Rates Of Distress Research Articles

Bio-Experiential Technology to Support Persons With Dementia and Care Partners at Home (TEND): Protocol for an Intervention Development Study.

Alzheimer disease and related dementias are debilitating and incurable diseases. Persons with dementia and their informal caregivers (ie, dyads) experience high rates of emotional distress and negative health outcomes. Several barriers prevent dyads from engaging in psychosocial care including cost, transportation, and a lack of treatments that target later stages of dementia and target the dyad together. Technologically informed treatment and serious gaming have been shown to be feasible and effective among persons living with dementia and their care partners. To increase access, there is a need for technologically informed psychosocial interventions which target the dyad, together in the home. This study aims to develop the toolkit for experiential well-being in dementia, a dyadic, "bio-experiential" intervention for persons with dementia and their caregivers. Per our conceptual model, the toolkit for experiential well-being in dementia platform aims to target sustained attention, positive emotions, and active engagement among dyads. In this paper, we outline the protocol and conceptual model for intervention development and partnership with design and development experts. We followed the National Institutes of Health (NIH) stage model (stage 1A) and supplemented the model with principles of user-centered design. The first step includes understanding user needs, goals, and strengths. We met this step by engaging in methodology and definition synthesis and conducting focus groups with dementia care providers (N=10) and persons with dementia and caregivers (N=11). Step 2 includes developing and refining the prototype. We will meet this step by engaging dyads in up to 20 iterations of platform β testing workshops. Step 3 includes observing user interactions with the prototype. We will meet this step by releasing the platform for feasibility testing. Key takeaways from the focus groups include balancing individualization and the dyadic relationship and avoiding confusing stimuli. As of September 2023, we have completed focus groups with providers, persons with dementia, and their caregivers. Additionally, we have conducted 4 iterations of β testing workshops with dyads. Feedback from focus groups informed the β testing workshops; data have not yet been formally analyzed and will be reported in future publications. Technological interventions, particularly "bio-experiential" technology, can be used in dementia care to support emotional health among persons with a diagnosis and caregivers. Here, we outline a collaborative intervention development process of bio-experiential technology through a research, design, and development partnership. Next, we are planning to test the platform's feasibility as well as its impact on clinical outcomes and mechanisms of action. DERR1-10.2196/52799.

Content Moderator Mental Health, Secondary Trauma, and Well-being: A Cross-Sectional Study.

Content moderators (CMs) analyze and remove offensive or harmful user generated content that has been uploaded to the internet. Jobs which involve exposure to other people's suffering are associated with raised rates of secondary traumatic stress and mental health problems. However, research establishing psychological baseline symptoms in CMs is lacking. This study used an online survey to explore rates of psychological distress, secondary trauma, and well-being in a sample of CMs. Regression analysis explored how various features of the work affected mental health. There was a dose-response effect between frequency of exposure to distressing content and psychological distress and secondary trauma, but not well-being. The results suggested supportive colleagues and feedback about the importance of their role ameliorated this relationship. Implications for CM working conditions are discussed.

Resilience and distress among individuals with chronic health conditions during the initial wave of the COVID-19 pandemic

BackgroundIndividuals with chronic health conditions (CHCs) have a higher risk for severe SARS-CoV-2 (COVID-19) infection and reported high rates of distress during the pandemic. However, research suggests individual characteristics distinguish those who are more likely to experience clinical levels of distress than others. We examined predicted differences in distress over time between individuals with CHCs who had resilient and non-resilient personality profiles. MethodsA national sample responded to an online survey that included the study measures. Individuals with CHCs (N = 649) provided complete data to an initial survey and a second administered three months later. Cluster analysis of personality traits identified resilient and non-resilient personality profiles. A longitudinal structural equation model tested an a priori model that specified the relationship of a resilient personality prototype to self-reported resilience, coping, depression and anxiety at both measurement occasions. ResultsThe final model explained 50.2 % of the variance in distress at Time 1 and 76.2 % at Time 2. A resilient personality prototype significantly predicted less distress at Time 1, and at both time points it predicted and operated through self-reported resilience and less disengaged coping to effect lower distress. LimitationsSampling biases may limit the generalizability of the study, as the study was limited to self-report data provided by those who completed the study measures at both assessments. ConclusionsIndividuals with CHCs who are particularly vulnerable to distress may have characteristics that contribute to a lower sense of confidence and rely on ineffective, disengaged coping behaviors that exacerbate their stress.

EXPLORING THE EVERYDAY EXPERIENCES OF FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA: A LONGITUDINAL DIARY STUDY

Abstract People living with dementia rely largely on the support of unpaid family caregivers to remain living at home in the community. The strain created by this dependence is evidenced by high rates of distress among caregivers of people living with dementia and underscores the importance of access to appropriate formal and informal supports for this group. Providing tailored and meaningful supports and services to families requires a good understanding of the multidimensional and dynamic nature of the caregiving experience. Our study employed longitudinal qualitative methodology to understand how caregivers of people living with dementia were experiencing progression of the disease and shifting support needs over a two year-period. Fourteen family caregivers in British Columbia, Canada, wrote monthly diaries reflecting on their experience of caregiving and navigating supports. Thematic analysis of 137 diary entries shed light on different facets of caregiving experience, including psychological and emotional challenges (e.g., feeling overwhelmed, lacking a sense of control, trouble maintaining sense of self) and difficulties navigating formal care and supports (e.g., lack of access to services and information, lack of flexibility in service delivery). However, accounts also reflected participants’ resilience, through a range of coping strategies adopted to resolve problems encountered in caregiving, drawing on emotional and practical support from family, friends, and community. The diaries offer critical perspectives on gaps and inadequacies in formal supports for family caregivers and opportunities to better support the health and wellness of caregivers and recipients through dementia care policy and practice.

A Hidden Burden On Public Health: Adolescent Pregnancy And Increased Adverse Perinatal Outcomes

ABSTRACT
 Objective: Adolescent pregnancy, associated with increased adverse pregnancy outcomes, is a major public health problem. This study aimed to assess adverse perinatal outcomes in adolescent pregnancies by comparing them with adult pregnancies. 
 Methods: 1104 adolescent and 2463 adult pregnant women were included. Presence of fetal anomaly, gestational diabetes, preeclampsia-eclampsia, intrauterine growth restriction, intrahepatic cholestasis, polyhydramnios, placenta previa, in utero mort fetus, uterine rupture, placenta abruption, umbilical cord prolapse, acute fetal distress, preterm birth, cesarean section, labor arrest, birth weight, macrosomia, dystocia, birth trauma, APGAR scores, neonatal intensive care unit admission, postpartum hemorrhage, hysterectomy, blood transfusion, and postpartum infection were recorded. 
 Results: Rates of acute fetal distress, preterm birth, low birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and blood transfusion were higher while birth weight, APGAR scores of fifth minutes, the rates of cesarean section, prolonged and arrested labor, gestational diabetes, and macrosomia were lower in adolescents. In regression analysis, being adolescent pregnant increase the risk of acute fetal distress by 1.4 times (aOR=1.439;95%CI=1.030-2.01, p=0.033), preterm birth by 1.7 times (aOR=1.692; 95%CI=1.104-2.596, p=0.016) and decrease the risk of gestational diabetes (aOR=0.182; 95%CI=0.116-0.286, p

Impact of Empathy on Oxytocin and Cortisol Responsivity in Caregivers to Older Adults with Chronic Conditions

AbstractBackgroundIndividuals who provide care for older adults with chronic conditions, such as dementia, experience poorer mental health when care recipients have low empathy. Empathy is thought to have two components: cognitive empathy (i.e., understanding others’ mental perspectives) and emotional empathy (i.e., feeling empathic concern/sympathy). Due to chronic stress, many caregivers experience burnout and compassion fatigue (i.e., emotional exhaustion and secondary traumatic stress). However, the impact of the caregiving role on empathy has not been well‐characterized in caregivers to older adults. Evidence from other populations show that stress hormones (e.g., cortisol) decrease when individuals engage in social bonding which in turn can increase levels of oxytocin. The present research study is highly novel because no previous studies have specifically investigated how empathy affects cortisol and oxytocin hormone levels in caregivers to older adults with chronic conditions.MethodsParticipants included 21 women caregivers to older adults with chronic conditions (Mage = 54.1; Medu = 16.1). Participants watched one video to induce empathy (empathy condition) and a separate video to induce an unemotional state (control condition) and completed self‐report ratings of empathy and distress before and after the videos. Saliva was collected using the passive drool method at baseline and after each video. Salivary hormone assays were conducted for cortisol and oxytocin. Participants completed standard measures of empathy (Interpersonal Reactivity Index) as well as compassion fatigue and burnout (Professional Quality of Life Scale).ResultsCaregivers with higher compassion fatigue reported higher levels of burnout (p<.05) and burden (p<.05). In addition, caregivers with higher compassion fatigue reported a reduced tendency to help others in daily life (p<.05). In response to an empathy‐evoking video, momentary feelings of distress were positively associated with greater oxytocin (p<.01), and there was a non‐significant trend towards lower cortisol (p = .1). Caregivers who reported higher levels of momentary empathic concern in response to the empathic video had lower oxytocin (p<.05), whereas participants reporting higher cognitive empathy had greater oxytocin (p<.05).ConclusionsThese results help to lay the groundwork for the possibility of developing hormonal interventions that may help to increase empathy and reduce stress in caregivers to older adults with chronic conditions.

Distress, demoralization, and fulfillment among palliative care providers during the COVID-19 pandemic.

Prolonged distress is a risk factor for burnout among health-care providers (HCP) and may contribute to demoralization. We examined sources of distress during the COVID-19 pandemic and associations with demoralization. This prospective cross-sectional survey of HCP was conducted among palliative care providers of an academic medical center. Participants completed a survey evaluating sources of distress and the Demoralization Scale-II (DS-II) to measure the intensity of demoralization. Of 106 eligible participants, 74 (70%) completed the survey. DS-II median (range) score was 2 (0-19). There were no statistically significant associations with demographic characteristics. Participants reported high rates of distress for multiple reasons and high rates of sense of fulfillment (90%) and satisfaction (89%) with their profession. Our study identified high levels of distress but low demoralization rates. Further study to evaluate fulfillment and satisfaction as protective factors against demoralization and burnout is indicated.

Untangling the association between COVID-19 health literacy, trust in the pandemic response, and mental distress, during the COVID-19 pandemic in Ireland: a repeated cross-sectional study

BackgroundThe impact of the COVID-19 pandemic on rates of mental distress is well described. However, the contribution of poor health literacy and low levels of trust in state institutions to mental distress is less well defined. This study aimed to assess the impact of COVID-19 health literacy and trust in the pandemic response (Trust) on mental distress during the COVID-19 pandemic in Ireland. MethodsWe did this nationally representative cross-sectional survey of adult Irish residents during three study periods: from May 26 to June 17, 2020 (n=947); from July 1 to July 23, 2020 (n=995); and from Sept 5 to Sept 28, 2020 (n=972). Participants were contacted using random-digit-dialling and interviewed by a professional market research organisation (Ipsos MRBI’ about 80% via mobile phone, 20% via landline). Mental distress was assessed by the Patient Health Questionnaire Anxiety Depression Scale (PHQ-ADS), for which a score of 10 or higher indicated mental distress. Heath literacy and trust were each assessed with three questions, which defined three categories: low, moderate, and high (appendix). Descriptive analysis and multivariate (MVA) Poisson regression were conducted in STATA17, Incidence Rate Ratios (IRR) are reported. Findings2914 participants completed the survey across three study periods (median age 46 years, 1510 [51·8%] women, 1401 [48·1%] men, three [0·1%] non-binary). 804 (27·6%) of 2914 participants experienced mental distress (n=804). More women experienced mental distress than men (508 [34%] of women vs 294 [21%] of men). Mental distress was inversely associated with age (from 43% in those aged <30 years [n=232/539] to 19% in those aged >70 years [n=66/349]). Most participants had high health literacy (n=2,530, 86·8%). While health literacy was positively and significantly associated with trust, it was not associated with mental distress and it was therefore excluded from the MVA. Level of trust was captured for 2693 adults; 42·2% participants reported low trust (n=457) or moderate trust (n=679). The prevalence of mental distress was inversely associated with trust; increasing from 24% in those with high trust (n=374/1557), 30% in those with moderate trust (n=202/679), to 36% in those with low trust (n=166/457). In MVA higher rates of mental distress were associated with low trust (IRR 1·45, 95% CI 1·20–1·75; p=0·000) and moderate trust (IRR 1·24, 1·04–1·47, p=0·016) compared with high trust when adjusted for age, sex, employment status, and income,. InterpretationIn Ireland, low levels of trust in the COVID-19 pandemic response were associated with higher levels of mental distress. Although poor health literacy was associated with low levels of trust, it was not independently associated with mental distress. Inference on the nature and direction of causal effects must be cautious given the cross-sectional study design. FundingHealth Research Board.

Do Employees Waive Financial Red Flags through the Glassdoor?

ABSTRACT We use Glassdoor employee rating measures to examine the relationship between employee perceptions about their employer and the employer’s level of financial distress, proxied by Bloomberg’s one-year default probability. Our results indicate that improvements (deterioration) in Glassdoor ratings reveal a decrease (increase) in the average firm’s level of financial distress. We also find that the relation between a firm’s level of financial distress and Glassdoor ratings is not uniform across all firms: the relation is stronger for small and mid-capitalization firms. By establishing a relationship between Glassdoor ratings and the level of financial distress, our study adds to the forensic accounting literature and shows that Glassdoor ratings can help auditors, regulators, investors, and market participants predict future concerns relating to financial distress. Our results suggest that employee perceptions provide an early warning for financial red flags, as the pressures from financial distress increase the risk of fraudulent behaviors. Data Availability: On request. JEL Classifications: G33; G41; M14; M41.

Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study.

Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

Prevalence of mental distress and factors associated with symptoms of major depression among people living with HIV in Norway

ABSTRACT For people living with HIV (PLHIV) who can access lifesaving treatment, HIV has become a chronic lifelong condition; however, PLHIV have more mental and somatic comorbidities than their HIV-negative peers. In this cross-sectional study, we assessed the prevalence of mental distress and identified factors associated with major depression among 244 well-treated PLHIV residing in Norway. Participants completed validated questionnaires covering mental and somatic health. The prevalence of mental distress, defined as a score on the Hopkins Symptom Check List-25 >1.75, was 32%, and that of symptoms of major depression, defined as a score on the Beck Depression Inventory-II ≥20, was 15%. The factors associated with major depressive symptoms identified using logistic regression were risk of drug abuse (adjusted odds ratio (AOR) 15.1, 95% confidence interval (CI) 3.28, 69.3), fatigue (AOR 12.5, 95% CI 3.90, 40.0), trouble sleeping (AOR 7.90, 95% CI 2.85, 21.9), African origin (AOR 3.90, 95% CI 1.28, 11.9), low education (AOR 3.31, 95% CI 1.18, 9.30), and non-disclosure (AOR 3.22, 95% CI 1.04, 10.0). Our findings indicate that the prevalence rates of mental distress and major depressive symptoms are higher among well-treated PLHIV residing in Norway than in the general population. These conditions are under-diagnosed and under-treated, and increased awareness is needed.

Primary Care Redesign for Value-Based Care

Summary To address the inefficiencies and high costs associated with the U.S. health care system’s dominant fee-for-service (FFS) model, leaders at Spectrum Health in Michigan — now Corewell Health West — decided in 2019 to undertake a transformation to value-based care, starting with primary care. The aim is to maximize value for patients by achieving the best outcomes at the lowest cost. A set of guiding principles was established to address this primary care initiative: to incorporate population segmentation (clinics tailored to distinct patient cohorts, including healthy, rising risk, high risk, and others); to integrate interdisciplinary care teams (emphasizing top-of-license care); to align physicians’ efforts to their clinical expertise (to create and manage care plans for complex patients); to deliver care through multiple modalities (including virtual care, asynchronous care, home visits, or other ways to meet patient needs); to utilize integrated data and information (facilitated by a robust electronic medical record and analytics capacity to track key performance indicators supporting operational, technical, and clinical workflows); to align provider compensation and incentives with value-based outcomes while shifting away from FFS volume); and to integrate specialty care in primary care (where primary and specialty providers function as members of a joint care team). Recognizing that value-based care delivery typically requires upfront investment and delayed financial ROI, the team effort adopted a two-pronged approach by implementing the value-based care model and simultaneously optimizing primary care FFS. Despite some challenges in meeting all the targeted metrics — including resistance to change management — surveys show improvement in experience scores among patients (rating provider communication and likelihood to recommend the clinic) and well-being scores among physicians and advanced practice providers (lower rates of high distress).

A Review on Optimization of Thermal Performance of Solar Air Heater with artificial Surface Roughness

The requirement of energy across the globe is increasing at a distressing rate. The conventional sources of energy may no longer be able to meet the requisite demands. India being the second most populous country in the world having 20% of the total world population has a per capita energy consumption of 400 KWh. Hence, the need of hour is to hunt for the sources of energy which can lost longer and wouldn`t harm any forms of lives on the planet earth. Solar energy originating from sun is evolved by a series of chemical reactions that convert about 65*107 tons of Hy drogen to Helium every second. The energy from sun at a distance of 1.5*108 Km reaches the surfaces of collector plates installed on buildings and structures in beam and diffused forms of electromagnetic radiations. The former is called as direct radiation since they don`t change direction while travelling while as latter are subjected to scattering, absorption, re-radiations and re- reflections in the atmosphere.

Group A Streptococcus Infection in Neonatal Population: A Systematic Review of The Literature.

(1) Background: The importance of group A streptococcus (GAS) infection severity has been recognized in children and adults. However, to our knowledge, there have been no systematic reviews or pooled assessments of the incidence and outcome of invasive GAS (iGAS) disease in neonates, a potentially high-risk population. Therefore, we performed a systematic review of available data regarding the risk factors, clinical presentation, and outcome of GAS infection in neonates. (2) Methods: An electronic search of the existing literature was carried out during the period July 2023-September 2023 in the PubMed and Scopus databases, considering studies referring to GAS infection in the neonatal population. (3) Results: Overall, 39 studies met all the inclusion criteria and were included in this review, evaluating data from 194 neonates. Unfortunately, there were a lot of missing data among the retrieved studies. Our systematic review highlighted the presence of differences with regards to clinical presentation, infection sites, and outcome of GAS invasive disease between neonates with early-onset (EOS) or late-onset sepsis (LOS). Common characteristics of EOS included respiratory distress, rapid deterioration, and high mortality rate irrespective of the infection site, while rash, gastrointestinal tract symptoms, and fever appeared to be the most frequent symptoms/clinical signs and manifestations of LOS disease. The management of severe invasive iGAS disease consists mainly of specific antimicrobial treatment as well as supportive care with fluids and electrolyte supplementation, minimizing or counteracting the effects of toxins. Furthermore, a mortality rate of approximately 14% was recorded for iGAS disease in the total of all studies' neonates. (4) Conclusions: Although iGAS is a rare entity of neonatal infections, the potential severity of the disease and the rapid deterioration requires the development of quick analysis methods for the detection of GAS allowing the prompt diagnosis and administration of the indicated antibiotic treatment. Furthermore, given the exceptional risk for both the pregnant woman and the neonate, it is very important to raise awareness and create easily accessible guidelines that could facilitate the prevention and management of maternal as well as the subsequent neonatal severe iGAS disease.

Improvement in health‐related quality of life and symptoms of anxiety and depression in patients with alopecia areata randomized to baricitinib or placebo: Results from two international randomized controlled trials

AbstractBackgroundAlopecia areata (AA) is an autoimmune hair loss disorder associated with high rates of emotional and psychosocial distress. Baricitinib, an oral selective Janus kinase (JAK) 1 and JAK 2 inhibitor, was superior to placebo with respect to hair regrowth in two phase 3 trials involving 1200 adults with severe AA (≥50% of scalp hair loss).ObjectivesThis analysis investigated the evolution of health‐related quality of life (HRQoL) and symptoms of anxiety and depression after treatment with baricitinib in severe AA.MethodsPatients were randomized to placebo, baricitinib 2‐mg, or baricitinib 4‐mg. Improvements in HRQoL and psychological burden were measured using Skindex‐16 AA and Hospital Anxiety and Depression Scales (HADS‐A and HADS‐D), respectively. Changes from baseline through Week 36 were analyzed using analysis of covariance with modified last observation carried forward for missing data. Proportion of patients with baseline HADS score ≥8 that shifted to &lt;8 (normal) was analyzed at Week 36 using logistic regression with nonresponder imputation.ResultsAt Week 36, patients receiving baricitinib 2‐mg and 4‐mg reported significant improvements versus placebo in Skindex‐16 AA symptoms (2‐mg: −2.80 and 4‐mg: −2.53), functioning (2‐mg: −14.02 and 4‐mg: −17.14), and emotions (2‐mg: −20.42 and 4‐mg: −24.11) domain scores. In comparison to placebo, patients receiving baricitinib 2‐mg and 4‐mg experienced significant reductions in HADS‐A (2‐mg:‐0.96 and 4‐mg:‐1.04) and HADS‐D (2‐mg: −0.30 and 4‐mg: −0.33) scores after 36 weeks. More patients on baricitinib shifted from a score ≥8 to &lt;8 for anxiety (2‐mg: 33% and 4‐mg: 39%) and depression (2‐mg: 34% and 4‐mg: 45%) but results were generally not significant.ConclusionsIn two large trials, greater improvements in HRQoL and symptoms of anxiety and depression were observed after treatment with baricitinib 2‐mg and 4‐mg compared to placebo. These results support that hair regrowth has a positive impact on HRQoL and psychological burden in severe AA.

Amputation Rates and Associated Social Determinants of Health in the Most Populous US Counties

Social Determinants of Health (SDOH) have been found to be associated with health outcome disparities in patients with peripheral artery disease (PAD). However, the association of specific components of SDOH and amputation has not been well described. To evaluate whether individual components of SDOH and race are associated with amputation rates in the most populous counties of the US. In this population-based cross-sectional study of the 100 most populous US counties, hospital discharge rates for lower extremity amputation in 2017 were assessed using the Healthcare Cost and Utilization Project State Inpatient Database. Those data were matched with publicly available demographic, hospital, and SDOH data. Data were analyzed July 3, 2022, to March 5, 2023. Amputation rates were assessed across all counties. Counties were divided into quartiles based on amputation rates, and baseline characteristics were described. Unadjusted linear regression and multivariable regression analyses were performed to assess associations between county-level amputation and SDOH and demographic factors. Amputation discharge data were available for 76 of the 100 most populous counties in the United States. Within these counties, 15.3% were African American, 8.6% were Asian, 24.0% were Hispanic, and 49.6% were non-Hispanic White; 13.4% of patients were 65 years or older. Amputation rates varied widely, from 5.5 per 100 000 in quartile 1 to 14.5 per 100 000 in quartile 4. Residents of quartile 4 (vs 1) counties were more likely to be African American (27.0% vs 7.9%, P < .001), have diabetes (10.6% vs 7.9%, P < .001), smoke (16.5% vs 12.5%, P < .001), be unemployed (5.8% vs 4.6%, P = .01), be in poverty (15.8% vs 10.0%, P < .001), be in a single-parent household (41.9% vs 28.6%, P < .001), experience food insecurity (16.6% vs 12.9%, P = .04), or be physically inactive (23.1% vs 17.1%, P < .001). In unadjusted linear regression, higher amputation rates were associated with the prevalence of several health problems, including mental distress (β, 5.25 [95% CI, 3.66-6.85]; P < .001), diabetes (β, 1.73 [95% CI, 1.33-2.15], P < .001), and physical distress (β, 1.23 [95% CI, 0.86-1.61]; P < .001) and SDOHs, including unemployment (β, 1.16 [95% CI, 0.59-1.73]; P = .03), physical inactivity (β, 0.74 [95% CI, 0.57-0.90]; P < .001), smoking, (β, 0.69 [95% CI, 0.46-0.92]; P = .002), higher homicide rate (β, 0.61 [95% CI, 0.45-0.77]; P < .001), food insecurity (β, 0.51 [95% CI, 0.30-0.72]; P = .04), and poverty (β, 0.46 [95% CI, 0.32-0.60]; P < .001). Multivariable regression analysis found that county-level rates of physical distress (β, 0.84 [95% CI, 0.16-1.53]; P = .03), Black and White racial segregation (β, 0.12 [95% CI, 0.06-0.17]; P < .001), and population percentage of African American race (β, 0.06 [95% CI, 0.00-0.12]; P = .03) were associated with amputation rate. Social determinants of health provide a framework by which the associations of environmental factors with amputation rates can be quantified and potentially used to guide interventions at the local level.

Yoga-based supportive care for patients with head and neck cancer undergoing radiotherapy: Results of a three-arm randomized controlled trial.

292 Background: Radiotherapy (RT) to treat head and neck cancer (HNC) may result in debilitating toxicities and functional problems. Targeted yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. Given the high distress rates in spouses and interdependence of distress in couples, involving a spousal caregiver in the intervention may have additional benefits. Thus, we randomized patient-caregiver dyads to either a dyadic yoga (DY), patient yoga (PY) or usual care (UC) control arm. We hypothesized that both yoga arms are better than the UC arm regarding functional outcomes and healthcare utilization (i.e., feeding tube (FT) placements, emergency department (ED) and hospital admissions (HA) across the standard RT period. The comparison between the DY vs PY group was considered exploratory. Methods: HNC patients planned to receive ≥25 fractions of RT and their caregivers completed baseline assessments and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the RT schedule. Sessions were either in person or via videoconference. Patients completed the self-report part of the PG-SGA on a weekly basis during the RT period (5-6 weeks). We extracted FT, ED and HA as healthcare utilization metrics from patients’ electronic medical records as binary variables (yes/no). Results: 100 patients (mean age: 60.3 yrs., 85% male, 79% NHW, 67% early stage, 54% chemo-RT) and caregivers (mean age: 54.9 yrs., 83% female, 78% NHW) were randomized (DY: n=34; PY: n=33, UC: n=33). Session attendance was high for both yoga arms (88% attended ≥ 10 session) with mean of 13.13 sessions in the DY and 13.30 sessions in the PY group. Intent to treat analyses using multi-level modeling controlling for patient age, sex, disease stage and treatment (RT vs CRT) revealed a significant effect between the DY and UC group for the physical function (F=5.27, p=.03) and the nutrition intake (F=4.97, p=.03) PG-SGA subscales favoring the DY group. The other comparisons (PY vs UC and DY vs PY) were not significant. None of the comparisons for the symptom and weight subscales were significant. Logistic regression analyses revealed a significant effect for FT placement so that both DY (p=.05) and PY (p=.02) groups had significantly fewer FTs than the UC group. The effect for ED visits was marginally significant and the effect for HA was not significant. Conclusions: Yoga therapy, particularly when delivered to patient-caregiver dyads, appears to be a beneficial behavioral supportive care strategy for HNC patients undergoing RT. We revealed significantly improved physical function and nutrition intake and fewer FTs relative to a UC comparison group. A larger comparative effectiveness trial is warranted. Clinical trial information: NCT04607590 .

Cross-sectional association between metabolic parameters and psychotic-like experiences in a population-based sample of middle-aged and elderly individuals.

Metabolic alterations are often found in patients with clinical psychosis early in the course of the disorder. Psychotic-like experiences are observed in the general population, but it is unclear whether these are associated with markers of metabolism. A population-based cohort of 1890 individuals (mean age 58.0years; 56.3% women) was included. Metabolic parameters were measured by body-mass index (BMI), concentrations of low-density and high-density lipoprotein cholesterol (LDL-C and HDL-C), total cholesterol, triglycerides, and fasting glucose and insulin in blood. Frequency and distress ratings of psychotic-like experiences from the positive symptom dimension of the Community Assessment of Psychic Experience questionnaire were assessed. Cross-sectional associations were analysed using linear regression analyses. Higher BMI was associated with higher frequency of psychotic-like experiences (adjusted mean difference: 0.04, 95% CI 0.02-0.06) and more distress (adjusted mean difference: 0.02, 95% CI 0.01-0.03). Lower LDL-C was associated with more psychotic-like experiences (adjusted mean difference: -0.23, 95% CI -0.40 to -0.06). When restricting the sample to those not using lipid-lowering medication, the results of BMI and LDL-C remained and an association between lower HDL-C and higher frequency of psychotic-like experiences was found (adjusted mean difference: -0.37, 95% CI -0.69 to -0.05). We observed no significant associations between cholesterol, triglycerides, glucose, insulin or homeostatic model assessment and psychotic-like experiences. In a population-based sample of middle-aged and elderly individuals, higher BMI and lower LDL-C were associated with psychotic-like experiences. This suggests that metabolic markers are associated with psychotic-like experiences across the vulnerability spectrum.

11.P. Workshop: Inequities in physical and mental health, and health care utilization for LGBTQ groups across Europe

Abstract Compared to heterosexual cisgender-identified individuals, lesbian, gay, bisexual, and transgender and queer (LGBTQ) individuals evidence pronounced poor mental and physical health outcomes, as well as sub-optimal healthcare access and utilization. Yet, most of the evidence documenting these disparities comes from a small group of Western countries. This limited knowledge across health conditions and geographical regions leaves multiple important questions unanswered. In particular, it remains unknown to what degree these disparities may be generalizable to contexts that have not yet been studied. This workshop includes novel reports on disparities in health, wellbeing, and healthcare access between LGBTQ groups and their heterosexual cisgender counterparts across several European countries where such data were not previously available. Through these four presentations, we explore health inequalities across Europe in physical and mental health, as well as healthcare utilization. Findings emphasize a continued need for attention to systems that can be modified (e.g., trainings of healthcare cadre, resource allocation) to reduce health disparities that uniquely burden LGBTQ groups. Andreas Pfister (Zurich University of Applied Sciences, Switzerland) will present the first national systematically documented psychosocial burden and healthcare access disparities for LGBTQ individuals compared to their heterosexual cisgender counterparts in Switzerland. Sladjana Baros (Centre for Disease Prevention and Control, Department for HIV, Hepatitis, Sexually Transmitted Infections and Tuberculosis, Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Republic of Serbia) will present findings from the HIV testing cascade among men who have sex with men at high risk for HIV. Michal Pitonak (Center for Epidemiological and Clinical Research of Drug Abuse and Dependence, National Institute of Mental Health, Klecany, Czech Republic) will present data on disproportionate rates of psychological distress reported by lesbian, gay and bisexual individuals compared to heterosexual individuals in the Czech Republic. Lastly, Luis Roxo (Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden) will present population-based data on differences in mental health services and unmet mental health needs based on sexual orientation among Swedish young adults. Key messages • Despite being the first of such evidence, findings from these four European countries are consistent with reports from other global regions, signalling that these disparities are universal. • A clear need emerges for structural changes to increase access to and expertise in affirmative LGBTQ healthcare to reduce disproportionate morbidity rates for LGBTQ people in Europe.

Alexithymia and aspects of dreaming: Differential associations of alexithymia facets with dream variables.

Research on aspects of dreaming associated with alexithymia has yielded mixed results. The present study recruited a young adult online sample of 577 participants who completed validated indices of alexithymia, emotion suppression, negative moods, and eight aspects of dreaming, with a focus on evaluating a counterintuitive previous finding that alexithymia and two of its core facets were associated with greater self-reported typical emotional intensity of dreams. Total alexithymia and facet scores showed differential relationships to aspects of dreaming including dream recall frequency, emotionality, meaningfulness, nightmare frequency, nightmare distress, usefulness of dreams in problem-solving and creativity, and learning about oneself through dreams. Planned hierarchical regression controlling for demographics, alcohol use, and dream recall frequency indicated that the difficulties identifying feelings (DIF) facet of alexithymia was a significant positive predictor of dream emotionality, whereas the externally oriented thinking (EOT) facet was a significant negative predictor. Stress, but not emotion suppression, mediated the positive relationship between DIF and dream emotionality. The likely role of dream emotionality in higher ratings of nightmare distress, dream meaningfulness, and learning about oneself through dreams among those with higher DIF scores is noted, along with other findings and the strengths and limitations of the study.