Distal Outcomes Research Articles

A longitudinal study of symptom cluster latent profiles in ovarian cancer patients undergoing chemotherapy.

This study aimed to identify distinct patterns within the symptom cluster of fatigue, pain, and sleep disturbance among ovarian cancer patients receiving chemotherapy, to determine the factors predicting these patterns and their impact on quality of life. The longitudinal study collected data from 151 ovarian cancer patients at three time points: before chemotherapy (T0), after the first chemotherapy cycle (T1), and following the completion of four cycles of chemotherapy (T2). Latent profile analysis and latent transition analysis were used to identify symptom patterns and evaluate changes in symptom patterns. A bias-adjusted three-step approach was utilized to examine predictor variables and distal outcomes associated with latent class membership. Three symptom patterns emerged: "All Low," "Moderate" (T0)/"Low pain and high sleep disturbance" (T1 and T2), and "All High." Patients with lower educational attainment and higher levels of anxiety and depression were found to be at an elevated risk of belonging to the "All High" class. All quality-of-life domains showed significant differences among the three subgroups, following an "All Low" > "All High" pattern (p < 0.05). Membership in three classes remained relatively stable over time, with probabilities of 0.749 staying within their groups from T0 to T2. This study underscores the existence of a diverse and heterogeneous experience within the symptom cluster of fatigue, pain, and sleep disturbance among ovarian cancer patients. Importantly, these patterns were stable throughout chemotherapy. Recognizing and understanding these patterns can inform the development of targeted interventions to alleviate the burden of symptom clusters in this population.

Counterfactual Mediation Analysis with a Latent Class Exposure

Latent classes are a useful tool in developmental research, however there are challenges associated with embedding them within a counterfactual mediation model. We develop and test a new method “updated pseudo class draws (uPCD)” to examine the association between a latent class exposure and distal outcome that could easily be extended to allow the use of any counterfactual mediation method. UPCD extends an existing group of methods (based on pseudo class draws) that assume that the true values of the latent class variable are missing, and need to be multiply imputed using class membership probabilities. We simulate data based on the Avon Longitudinal Study of Parents and Children, examine performance for existing techniques to relate a latent class exposure to a distal outcome (“one-step,” “bias-adjusted three-step,” “modal class assignment,” “non-inclusive pseudo class draws,” and “inclusive pseudo class draws”) and compare bias in parameter estimates and their precision to uPCD when estimating counterfactual mediation effects. We found that uPCD shows minimal bias when estimating counterfactual mediation effects across all levels of entropy. UPCD performs similarly to recommended methods (one-step and bias-adjusted three-step), but provides greater flexibility and scope for incorporating the latent grouping within any commonly-used counterfactual mediation approach.

Influences of Social-Psychological Constructs in Predicting Taiwanese Pro-Environmental Behaviors.

A value-belief-norm (VBN) model for understanding the pro-environmental behaviors (PEB) of Taiwanese was developed. This formulated VBN model included personal values, openness to change, awareness of consequences, personal norms, social norms, and PEB. Ecological world view and ascription of responsibility were excluded to develop a tighter model. A total of 1079 completed questionnaires were collected and structural equation modelling was utilized, where standard estimates and coefficients of determination validated the formulated VBN model's effectiveness. Each construct served its role as the mediator between its distal variable and outcome variable, with a substantial level of predictive accuracy, and 74.3% of the variance in PEB was accounted for. Further findings found that mature individuals had a stronger tendency towards awareness of consequences due to personal values; the young had a stronger tendency towards personal norms due to awareness of consequences; men had a stronger tendency towards personal norms due to awareness of consequences; and women had a weaker tendency due to a greater emphasis on altruism. Future interventions, such as sharing of personal pro-environmental lifestyles verbally or through social media, periodically decluttering personal items and maintaining a minimalist lifestyle, where these personal norms are in line with collective social norms, could help to strengthen PEB.

Relation between the dash score and radiographic evaluation of the wrist in patients with wrist fracture.

Traditionally, the assessment of distal radius fracture outcomes has been based on radiological measurements and self-evaluation scores. However, there is uncertainty regarding how accurately these measurements reflect the patient's perception of their outcome. In this study, we examined the correlation between radiological measurements and patient-perceived outcomes using the Disabilities of the Arm, Shoulder, and Hand outcome (DASH) score. 140 individuals who had recovered from a distal radius fracture. and had been treated with DVR, Kapandji, percutaneous pinning or closed reduction were included in the study. The retrospective assessment included 78 females and 62 males, with a mean DASH score of 3.54 points.Except for the ulnar variance, the study found little to no significant association between the DASH score and the final radiological measurement.In summary, the DASH score did not always indicate that a superior radiological result translated into a better patient-perceived outcome.

How orientation training socializes newcomers: The mediating role of learning in reducing turnover and boosting performance among new salespersons

AbstractOrientation training plays a crucial role in the process of newcomer socialization by equipping employees with the knowledge, abilities, and skills necessary for success in a new work setting. However, relatively few studies have investigated orientation training from a socialization perspective and addressed its underlying mechanisms. To address this issue, we developed a model to elucidate the socialization process of newly hired salespersons undergoing skill‐based orientation training. The model includes training reactions, two learning outcomes (learning engagement and skill acquisition), as well as two distal socialization outcomes (retention status and annual sales performance). Using a one‐year multiperiod design, we conducted a multilevel analysis on data of 1184 new salesperson records nested in 37 off‐site classes, which was obtained from a US pharmaceutical company operating in China. The results revealed that newcomers' reactions to orientation training were positively associated with their learning engagement and skill acquisition, which in turn resulted in a higher newcomer retention ratio. Furthermore, skill acquisition was found to be a significant mediator between training reactions and newcomers' annual sales performance. By combining self‐report, trainer‐report and objective indicators, this study provides a new and compelling evidence on how orientation training accelerates newcomer socialization success.

Electric massage chairs reduce labor pain in nulliparous patients: a randomized crossover trial

BACKGROUND: Labor pain varies significantly among pregnant women, ranging from mild to extremely distressing. Non-pharmacologic pain relief methods during vaginal birth are increasingly popular, either as a complement to pharmacologic agents or at times as the primary method of pain relief. Multiple trials have reported that manual or by-hand massage reduces labor pain. The effectiveness of full-body mechanical massage using electric massage chairs on labor pain remains unexplored.OBJECTIVE: To evaluate mechanical massage using electric massage chair on labor pain in nulliparous women.STUDY DESIGN: A randomized counterbalanced crossover trial was conducted in a university hospital in Malaysia from August 2022 to February 2023. Eligible nulliparas in labor with a minimum labor pain score of 5 (0-10 numerical rating scale) were enrolled. Participants were randomized to 30 minutes on the massage chair with mechanical massage followed by 30 minutes on the massage chair without mechanical massage, or the other way around in massage sequence. The primary outcome was change in pain score comparing pain with and without mechanical massage as a paired comparison for the entire trial participants. Secondary outcomes were across arms analyses of maternal and neonatal outcomes. The paired t-test, t test, Mann- Whitney U test, Chi square test and Fisher exact test were used as appropriate for the data.RESULTS: 208 women were randomized; 104 to each intervention. Data was available from 204 participants (103 randomized to massage first and 101 to no massage first). The primary outcome of change in labor pain score (0-10 Numerical Rating Scale, NRS) after massage and no massage (all participants included after crossover, paired t-test analysis) was mean±standard deviation 4.51±2.3 vs 5.38±2.1 mean difference - 0.87 (95% CI -1.14 to -0.59), p<0.001, a significant reduction in pain score after electric chair mechanical massage compared to no massage. On the across randomized arms secondary analyses, labor pain score after their first massage chair session was 4.35±2.52 (randomized to massage first, received massage as initial intervention) vs 5.66±1.73 p<0.001 (randomized to no massage first, received no massage as initial intervention) mean difference -1.31 (95% CI -1.91 to -0.748), a significant reduction after mechanical massage. Other distal maternal outcomes (mode of delivery, labor analgesia, duration of labor and maternal agreement that mechanical massage is effective for labor pain) and neonatal outcomes (Apgar score at 1 and 5 minutes, cord artery blood pH and base excess, and neonatal admission) were not different across randomized arms.CONCLUSION: Mechanical massage using an electric massage chair significantly reduces labor pain, offering a potential non-pharmacologic pain management option during labor.

Assessing HR department effectiveness: managerial perspective in Polish firms

Abstract Purpose This paper aims to determine variations in how different groups of stakeholders, such as top managers, HR managers, and line managers, perceive HR department effectiveness. Additionally, it explores the relation between different views on HR department effectiveness and multidimensional firm performance, encompassing proximal and distal outcomes. Design/methodology/approach The study comprised 150 Polish firms, with questionnaires collected from top managers, HR managers, and line managers within each organization. The analysis involved regression analysis and testing for two regression coefficients to confirm the hypotheses. Findings Research highlighted variations in how stakeholders perceive HR department effectiveness and its influence on organizational outcomes. Notably, top managers exhibited a strong association between HR department effectiveness and firm performance, especially concerning organizational and market performance. Surprisingly, assessments by HR managers and line managers did not display a stronger correlation with proximal outcomes, such as employee productivity and firm growth, compared to top managers, indicating a convergence in perspectives between different managerial levels. Originality/value Viewed through a managerial perspective, this paper emphasizes the significance of (dis)agreement in perceptions of HR department effectiveness at various hierarchical levels. In particular, this article enhances our knowledge of how top managers perceive HR department effectiveness, which has been relatively underexplored in prior research. Furthermore, it underscores the importance of top management as a critical stakeholder in HRM.

The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis.

Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.

LGBT sexuality and gender minority experiences of minority stress: a comparison of models and theories

Compelling evidence demonstrates that Lesbian, Gay, and Bisexual (LGB) populations have a higher prevalence of mental disorders compared to their heterosexual peers (Meyer in Psychol Bull 129(5):674–697, 2003). This has been attributed to minority stressors in the minority stress model. Since this model was established in 2003, there have been significant socio-political events that discriminate against SGM LGBTQ+ individuals. There have also been rival hypotheses, including rejection sensitivity (Feinstein in Arch Sex Behav 49(7):2247–2258, 2020) and ‘misperceiving of neutral events’ (Bailey in Arch Sex Behav 49(7):2265–2268, 2019). Examine SGM perspectives and investigate how well they align with Meyers model (2003). 16 qualitative studies capturing SGM minority stress experiences were extracted from scientific databases and, thematically analysed deductively using Meyer’s minority stress model, in addition to generating original subthemes. This systematic review thematically analysed 16 eligible studies, which generated 6 superordinate themes (Discrimination, Lack of representation, Navigation, Harassment, Depersonalization and Mental Health Outcomes) and 18 sub-themes. These themes were then situated in categories from Meyer’s Minority Stress Model (2003) (Circumstances, Minority Status, Distal stressors, Proximal stressors, and Mental health outcomes). SGM-specific stress experiences integrated into the Minority Stress Model (circumstances, navigation, distal, proximal, and mental health outcomes). The collected data elaborated the model with sub-themes such as discrimination, lack of representation, vigilance, depression, body image and positive coping in sum, this study offers support for and updates Meyer’s minority stress model whilst rejecting competing theories (Bailey 2019; Feinstein 2019).

How to support peer resistance in adolescents with mild-to-borderline intellectual disability? Intervention development and feasibility.

Adolescents with mild-to-borderline intellectual disability face peer resistance challenges, risking harmful or dangerous situations. We designed a peer resistance group intervention at school for adolescents with mild-to-borderline intellectual disability, tested its feasibility (N = 4, Mage = 14.1, MIQ = 78.8), adapted it, and tested it again (N = 6, Mage = 15.0, MIQ = 72.8). Study 1 demonstrated feasibility in recruitment, resources, and potential benefits on the distal outcome risk taking. However, attendance, obtained knowledge, and potential benefits on peer resistance, peer problems, and prosocial behaviour were suboptimal. Consequently, study 2 contained more learning by doing and individual lessons, resulting in higher attendance and greater personalization. While potential benefits on improved peer resistance measures were not observed, risk taking improved. Despite finding no potential benefits on peer resistance, running a peer resistance intervention for adolescents with mild-to-borderline intellectual disability at school is considered feasible.

When Average Isn't Good Enough: Identifying Meaningful Subgroups in Clinical Data

BackgroundClinical data are usually analyzed with the assumption that knowledge gathered from group averages applies to the individual. Doing so potentially obscures patients with meaningfully different trajectories of therapeutic change. Needed are “idionomic” methods that first examine idiographic patterns before nomothetic generalizations are made. The objective of this paper is to test whether such an idionomic method leads to different clinical conclusions.Methods51 patients completed weekly process measures and symptom severity over a period of eight weeks. Change trajectories were analyzed using a nomothetic approach and an idiographic approach with bottom-up clustering of similar individuals. The outcome was patients’ well-being at post-treatment.ResultsIndividuals differed in the extent that underlying processes were linked to symptoms. Average trend lines did not represent the intraindividual changes well. The idionomic approach readily identified subgroups of patients that differentially predicted distal outcomes (well-being).ConclusionsRelying exclusively on average results may lead to an oversight of intraindividual pathways. Characterizing data first using idiographic approaches led to more refined conclusions, which is clinically useful, scientifically rigorous, and may help advance individualized psychotherapy approaches.

Patterns of Social Determinants of Health and Publicly-Funded Service Access among Children Involved in Educational, Child Welfare, and Social Service Systems.

Social determinants of health (SDOH)-conditions in which children live, learn, and play-affect child health and well-being. Publicly funded services in education and child welfare systems are important resources to support child well-being, but cross-system coordination is rare. Leveraging integrated administrative data from 60,287 6th graders enrolled in public schools in Minnesota, we used latent class analysis (LCA) to examine patterns of cross-system SDOH, including educational services and involvement in child welfare. Five classes emerged. The largest class was characterized by a few multi-system SDOH and had low service needs. Two classes had differing patterns of school service use, one with a greater likelihood of special education service use alone and the other characterized by the use of multiple school services. Two classes were characterized by cross-system SDOH/service use (e.g., homelessness, child protection, placement in care, mental health, and special education services). We then assessed whether race/ethnicity predicted class membership and tested educational distal outcomes. American Indian, Black, and Latinx children had higher odds of exposure to both cross-system SDOH classes. Students facing any SDOH, particularly those with greater multi-system SDOH exposure, had worse attendance and academic achievement. Our study indicates that children are navigating complex experiences of SDOH and service needs, with a disproportional likelihood that Black children, Indigenous children, and other children of color (BIPOC) experience SDOH. Identifying patterns of SDOH provides an opportunity for policymakers and practitioners to intervene to promote health equity. By understanding facilitators and barriers to child well-being, the results inform how child-serving systems can strive toward health equity.

Menu labeling and portion size control to improve the out‐of‐home food environment: A scoping review

AbstractBackgroundMenu labeling and portion size control interventions may be effective strategies to mitigate the health risks posed by the out‐of‐home food environment. We conducted this scoping review to map the body of evidence (BoE) addressing the effects of menu labeling and portion size control interventions in the out‐of‐home food environment and to summarize the research gaps in this evidence base.MethodsWe searched PubMed, Embase, Epistemonikos, and PROSPERO in phase 1 for systematic reviews (SRs) and PubMed and Embase in phase 2 for primary studies in areas with insufficient SR evidence. We used a comprehensive search strategy without any restrictions on publication date, language, study population characteristics or outcomes. We screened all titles independently and in duplicate. We mapped the number of systematic reviews providing evidence per intervention‐setting combination in a matrix. The gaps in the matrix informed the searches for primary studies in phase 2. For the included SR protocols and primary studies, we charted the population, intervention, comparator, outcome, period, and study design to facilitate their evaluation and inclusion in future evidence syntheses.ResultsWe included 69 completed SRs; 37 on menu labeling, 9 on portion size control, and 23 on both. The types of menu labeling interventions studied were quantitative nutrient information (74%), interpretational guidance (48%), or contextual guidance (13%). Most reviews were from the United States, United Kingdom, and Canada. Most SRs included studies in establishments like cafeterias (51%) or restaurants (39%) and measured change in the quantity of food offered/ordered/consumed (96%). Phase 2 search yielded 24 primary studies; 16 experimental, 6 quasi‐experimental, and 2 observational studies.ConclusionThe BoE on the effectiveness of menu labeling and portion size control is predominantly from the developed world, on nutrient information labeling and reporting impact on consumer food choice. There is a need for studies in the online environment and reporting distal health outcomes.

U.S. Mexican-origin young adults' mental health relative to interpersonal stressor transitions from childhood to adolescence.

This study sought to describe latent transitions in developmentally and culturally salient interpersonal stressors from late childhood to late adolescence and examine whether different transition patterns predicted early adult mental health problems. Data from four waves (Grades 5, 7, 10, 12) of a study of 749 U.S. Mexican-origin youth were used for a latent transition analysis (LTA) of family, peer, and community stressors; distal outcomes of externalizing and internalizing problems were measured 5 years after Grade 12. Latent class analysis (LCA) and LTA were conducted for investigating underlying subgroups of interpersonal stress at each wave and transitions between subtypes over waves. For the LCA, two latent classes emerged at all four waves, representing low and high interpersonal stress. The LTA model with two classes at all waves was conducted with good fit. Six prominent transition classes emerged and related to young adult internalizing and externalizing problems. Transition class related to young adult internalizing and externalizing problems, such that youth who consistently had exposure to interpersonal stress or who had transitions from low to high exposure had more internalizing and externalizing problems. Findings are discussed relative to the developmental salience of these transitions and opportunities to intervene during adolescence to mitigate later mental health problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

E-HRM practices with Transformational e-HRM outcomes: The mediating role of proximal outcomes

The aim of this quantitative study is to analyze the impact of e-HRM practices on operational, relational, and transformational e-HRM outcomes. It also aims to explore if the adoption of e-HRM practices influences transformational e-HRM outcomes through the mediation of operational and relational e-HRM outcomes. Remenyi's and Zuboff's IT frameworks and the RBV paradigm serve as the foundation for the research framework. The study found evidence supporting these theories, showing that e-HRM practices have a significant impact on operational, relational, and transformational e-HRM outcomes. It also provided empirical evidence that operational and relational e-HRM outcomes positively mediate the relationship between e-HRM practices and transformational e-HRM outcomes. The study's generalizability is limited due to its small sample size and participants being Pakistani HR managers and executives only. Future research should include all stakeholders, consider long-term outcomes, and explore contingency factors like innovative climate, supportive work environment, and sustainable leadership style. Longitudinal data is recommended in future studies for causal relationships. It is recommended that organizations should align their e-HRM practices to achieve strategic excellence and utilize their capabilities for operational, relational, and transformational e-HRM outcomes. Embracing technology can enhance performance and competitive advantage. HR functions should act as change strategists to meet business demands and optimize outcomes. The study offers valuable insights for selecting and tuning their practices to achieve optimal proximal and distal outcomes. The main novelty of this study is the findings that operational and relational e-HRM outcomes partially mediate the influence of e-HRM practices on transformational e-HRM outcomes.

CARE-RESISTANT BEHAVIOR TRAJECTORIES OF PERSONS WITH DEMENTIA IN NURSING HOMES AND DISTAL OUTCOMES IN ORAL HEALTH

Abstract Persons with dementia (PWD) who exhibit care-resistant behaviors (CRB) are likely to resist mouthcare and have poor oral health. This study aimed to examine predictors and describe the characteristics of CRB trajectories and their distal outcome in oral health among PWD in nursing homes (NH). Group-based trajectory modeling was used to analyze dynamic changes in CRB intensity over 21 days with two time-points (morning and afternoon) among 75 PWD. Sub-group analysis demonstrated the characteristics of each trajectory group membership. Distal-outcome models explored the association between oral health variation and mouthcare completion to CRB trajectories. The most influential predictors included CRB intensity at baseline, duration of mouthcare, and the number of antipsychotics prescribed. Three distinctive CRB trajectories were identified for both morning and afternoon in the context of mouthcare. Oral health status and the mouthcare completion rates differed by CRB trajectory groups, and worse oral health status was associated with higher level of CRB intensity trajectories. The High-start CRB groups had the worst oral health status and lowest mouthcare completion in both model estimation and pre-post test. Oral health showed improvement across all three trajectory groups. A tailored individual-level strategy based on a daily pattern of CRB intensity may provide the key to developing interventions that find the “sweet spot” between providing optimal mouthcare while minimizing CRB. Results imply that balancing CRB and mouthcare by providing morning-only mouthcare to those with high CRBs may allocate resources to PLWD most in need of mouthcare. Antipsychotics have not shown usefulness in managing CRB.

DEVELOPING A CONCEPTUAL MODEL TO ASSESS ACTIVE ENGAGEMENT WITHIN A DEMENTIA CAREGIVER INTERVENTION

Abstract Active engagement is identified as an effective component of psychoeducational interventions for caregivers of persons living with dementia. There are many approaches to active engagement; however, limited assessment of this component within interventions reduces optimization and standardization. To fill this gap and increase transparency, we aimed to strengthen active engagement by developing Enhancing Active Caregiver Training (EnACT), an arts-based intervention designed to help caregivers address the behavioral symptoms of dementia. The intervention uses multi-sensory activities, including interacting with caregiver-informed vignettes, to foster engagement and process caregiving experiences. We partnered with caregivers of persons living with dementia (n=9) to iteratively refine EnACT through six focus groups. The purpose of this presentation is to report the process we took to identify how intervention participants actively engaged with EnACT. Focus group data were analyzed using process coding to identify the patterns of participant engagement with 17 intervention activities. The process codes were mapped to create a diagram of participant engagement for each activity. These diagrams were used to develop the EnACT Cycle of Engagement, a conceptual model illustrating how participants engaged with the intervention. The three-step model illustrates that: 1) antecedents (personal and intervention) contribute to 2) interaction with EnACT through participation, contribution, and application, which leads to 3) EnACT’s hypothesized proximal outcomes (capacity to adapt and appraisal of caregiving demands) and distal outcomes (perceived stress and caregiver well-being). The EnACT engagement model will be tested in the forthcoming randomized control trial assessing feasibility and acceptability.

AFFECTIVE RESPONSES TO DAILY MEMORY LAPSES IMPACT PSYCHOLOGICAL WELL-BEING IN MIDUS

Abstract Daily experiences have broad and far-reaching impacts on physical and mental health. Past work has linked micro-level experiences (e.g., daily stress) to macro-level processes (e.g., anxiety and depression; Charles et al., 2013) with a goal of understanding how day-to-day experiences influence development of physiological and psychological pathology. One mechanistic pathway for the link between daily experiences and longer-term outcomes are affective responses. This study extends previous work by examining mediation effects of positive and negative affect to a common daily experience: daily memory lapses on psychological well-being in a national sample of participants (N = 2,018; 56.6% Women, Mage = 56.92, SD = 13.37) from the MIDUS Refresher (2011-2014) and the MIDUS-3 (2013-2019). Each day participants reported on positive and negative affect and memory lapses. At the start of each wave, a comprehensive well-being assessment included different facets of psychological well-being (e.g., autonomy, environmental mastery). Daily memory lapses were significantly associated with increased negative affect and decreased positive affect on that same day. As expected, positive affect was associated with greater psychological well-being, while negative affect was associated with an inverse relationship. Importantly, significant indirect (mediation) effects were obtained for all models. This suggests that daily memory lapses have an impact on psychological well-being through their impacts on daily affect. This work provides increased evidence for the importance of emotional responses to daily stressors (such as memory lapses) being a determinate of distal health-related outcomes.

Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes

BackgroundPeople with substance use disorders (SUDs) frequently use emergency department (ED) services. Despite evidence demonstrating that post-discharge SUD treatment linkage effectively reduces the number of ED re-presentations, relatively few hospitals have implemented interventions to identify and connect patients with SUDs to appropriate care. ED-based peer recovery support specialist (PRSS) interventions have emerged as a promising approach for hospitals, but more research is needed to understand the extent to which these interventions meet the needs of patients who present to the ED for different reasons and with various underlying concerns. MethodA retrospective cohort analysis used data from a telehealth PRSS program in 15 EDs within one Indiana hospital system. The study included 2950 ED patients who engaged with telehealth PRSS services between September 2018 and September 2021. Latent class analysis identified patterns of patient characteristics associated with post-discharge PRSS engagement and ED re-presentations. Covariate predictors and distal outcomes were assessed to examine the associations between class membership, demographic factors, and patient outcomes. ResultsThe study team selected a six-class model as the best fit for the data. Class 1, representing patients with opioid use disorder and mental health diagnoses who presented to the ED for an opioid overdose, was used as the reference class for all other statistical tests. Multinomial logistic regression analysis demonstrated significant associations between covariate predictors, outcomes, and class membership. Regression results also demonstrate PRSSs had greater success contacting patients with prior year ED use and patients with a successful post-discharge PRSS contact were less likely to re-present to the ED. ConclusionResults highlight the heterogeneity of patients with SUDs and emphasize the need for tailored interventions to address patient-specific needs more effectively. They also provide support for the perceived utility of PRSS engagement for ED patients.

Which Factors Are Associated with Distal Pancreatectomy Outcomes' Optimization with the Application of an Enhanced Recovery After Surgery Program?

Background: Distal pancreatectomy (DP) represents the best therapeutic option for patients with body-tail pancreatic neoplasms (PNs). The enhanced recovery after surgery protocol is widely used for treating patients with PN to speed up postoperative recovery. This study aims to describe our institute's experience in the application of fast recovery protocol in a cohort of patients treated with DP, identifying predictors facilitating a decrease in the length of hospital stay. Patient and Methods: Were retrospectively enrolled 60 consecutive cases of DP performed from January 2016 to June 2022 in patients treated with enhanced recovery protocol, 25% of them were treated with spleen preserving procedure. Single-variable logistic regression models were used to evaluate the potential association between patient characteristics and the probability of postoperative complications. Standard linear regression models were used for length of stay, number of postoperative days (PODs) from surgery to full bowel function recovery, and PODs to the interruption of intravenous analgesia administration. Results: Thirty-four (57%) patients underwent open surgery and 26 (43%) laparoscopic surgery. Patients who underwent laparoscopic surgery and spleen-preserving procedures experienced a lower complication rate (P = .037), shorter length of stay, and time of analgesic requirements. With single-variable logistic regression models patients treated with laparoscopic surgery had statistically significant higher recovery times in terms of nasogastric tube removal (P = .004) and early enteral nutrition (P = .001). Conclusion: Continual refinement with enhanced recovery protocol for treating PN patients based on perioperative counseling and surgical decision-making is crucial to reduce patient morbidity and time for recovery.