Changes In Self-reported Health Research Articles

Establishing how much improvement in lung function and distance walked is clinically important for adult patients with Pompe disease.

Pompe disease is a rare, inheritable, progressive metabolic myopathy. This study aimed to estimate the minimal clinically important difference (MCID) for an improvement in forced vital capacity in the upright seated position (FVCup) and the 6-min walk test (6MWT) after a year of treatment with enzyme replacement therapy. Data were obtained from two prospective follow-up studies. Between-group and within-group MCIDs were estimated using anchor-based methods. Additionally, a distribution-based method was used to generate supportive evidence. As anchors, self-reported change in health and in physical functioning, shortness of breath and a categorization of the Short-Form 36 Physical Component Summary score were used. Anchor appropriateness was assessed using Spearman correlations (absolute values ≥0.29) and a sufficient number of observations in each category. In all, 102 patients had at least one FVCup or 6MWT measurement during enzyme replacement therapy. Based on the anchors assessed as appropriate, the between-group MCID for an improvement in FVCup ranged from 2.47% to 4.83% points. For the 6MWT, it ranged from 0.35% to 7.47% points which is equivalent to a distance of 2.18-46.61 m and 1.97-42.13 m for, respectively, a man and a woman of age 50, height 1.75 m and weight 80 kg. The results of the distribution-based method were within these ranges when applied to change in the outcome values. The MCIDs for FVCup and 6MWT derived in this study can be used to interpret differences between and within groups of patients with Pompe disease in clinical trials and cohort studies.

Changes in self-reported health and wellbeing outcomes in 36,951 primary school children from 2014 to 2022 in Wales: an analysis using annual survey data.

This study examines the changes in childhood self-reported health and wellbeing between 2014 and 2022. An annual survey delivered by HAPPEN-Wales, in collaboration with 500 primary schools, captured self-reported data on physical health, dietary habits, mental health, and overall wellbeing for children aged 8-11 years. The findings reveal a decline in physical health between 2014 and 2022, as evidenced by reduced abilities in swimming and cycling. For example, 68% of children (95%CI: 67%-69%) reported being able to swim 25m in 2022, compared to 85% (95% CI: 83%-87%) in 2018. Additionally, unhealthy eating habits, such as decreased fruit and vegetable consumption and increased consumption of sugary snacks, have become more prevalent. Mental health issues, including emotional and behavioural difficulties, have also increased, with emotional difficulties affecting 13%-15% of children in 2017-2018 and now impacting 29% of children in 2021-2022. Moreover, indicators of wellbeing, autonomy, and competence have declined. Importantly, this trend of declining health and wellbeing predates the onset of the Covid-19 pandemic, suggesting that it is not solely attributed to the pandemic's effects. The health of primary school children has been on a declining trajectory since 2018/2019 and has continued to decline through the COVID recovery period. The study suggests that these trends are unlikely to improve without targeted intervention and policy focus.

Improved health-related quality of life after renal denervation in patients with resistant hypertension: 3-year outcomes in the global symplicity registry

Abstract Background Hypertension is associated with increased mental anxiety and depression. Renal denervation (RDN) reduces blood pressure (BP) in patients with uncontrolled, resistant hypertension (rHTN). The Global SYMPLICITY Registry (GSR) DEFINE is a prospective, open-label, single-arm, all-comer worldwide study, enrolling patients to undergo RDN. Whether BP reductions after RDN improve patients’ self-reported health and quality of life through long-term follow-up remains elusive. Purpose To evaluate changes in self-reported health and quality of life of rHTN patients following radiofrequency RDN. Methods GSR DEFINE patients completed the EuroQoL five-dimensions three-level (EQ-5D) questionnaire to assess their own health state on a visual analog scale (VAS: 0 to 100, with 0 being ‘worst possible’ and 100 being ‘best possible'). Patients were also asked to assess five dimensions of quality of life including mobility, self-care, usual activities, pain/discomfort, anxiety/depression at 3 levels: no problems (score: 0), some problems (1), severe problems (2). Patients answered the questionnaire at 6, 12, 24, and 36-month follow-up after the RDN procedure. Categorical measures from the pooled results of the questionnaire between subgroups were compared using the Kruskal-Wallis test. Here we assess the self-reported health state and quality of life measures among patients with rHTN (office systolic BP ≥150 mmHg and on ≥3 antihypertensive drugs) at baseline through 36 months. Results At baseline, GSR patients with rHTN (n=2051) had an office systolic blood pressure (OSBP) of 175.2 ± 19.8 mmHg and a 24-h ambulatory systolic blood pressure (ASBP) of 157.4 ± 18.6 mmHg. At 36 months after RDN, rHTN patients had significant reductions in OSBP (-23.5 ± 27.0 mmHg; n=906; p<0.001) and ASBP (-10.3 ± 20.9 mmHg; n=329; p<0.001), respectively. Antihypertensive medication remained unchanged through 36 months. Correspondingly, patients with rHTN reported a significant improvement in the self-reported health state from baseline after RDN at each follow-up through 36 months (Figure). At baseline (n=1813), patients with rHTN reported a 0.86 ± 0.20 EQ-5D quality of life score. At 36 months (n=839), patients with rHTN reported an improved quality of life with a 0.85 ± 0.21 score which was a statistically significant change from baseline (p=0.0024). Conclusion Following RDN, self-reported health state and quality of life data from a large population of rHTN patients improved from baseline through 36-months. These results suggest that BP reductions following radiofrequency RDN may alleviate mental anxiety and depression associated with hypertension.

Associations Between Adherence to Self-Management Activities and Change in Function and Health Outcomes in the Rehabilitation of Patients with Rheumatic and Musculoskeletal Diseases.

To explore the content of, and adherence to, self-management activities reported by patients with rheumatic and musculoskeletal diseases (RMDs), and whether adherence to self-management activities is associated with changes in self-reported health and function over a 1-year period following rehabilitation in specialized healthcare. Participants (n = 523) reported function and health outcomes at admission, discharge, and 4, 8 and 12 months post-rehabilitation. Self-management activities reported at discharge were self-evaluated as adherence level at home. Self-management activity content was linked to the International Classification of Functioning, Disability and Health coding system, and summarized as high or low adherence. Associations between adherence to self-management activities and change in outcomes were investigated using a linear mixed model approach with repeated measures. Self-management activities focused mainly on enhanced physical health and managing everyday routines, and seldom addressed work participation. Adherence to self-management activities was challenging with regard to structure and daily life routines, mental health, and the application of knowledge and coping strategies. Adherence to self-management activities was significantly associated with improvements in all outcomes, except for mental health and activities of daily living. Adherence to self-management activities, and creating structure and setting everyday routines at home, appear to be important for maintaining health and function over time. Rehabilitation should include a greater focus on mental health challenges and work participation.

A comparison of patient-reported outcomes among Canadian women having hysterectomies.

Many indications for hysterectomy can negatively affect patients' quality of life. This study uses patient-reported outcomes to measure changes in self-reported health among hysterectomy patients. A prospective cohort of 294 hysterectomy patients completed patient-reported outcomes preoperatively and six months postoperatively in Vancouver, Canada. Patient-reported outcomes measured pelvic health, sexual function, pain, and depression. Changes in health were compared with paired t-tests, and multi-variable regression analysis measured associations between patient and clinical factors with postoperative outcomes RESULTS: Many patients reported improvements in health. Unadjusted analysis found that 65% of participants reported less pelvic distress, 55% reported less pain, and 47% reported less depression symptoms postoperatively. Multivariable regression analysis found that poorer preoperative health was associated with poorer postoperative outcomes in all domains of health measured (p-value < 0.01). Postoperative pain scores were lower (less pain) by 0.78 among residents of the most affluent neighborhoods (p-value = 0.02) compared to those in less affluent neighborhoods. Postoperative depression scores were 1.58 points worse among participants with endometriosis (p-value = 0.03) and 1.02 points worse among participants having abdominal surgery (p-value = 0.02). Many participants reported improvements in pelvic symptoms, pain, and depression after hysterectomy. Lower socioeconomic status patients may be at risk for reporting higher pain after surgery, and endometriosis patients may report higher depression. Further investigation is needed to determine effective interventions for the higher postoperative pain observed in this study for residents of less affluent neighborhoods.

NEIGHBORHOOD QUALITY AS IT RELATES TO HEALTH AND WELL-BEING IN OLDER AFRICAN AMERICANS

Abstract With the burgeoning older adult population, there will be an increased demand for neighborhood environments that are conducive to successful aging. For example, the need for affordable and usable housing developments for older adults that provide greater opportunities for social engagement, social services, and convenience to neighborhood resources (e.g., grocery stores, healthcare) will continue to rise. Several initiatives have sought to develop age-friendly neighborhoods, which focused on improving accessibility and affordability of community resources. However, limited effort has focused on the health and cognitive effects of neighborhood-level socioeconomic disadvantage, with respect to neighborhood income, education, employment, and housing quality. This symposium will include presentations from two studies that explored how neighborhood disadvantage (measured by the Area Deprivation Index) relates to health and cognition. The objectives of the proposed symposium are the following: (1) discuss how neighborhood disadvantage relates to subjective and objective measures of physical health; and (2) discuss how neighborhood disadvantage relates to cognitive functioning. Allan and colleagues explored the association between neighborhood disadvantage as it relates to changes in self-reported health and objective measures (i.e., blood pressure) of health among older Black adults. Wright and colleagues explored the association between neighborhood disadvantage and measures of subclinical cardiovascular disease in older Black and White adults. Aiken-Morgan and colleagues examined associations between neighborhood disadvantage and cognitive functioning among Black older adults. Lastly, McCain and colleagues explored associations between neighborhood disadvantage and mobility among Black older adults.

Beyond “pains” and “gains”: untangling the health consequences of probation

BackgroundResearch on the health consequences of criminal legal system contact has increasingly looked beyond imprisonment to understand how more routine forms of surveillance and punishment shape wellbeing. One of these sites is probation, the largest form of supervision in the U.S. Drawing on an interview study with 162 adults on probation in Hennepin County, MN, in 2019, we map how adults on probation understand the consequences of supervision for their health and how these self-reported health changes correlate with individual, social, and structural circumstances.ResultsRoughly half of participants described their health as having improved since starting probation, while the remainder were split between no change and worsened health. Examining both closed-ended survey questions and open-ended interview prompts, we find that the “gains” of supervision were correlated with substance use treatment (often mandated), reduced drug and alcohol use, increased housing and food security, and perceptions of support from their probation officer. However, these potentially health-promoting mechanisms were attenuated for many participants by the significant “pains” of supervision, including the threat of revocation, which sometimes impacted mental health. In addition, participants in the most precarious circumstances were often unable to meet the demands of supervision, resulting in further punishment.ConclusionsMoving beyond the “pains” and “gains” framework, we argue that this analysis provides empirical evidence for the importance of moving social services outside of punishing criminal legal system interventions. People with criminal legal contact often come from deeply marginalized socio-economic contexts and are then expected to meet the rigorous demands of supervision with little state aid for redressing structural barriers. Access to essential services, including healthcare, food, and housing, without the threat of further criminal legal sanctions, can better prevent and respond to many of the behaviors that are currently criminalized in the U.S. legal system, including substance use.

Health and Mental Health Impact of Tornadoes: Are Older Adults More Resilient?

Guided by influential theories of disaster research and gerontology, this study examines health resilience associated with tornadoes, particularly focusing on how individuals’ tornado-associated stress, financial losses, and family members’ well-being affected posttraumatic distress (PTD), posttraumatic growth (PTG), and self-reported changes in health among adults. To reach this goal, this study collected data from residents affected by two violent tornadoes in 2013, with the assistance of a professional survey lab which implemented a random-digit-dialling telephone survey. The working sample included 517 respondents with oversampled older adults. Multinomial logistic regression, Poisson regression, and Ordinary Least Square Regression were conducted separately for younger and older adults. The results indicated a significant effect of stress levels on PTG among older adults only. Nonetheless, the differences in effect sizes between the two groups were not significant. Meanwhile, respondents’ financial losses and their family members’ declined health were significant predictors of improved health among older adults. Similarly, family members’ declined mental health was a significant predictor of PTD among older adults, but not younger adults. Compared to young adults, older adults were more vulnerable to their family members’ declined mental health, but also more resilient to stressful situations, financial losses, and family members’ declined physical health. Lastly, although risk and resilience factors could be constructed with the same set of items, they function differently among different groups of people. Hence, more studies on heterogeneity are needed to further refine resilience frameworks.

Digital Mental Health Intervention Plus Usual Care Compared With Usual Care Only and Usual Care Plus In-Person Psychological Counseling for Orthopedic Patients With Symptoms of Depression or Anxiety: Cohort Study

BackgroundDepression and anxiety frequently coexist with chronic musculoskeletal pain and can negatively impact patients’ responses to standard orthopedic treatments. Nevertheless, mental health is not routinely addressed in the orthopedic care setting. If effective, a digital mental health intervention may be a feasible and scalable method of addressing mental health in an orthopedic setting.ObjectiveWe aimed to compare 2-month changes in mental and physical health between orthopedic patients who received a digital mental health intervention in addition to usual orthopedic care, those who received usual orthopedic care only (without a specific mental health intervention), and those who received in-person care with a psychologist as part of their orthopedic treatment plan.MethodsIn this single-center retrospective cohort study involving ancillary analysis of a pilot feasibility study, 2-month self-reported health changes were compared between a cohort of orthopedic patients who received access to a digital mental health intervention (Wysa) and 2 convenience sample comparison cohorts (patients who received usual orthopedic care without a specific mental health intervention and patients who received in-person care with a psychologist as part of their orthopedic treatment plan). All patients were 18 years or older and reported elevated symptoms of depression or anxiety at an orthopedic clinic visit (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression or Anxiety score ≥55). The digital intervention was a multi-component mobile app that used chatbot technology and text-based access to human counselors to provide cognitive behavioral therapy, mindfulness training, and sleep tools, among other features, with an emphasis on behavioral activation and pain acceptance. Outcomes of interest were between-cohort differences in the 2-month longitudinal changes in PROMIS Depression and Anxiety scores (primary outcomes) and PROMIS Pain Interference and Physical Function scores (secondary outcomes).ResultsAmong 153 patients (mean age 55, SD 15 years; 128 [83.7%] female; 51 patients per cohort), patients who received the digital mental health intervention showed clinically meaningful improvements at the 2-month follow-up for all PROMIS measures (mean longitudinal improvement 2.8-3.7 points; P≤.02). After controlling for age and BMI, the improvements in PROMIS Depression, Pain Interference, and Physical Function were meaningfully greater than longitudinal changes shown by patients who received usual orthopedic care (mean between-group difference 2.6-4.8 points; P≤.04). Improvements in PROMIS Physical Function were also meaningfully greater than longitudinal changes shown by patients who received in-person psychological counseling (mean between-group difference 2.4 points; P=.04).ConclusionsPatients who received a digital mental health intervention as part of orthopedic care reported greater 2-month mean improvements in depression, pain interference, and physical function than patients who received usual orthopedic care. They also reported a greater mean improvement in physical function and comparable improvements in depression, anxiety, and pain interference compared with orthopedic patients who received in-person psychological counseling.

Well-being of Canadian Armed Forces members during the COVID-19 pandemic: the influence of positive health behaviours.

The COVID-19 pandemic has been linked to increased depression, anxiety and other adverse mental health outcomes. Understanding the behaviours that positively influence health is important for the development of strategies to maintain andimprove well-being during the pandemic. This study focussed on Canadian Armed Forces Regular Force members (N = 13 668) who participated in the COVID-19 Defence Team Survey, administered between April and May 2020. The use of positive health behaviours and the extent to which such behaviours were associated with anxiety, depression and self-reported change in health and stress levels compared to before the pandemic were examined. Depression and anxiety were experienced by 14% and 15% of the sample, respectively, while 36% reported that their mental health had gotten worse since the pandemic started, and close to half reported worse physical health and stress levels. The most common behaviours respondents reported engaging in to maintain or improve their health were exercising outdoors, healthy eating and connecting with loved ones. Although most behaviours were associated with better health outcomes, meditation and connecting with loved ones showed associations with worse health. Engaging in behaviours such as exercise and healthy eating was generally associated with better health outcomes. Unexpected relationships of meditation and connecting with loved ones are discussed in terms of their use in stressful times among those with mental health issues, past research on coping strategies and impacts of the pandemic and physical distancing on social connections. The findings may have implications for strategies to promote healthy behaviours during the remainder of the pandemic and similar crises in the future.

Change in self-reported health: A signal for early intervention in a medicare population

BackgroundHealth plans and risk-bearing provider organizations seek information sources to inform proactive interventions for patients at risk of adverse health events. Interventions should take into account the strong relationship between social context and health. This retrospective cohort study of a Medicare Advantage population examined whether a change in self-reported health-related quality of life (HRQOL) signals a subsequent change in healthcare needs. MethodsA retrospective longitudinal analysis of administrative claims data was conducted for participants in a Medicare Advantage plan with prescription drug coverage (MAPD) who responded to 2 administrations of the Centers for Disease Control and Prevention 4-item Healthy Days survey within 6–18 months during 2015–2018. Changes in HRQOL, as measured by the Healthy Days instrument, were compared with changes in utilization and costs, which were considered to be a reflection of change in healthcare needs. ResultsA total of 48,841 individuals met inclusion criteria. Declining HRQOL was followed by increases in utilization and costs. An adjusted analysis showed that every additional unhealthy day reported one year after baseline was accompanied by an $8 increase in monthly healthcare costs in the subsequent six months for the average patient. ConclusionsDeclining HRQOL signaled subsequent increases in healthcare needs and utilization. ImplicationsFindings suggest that HRQOL assessments in general, and the Healthy Days instrument in particular, could serve as a leading indicator of the need for interventions designed to mitigate poor health outcomes and rising healthcare costs. Level of evidenceIII.

A shift in women's health? Older workers' self-reported health and employment settings during the COVID-19 pandemic.

BackgroundThe first wave of COVID-19 has had a massive impact on work arrangements settings in many European countries with potential effects on health that are likely to vary across gender.MethodsFocusing on the workforce aged 50 and over in 27 European countries using data from SHARE wave 8 (N = 11,221), the study applies a generalized logit mixed-effects model to assess the relationship between negative and positive change in self-reported health since the start of the pandemic and change in employment settings using an interaction effect between gender and employment arrangements to distinguish their specific association by gender after controlling for socio-economic covariates and multicollinearity.ResultsFemale respondents have higher probabilities to declare a positive health when working fully or partially from home or when temporarily and permanently unemployed. However, introducing the main effect of gender exacerbates discrepancies and such benefits fade away. Differences across countries do not significantly change the estimates.ConclusionThe benefits of work arrangements to improve women’s health during the first wave of COVID-19 have not compensated the negative effect of gender discrepancies exacerbated by the pandemic to the extent that employment arrangements have no role, or just a negative impact, in modulating them.

Varied and unexpected changes in the well-being of seniors in the United States amid the COVID-19 pandemic.

Recent evidence suggests that psychological health deteriorated during the COVID-19 pandemic but far less is known about changes in other measures of well-being. We examined changes in a broad set of measures of well-being among seniors just before and after the recognition of community spread of COVID-19 in the United States. We fielded two waves of a survey to a large, national online panel of adults ages 60 to 68 at wave 1. We measured depressive symptoms, negative affect, positive affect, pain, life satisfaction and self-rated health in each survey wave. 16,644 adults answered well-being questions in waves 1 and 2 of our survey (mean[SD]: age 64 [2.6]; 10,165 women [61%]; 15,161 [91%] white). We found large (20%; p<0.001) increases in the rate of depressive symptoms (1.4 percentage points; 95% CI, 0.97 to 1.86) and negative mood (0.225 scale points; 95% CI, 0.205 to 0.245) but no change in self-reported health and a decrease (12.5%; p<0.001) in the rate of self-reported pain (5 percentage points; 95% CI, -5.8 to -4.3). Depressive symptoms and negative affect increased more for women. Higher perceived risk of getting COVID-19 and of dying from the disease were associated with larger increases in the rate of depressive symptoms and negative affect and larger decreases in positive affect and life satsifaction. COVID-19 related job/income loss was the only pandemic-related factor predictive of the decline in pain. Although depressive symptoms and mood worsened during the COVID-19 pandemic, other measures of well-being were either not materially affected or even improved.

The Prospective Association of Patient Hospitalization with Spouse Depressive Symptoms and Self-Reported Heath

After hospital discharge, patients experience a period of generalized risk for adverse mental and physical health outcomes (post-hospital syndrome [PHS]). Hospital stressors can explain these effects in patients (e.g., sleep disruption, deconditioning). Patients’ partners also experience adverse outcomes following patient hospitalization, but mechanisms of these effects are unknown. The purpose of this study was to test whether greater times and nights of patient hospitalization (proxies for partner exposure to hospital stressors) are prospectively associated with greater increases in partner depression and in partner self-reported poor health. Participants were 7,490 married couples (11,208 individuals) enrolled in the Health and Retirement Study. Outcomes were prospective changes in depressive symptoms and self-reported poor health, and primary predictors were spouse hospitalization over the past two years (yes/no), spouse hospitalized ≥ two times (yes/no), and spouse spent ≥ eight nights in-hospital (yes/no). Covariates included age, gender, race, ethnicity, income, own hospitalization experiences during the past 12 months, and one’s own and spouse comorbidities. Having a spouse who experienced two or more hospitalizations was associated with an increase in one’s own depression over time, as was having a spouse who spent eight or more nights in-hospital. Spouse hospitalization was not associated with prospective changes in self-reported health. Results suggest that PHS mechanisms may account for adverse post-hospitalization outcomes in patients’ partners.

Changes in self-reported health, alcohol consumption, and sleep quality during the COVID-19 pandemic in the United States

ABSTRACT When the novel coronavirus entered the US in early 2020, the initial response to protect the health-care system capacity, slow transmission, and associated morbidity and mortality has been stay-at-home orders, social distancing, and proper hygiene. However, extended social isolation can result in unintended consequences. To examine possible unintended consequences, we fielded a longitudinal survey with the same sample of respondents – the first at the end of March 2020 and the second one month later at the end of April 2020. We calculated changes over time in physical health status, mental health status, alcohol consumption, and sleep quality. Random-effects logit models were estimated to identify statistically significant predictors for each outcome. Results show that individuals reported significantly worse outcomes in all four areas as the pandemic progressed, especially for alcohol consumption and sleep quality. In general, age, non-White race, religiosity, and resiliency are protective factors while being female and having greater fear of the coronavirus are risk factors. If these trends continue as we enter future stages of the pandemic, then the full societal costs could become extreme.

Association between frailty and self-reported health following heart valve surgery.

BackgroundKnowledge about the association between frailty and self-reported health among patients undergoing heart valve surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing heart valve surgery.MethodsIn a prospective cohort study, consecutive patients undergoing heart valve surgery, including transapical/transaortic valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L).To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI).ResultsFrailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51–7.52), VAS 2.41 (1.13–5.14), and KCCQ 2.84 (1.35–5.97).ConclusionFrailty is present at discharge in 18% of patients undergoing heart valve surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among heart valve teams broadly, and not only to measure frailty as a marker of operative risk.

The effects of job displacement on spousal health

This paper studies how job displacement influences the health of the worker’s spouse. Results show that the husband’s displacement leads to an increase in the probability of the wife reporting her physical health as fair/poor. These wives are also more likely to experience high blood pressure, heart disease, and/or emotional issues. Wives who are in poor health at baseline, are in low financial standing prior to the husbands’ job loss, are not working two years before the husbands’ job loss, and have children at home at the time of the husbands’ displacement tend to drive these results. Husbands of displaced wives experience little change in self-reported health, the probability of high blood pressure, heart disease, or emotional issues.

Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo)

BackgroundFollow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care.MethodsThe current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up.ResultsIn intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life.ConclusionsThere were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life.Trial registrationClinicaltrials.gov, NCT01710774. Registered October 19th, 2012.

Classical Chinese medicine self-care: Participants' perspectives on a pilot program for community health

IntroductionClassical Chinese medicine (CCM) includes numerous simple lifestyle recommendations which can be adopted into daily life in support of short and long-term health outcomes. The rise of chronic illness and non-communicable disease globally, in recent decades, has created a call for acceptable, cost-effective and scalable health care programs. This analysis explores the experience of participants in a CCM community healthcare program delivered in rural Scotland. MethodsSemi-structured interviews were employed in which a sample of program participants (n = 11) were interviewed about their overall experience in participating in the CCM program, inclusive of their experience adopting the recommended practices, program challenges and/or perceived barriers and any self-reported changes in health and well-being. The data were analysed and themes developed using the Framework Approach. ResultsThemes emerged in four key areas: Improvements in health and self-awareness; Self-direction, adaptability and prior exposure; Personalised support, self-reflective tools, sustaining engagement; and Cultural barriers, accessibility and strengthening networks. Interviewees were from a diverse range of occupational backgrounds with the majority aged over 50 years. ConclusionThis study suggests individuals engaged in a CCM community healthcare program may experience improved physical and emotional health outcomes and may feel motivated to adopt CCM self-care practices through program elements which enhance self-efficacy. The clinical benefit of these self-care practices and the feasibility of CCM community healthcare programs on other settings warrant closer researcher attention.

Medicaid Expansion Slowed Rates Of Health Decline For Low-Income Adults In Southern States.

Of the fourteen states that have not expanded eligibility for Medicaid, nine are in the southern census region, and two others border that region. Ongoing debate over the merits of Medicaid expansion in these states has focused, in part, on whether the safety net provides sufficient access for uninsured low-income Americans. We analyzed longitudinal survey and vital status data from the twelve-state Southern Community Cohort Study (SCCS) for 15,356 nonelderly adult participants with low incomes, 86percent of whom were enrolled at community health centers. In difference-in-differences analyses, we compared changes in self-reported health between participants in four expansion and eight nonexpansion states before (2008-13) and after (2015-17) Medicaid expansion. We found that a higher proportion of SCCS participants in expansion states reported increases in Medicaid coverage (a differential change of 7.6percentage points), a lower proportion experienced a health status decline (-1.8percentage points), and a higher proportion maintained their baseline health status (1.4percentage points). The magnitude of estimated reductions in health declines would meaningfully affect a nonexpansion state's health ranking in our sample if that state elected to expand Medicaid. Our results suggest that for low-income adults in the South, Medicaid expansion yielded health benefits-even for those with established access to safety-net care.