-to-ED transfers, possibly as a result of the pandemic-related facility outbreak restrictions. Teams should tailor implementation sessions and materials to site specific needs and contexts to help address their unique barriers and facilitators. Partnerships with key stakeholders across the care continuum are essential to ensure adequate support and effective uptake and sustainability of the mutli-faceted change intervention.

Weight change and mental health status in a behavioral weight loss trial

BackgroundObesity, depression, and anxiety often co-occur, but research on weight change and mental health status is limited. This analysis examined how the mental component score (MCS-12) from the Short Form health survey changed over 24 months in weight loss trial participants with vs. without treatment seeking for affective symptoms (TxASx) and by weight change quintiles. MethodsParticipants with complete data (n = 1163) were analyzed from enrollees in a cluster-randomized, behavioral weight loss trial in rural U.S. Midwestern primary care practices. Participants received a lifestyle intervention with different delivery models, including in-clinic individual, in-clinic group, or telephone group counseling visits. Participants were stratified by baseline TxASx status and 24-month weight change quintiles. Mixed models were used to estimate MCS-12 scores. ResultsThere was a significant group-by-time interaction at the 24-month follow-up. The largest 0–24 month increase in MCS-12 scores (+5.3 points [12 %]) was observed in participants with TxASx who lost the most weight during the trial, while the largest decrease in MCS-12 scores (−1.8 points [−3 %]) was observed in participants without TxASx who gained the most weight (p < 0.001). LimitationsNotable limitations included self-reported mental health, the observational analytical design, and a largely homogenous source population, as well as the possibility of reverse causation biasing some findings. ConclusionsMental health status generally improved, particularly among participants with TxASx who experienced significant weight loss. Those without TxASx who gained weight, however, had a decline in mental health status over 24 months. Replication of these findings is warranted.

Fingerprinting walking using wrist-worn accelerometers

BackgroundIdentifying an individual from accelerometry data collected during walking without reliance on step-cycle detection has not been achieved with high accuracy. Research questionWe propose an open-source reproducible method to: (1) create a unique, person-specific “walking fingerprint” from a sample of un-landmarked high-resolution data collected by a wrist-worn accelerometer; and (2) predict who an individual is from their walking fingerprint. MethodsAccelerometry data were collected during walking from 32 individuals (23–52 y.o., 19 females) for at least 380 s each. For this study's purpose, data are not landmarked, nor synchronized. Individual walking fingerprints were created by: (1) partitioning the accelerometer time series in adjacent, non-overlapping one-second intervals; (2) transforming all one-second interval data for a given individual into a three-dimensional (3D) image obtained by plotting each one-second interval time series by the lagged time series for a series of lags; (3) partitioning these resulting participant-specific 3D images into a grid of cells; and (4) identifying the combinations of cells (areas in the 3D image) that best predict the individual. For every participant, the first 200 s of data were used as training and the last 180 s as testing. This approach does not use segmentation methods for individual strides, which reduces dependence on complementary algorithms and increases its generalizability. ResultsThe method correctly identified 100 % of the participants in the test data and highlighted unique features of walking that characterize the individuals. SignificancePredicting the identity of an individual from their walking pattern has immediate implications that can complement or replace those of actual fingerprinting, voice, and image recognition. Furthermore, as walking may change with age or disease burden, individual walking fingerprints may be used as biomarkers of change in health status with potential clinical and epidemiologic implications.

Responsiveness of the International Spinal Cord Injury Quality of Life Basic Data Set V2.0: An international longitudinal study

Context/Objective Examine the sensitivity of the International Spinal Cord Injury Quality of Life Basic Data Set V2.0 (QoL-BDS V2.0) to reflect changes in mobility and secondary health conditions (SHCs) between inpatient rehabilitation and one-year follow-up. Design International longitudinal study. Questionnaires were administered at baseline (Median 6 weeks, inter-quartile range 4–10 weeks post-onset) and after 12 months. Setting Spinal cord rehabilitation institutions in the US, Brazil, Australia and the Netherlands. Participants : Individuals with recent onset of spinal cord injury or disease (SCI/SCD) admitted to inpatient rehabilitation. Outcome measures The QoL-BDS V2.0, comprises four items on satisfaction with ‘life as a whole’, ‘physical health’, ‘psychological health’, and ‘social life’. Mobility level was measured with a single item and SHCs with the SCI Secondary Conditions Scale (SCI-SCS). Results Of the 160 participants, 61% had SCI, 48% had tetraplegia and 82% were wheelchair-users. Scores on ‘life as a whole’, ‘physical health’ and the total scale were significantly higher at follow-up compared to baseline in the total sample and the SCD subgroup, but not in the SCI subgroup. Increases in ‘physical health’, ‘psychological health’, ‘social life’ and the total score were significantly associated with improvements in the SCI-SCS or mobility scores. Participants with improved SCI-SCS and mobility at follow-up showed significantly more improvement in satisfaction with social life and the total score compared to participants without such favorable changes. Conclusion The results of this study provide partial evidence of responsiveness of the QoL-BDS V2.0 total score as a measure of QoL among individuals with SCI/SCD.