Self-care Domains Research Articles

Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register.

Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO. Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models. In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12). Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.

Symptom Severity and Health Impacts of Functional Tic-Like Behaviors in Youth

BackgroundWe performed this study to improve understanding of the relationship between functional tic-like behaviors (FTLBs) and quality of life, loneliness, family functioning, anxiety, depression, and suicidality. MethodThis cross-sectional study assessed self-reported quality of life, disability, loneliness, depression, anxiety, family functioning, tic severity, and suicide risk in age- and birth-sex matched youth with FTLBs, Tourette syndrome (TS), and neurotypical controls. We performed specific subanalyses comparing individuals with FTLBs who identified as transgender/gender diverse (TGD) with cisgender individuals. ResultsEighty-two youth participated (age range 11 to 25, 90% female at birth), including 35 with FTLBs, 22 with TS, and 25 neurotypical controls. A significantly higher proportion of participants with FTLB identified as TGD (15 of 35) than TS (two of 22) and neurotypical control (three of 25) participants. Compared with neurotypical controls, individuals with FTLBs had significantly lower quality of life, greater disability, loneliness, social phobia, anxiety symptoms, depressive symptoms, and suicidality. Compared with individuals with TS, individuals with FTLBs had more school/work absences due to tics, had more depressive symptoms, were more likely to be at high risk for suicidality, and had disability in self-care and life activity domains. There were no significant differences between cisgender and TGD participants with FTLB in any of the domains assessed. ConclusionsYouth with FTLB have unique health care needs and associations with anxiety, depression, sex, and gender.

Human rights and support groups to improve quality of life, self-care and disability in epilepsy: [Rights and support groups for epilepsy

BackgroundPeople with epilepsy have multiple barriers to recovering their quality of life. The objective of the present study was to determine the impact of a community group intervention focused on the components of mutual aid and human rights, to improve the quality of life in people with epilepsy. MethodsProspective quasi-experimental study, incorporating pre- and post-intervention evaluations. There were 102 people who underwent an intervention focused on the central components of mutual aid groups (Active agency, Coping strategies, Emotion recognition and management, Problem solving, Supportive interaction, Identity construction, Trust, and Social networks) and in the QualityRights strategy. As evaluation instruments, scales were used to determine quality of life (QOLIE-10), treatment adherence (Morisky Test), self-care behaviors, perception of disability and quality in the provision of health services. ResultsCorrelations were shown between the variables proposed for quality of life. The intervention showed an improvement in all variables and a moderate to large effect in the self-care domain. There was a significant effect size in the self-care and quality of life variables with the intervention. Pharmacological adherence showed a moderate effect size in young people, adults and older adults. Regarding the perception of disability, the effect size was found only in adults. The pharmacological adherence variable also had a moderate effect size. This does specify the age groups, but not in the general sample. ConclusionSeizure-free time constitutes a fundamental element in recovery. However, psychosocial conditions constitute key elements to achieve a better quality of life in people with epilepsy.

Comparison of the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 using longitudinal data from community mental health outreach service users.

This study aimed to compare the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 using longitudinal data from community mental health outreach service users. Using data from Tokorozawa City mental health outreach service users in Japan, total and domain WHODAS-12 and WHODAS-36 scores were compared. First, we examined score-change differences by domain at the start of outreach services (T1) and 1 year later (T2) for each version. Next, we compared differences between the two versions using Pearson's correlation, Wilcoxon signed-rank test, and Bland-Altman analysis. Among 20 participants, total scores and scores of some domains (i.e., cognition, getting along, life activities, and participation) were significantly lower at T2 than at T1 on both versions (p < 0.010). WHODAS-36 scores were significantly lower at T2 than at T1 for the self-care domain (p = 0.018). Except for self-care, strong correlations were found between scores from the two versions (p < 0.001). In the Wilcoxon signed-rank test and Bland-Altman analysis, we found significant differences between the scores of the two versions in the mobility, self-care, and participation domains. There were no significant differences in the distribution or systematic errors between the two versions in scores for the other domains or total score. We found strong positive correlations between WHODAS-12 and WHODAS-36 total scores with no statistical differences between them. For some domains, differences in distribution and systematic errors were found.

Interplay of self-care, self-efficacy, and health deviation self-care requisites: a study on type 2 diabetes patients through the lens of Orem’s self-care theory

BackgroundThis study aimed to examine the relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes based on Orem’s Self-Care Theory.MethodsThe research involved 341 patients with type 2 diabetes in Rasht, Iran, using a descriptive-analytical cross-sectional design. The data collection included questionnaires assessing Self-Care Behaviors, Self-Efficacy, and Health Deviation Self-Care Requisites based on Orem’s model.ResultsDemographic factors such as gender, marital status, employment, education, age, duration of disease, and oral treatment and insulin had no consistent effect on self-care behaviors. Self-efficacy was a key factor influencing Self-Care Behaviors in diabetic patients. There was a strong and direct correlation between Self-Care Behaviors and Self-Efficacy, indicating the role of individuals’ confidence in managing diabetes. Health Deviation Self-Care Requisites had both positive and negative correlations with different domains of Self-Care Behaviors.The physical exercise construct of self-efficacy was the most significant predictor of Self-Care Behaviors.ConclusionsThis study provides valuable insights into the complex relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes. The findings underscore the importance of addressing Self-Efficacy and specific self-care domains, such as physical activity and foot care, in diabetes management strategies. This research contributes to the existing knowledge base and may inform healthcare professionals and policymakers in developing targeted interventions to improve self-care practices in diabetic patients.

Health literacy and self-care among patients with chronic kidney disease in a primary care setting.

The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD). This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21-80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0-240, domain range 0-80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0-50, limited literacy ≤33). The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9-40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = -5.29, 95% CI -10.56 to -0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001). Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.

Self-care dependency assessment of person with lower limb amputation: an exploratory study.

(1) Dysvascular major lower limb amputation interferes with activities of daily living. (2) Self-care with the highest level of dependency is "walking". (3) Self-care with the lowest level of dependency is "feeding". (4) Develop future interventions on the degree of dependency of patients with dysvascular amputation. to identify the sociodemographic and clinical characteristics of the person with dysvascular major lower limb amputation and to assess their degree of dependence and autonomy in self-care activities at home. quantitative, exploratory, cross-sectional and descriptive study. The convenience sample consisted of 40 participants. A sociodemographic questionnaire and the short version of the Self-Care Dependence Assessment Form were used for data collection. of the 40 (100%) participants, the majority were male; 75% were over 65 years of age, 77.5% had a transfemoral amputation, and 72.5% were confined to a wheelchair. The higher levels of dependency predominated in self-care: "walking", "bathing", "dressing and undressing", "using the toilet" and "transferring". this study showed that the self-care domain with the highest level of dependence is "walking" self-care, and the lowest is "feeding". Greater autonomy in using the toilet, walking and transferring from bed to chair were shown to be self-care activities with the best ability to predict patient autonomy.

Unmet Needs and Barriers to Assistive Technology in the Coastal Districts of Karnataka, India.

Assistive Technologies (AT), such as hearing aids, walking aids, prostheses, spectacles, can improve the quality of life and enable many to lead dignified lives. The rapid Assistive Technology Assessment (rATA) tool developed by World Health Organization (WHO) can measure the needs of AT and the barriers to accessing them. This study aimed to measure the unmet needs and the usage of AT via the rATA tool in the coastal state of Karnataka in India. A population-based survey was conducted among a total of 500 households - 250 from Mangalore and 250 from Udupi of Coastal Karnataka. The need for AT was assessed under six domains of activities, including mobility, seeing, hearing, communication, remembering, and self-care. The mean age of study participants was 34.3 years with standard deviation of 21.2 years. 30.6% of the study participants reported the use of assistive products out of which 27.3% used one product and 2% used two products. 89.5% of assistive products were procured from private sector and only 4.1% was obtained from public sector. The level of difficulty in doing any activity increased with age. 301 participants reported out of pocket expenditure for assistive products with mean expenditure of Rs 2226.05 (S. D. 2204) per year. Spectacles, orthoses (spinal) and therapeutic footwear were most common assistive products with unmet need. Our findings highlight the urgent need to mainstream geriatric care policies which address functional difficulties among older people, resolve out-of-pocket spending through public private partnership for assistive technologies.

Equine-assisted therapy in quality of life and functioning of people with active epilepsy: A feasibility study

People with active epilepsy, which is often associated with specific neurological conditions, endure significant impairments in quality of life (QoL) and functioning, particularly those in middle-income countries. Physical intervention plays an essential role in addressing these challenges. This study investigated the impact of equine-assisted therapy (EAT) on QoL, functional independence, sleep quality, antiseizure medications, and frequency of seizures among people with epilepsy (PWE), with or without additional neurological conditions. Fourteen participants aged 4–34 years old diagnosed with focal epilepsy participated in a structured EAT program. The EAT program consisted of 36 sessions, each lasting 30 min and conducted weekly. Data were collected at four different times: baseline (T1), after 12 sessions (T2), after 24 sessions (T3), and after 36 sessions (T4). The assessments included the Quality of Life in Epilepsy (QOLIE-31), Functional Independence Measure (FIM), Pittsburgh Sleep Quality Index (PSQI), and Liverpool Adverse Event Profile (LAEP) scores. Seizure frequency was monitored continuously. Horse welfare was evaluated using the Horse Welfare Assessment Protocol (HWAP). After the EAT intervention, significant improvements were observed in the QoL scores (from 62.18 [57.88 – 70.25] to 80.18 [65.30 – 86.78]) and in FIM values (from 70.00 [36.50 – 97.75] to 70.00 [51.75 – 116.75]), particularly in the self-care and social cognition domains. Additionally, there was also a decrease in seizure frequency, adverse effects of antiseizure medications, and sleep quality. The HWAP indicated satisfactory welfare conditions for the horses. These findings indicate that EAT holds promise as a therapeutic intervention for improving the QoL and functioning of PWE. Tailored interventions are essential to address the diverse challenges faced by PWE, emphasizing the need for further research on effective therapeutic approaches.

The unmet need for mental health support among persons with disabilities in Somalia: Principal correlates and barriers to access.

Disability and mental ill-health may be especially prevalent in Somalia, largely due to a protracted armed conflict and its consequent humanitarian crises. Little, if any, research to date, however, has simultaneously explored disability- and mental health-related factors in the Somali context. Using both descriptive and regression analytical techniques, we aimed to determine how increasing levels of functional impairment reported across different disability domains (i.e., visual, hearing and cognition), number of concomitant disabilities, and other empirically supported variables (such as employment and sex) are associated with the likelihood of self-identifying the need for mental health support among a sample (N=1,355) of Somalis with disabilities, as well as identify the common barriers to such support. Despite most participants self-identifying a need for mental health support, only 15% were able to access it, with the most common barriers being the cost of services and the unavailability of local services. Being female, married, and having increasing levels of functional difficulty in the cognitive, mobility and self-care domains of disability were each significantly associated with an increased likelihood of the self-identified need for mental health support. This study's findings highlight potential points of prioritisation for mental health policy and programming in Somalia. A Somali version of this abstract can be found in the SupplementaryMaterial.

Comparison of Quality of Life among Adolescents with and without Diabetes in Gujrat, Pakistan

Objective: To compare the quality of life among adolescents with and without diabetes and explore the association of age and gender with diabetes. Study Design: Cross-sectional comparative study. Place and Duration of Study: Different Clinics and Hospitals, of District, Gujrat Pakistan, from Sep 2020 to Mar 2021. Methodology: Adolescents with diabetes who had an HbA1C level of ≥6.5%, and age-matched, healthy adolescents as controls were included. The adolescents with diabetes were sub-grouped into early and late adolescents based on age (10-14 years and 15-19 years, respectively). Youth Quality of Life Questionnaire was used as the investigative tool. Results: Twenty-nine adolescents (mean age: 14.2±2.9 years) were in the Diabetes-Group, and 356 adolescents (mean age: 14.8±2.7 years) were in the Control-Group. The Control-Group had significantly better mean scores in each domain than the Diabetes-Group (p&lt;0.001). Early adolescents with diabetes had better scores in the self-care domain (p=0.014) than late adolescents. The scores remained uninfluenced by gender in adolescents with diabetes (p=0.118, 0.284, 0.185, 0.419, and 0.169, respectively). Conclusion: The quality of life scores among our study adolescents with diabetes was poor as compared to the age-matched healthy adolescents. Age appeared to be a negative factor for the quality of life parameters among adolescents with diabetes.

Evaluating the role of psychedelic psychotherapy in addressing societal alienation: Imaginaries of liberation

AbstractQuestions are currently being posed concerning the implications of the clinical uptake of psychedelics. While enthusiasm surrounds the potential therapeutic benefits of psychedelics and critique surrounds their appropriation to commercial ends, limited attention has been given to the role of psychedelics in generating social transformation. Herbert Marcuse contended radical change requires ‘new imaginaries of liberation’. We consider whether clinical uptake of psychedelics may produce the perceptual shifts necessary to generate social transformation surrounding contemporary alienating conditions. Economic structures contributing to these alienating conditions are highly resistant to change and may neuter psychedelics' revolutionary potential. We illustrate how psychedelics may be instrumentalised: regulating individuals into unjust systems; redirecting psychedelic usage away from therapeutic ends towards productivity; distracting or diverting attention from systemic forms of control; usurping non-ordinary states into the domain of self-care; and fetishistically commodifying psychedelic experience as a consumable. There are, however, reasons to believe that psychedelics, in raising consciousnesses, may prove resistant to co-option. In particular, psychedelics induce perceptual experiences that: challenge the paradigmatic assumptions of industrial society by provoking alternative epistemologies and metaphysics; generate expanded or ecological constructions of selfhood, thereby offering resignifications of meanings, desires, and life potentials; and offer the enriched phenomenological insight into self, other, and world called for in combating ubiquitous social alienation. In this way, psychedelics may induce the revolution in perception necessary to imagine liberatory potentials and spark the desire for collective emancipation.

An analysis of digital stories of self-care practices among first- year students at a university of technology in South Africa

This article reports on a qualitative study that explored self-care practices among first-year studentsin managing stressors related to the first-year experience in the context of the COVID-19 pandemic.Qualitative data were collected using a purposive sample between March and June 2022. A total of 26first-year students registered at a university of technology in South Africa participated in the study byproducing digital stories sharing how they practised self-care. The domains of self-care were adoptedas a framework and data were analysed using thematic analysis. Six domains of self-care practicesemerged from the data and were categorised as physical, emotional, spiritual, relational, professional,and psychological. The findings show that first-year students engaged in a range of self-care practicesacross the domains of self-care including exercising, listening to music, performing ancestral rituals,donating blood, following successful people on social media, and learning new skills. Further,&#x0D; relational self-care was the most fundamental domain that underpinned first-year students’ well-being. In contrast, oversleeping or sleep deprivation, reckless spending, and eating unhealthy food&#x0D; to cope with stressors related to the first-year experience pointed to unhealthy self-care practicesin managing the stressors. Unhealthy self-care practices can threaten first-year students’ well-beingand possibly academic success. Student affairs and services need to design self-care programmes andcurricula to prevent harm and support adequate self-care. In designing self-care programmes, socialinvolvement and engagement are fundamental principles that should be emphasised. Future studiescan develop a self-care inventory to identify students at risk of poor self-care and design targetedinterventions to promote self-care.

Psychometric Properties of the Polish Version of the Mindful Self-Care Scale-Standard

ObjectivesThe Mindful Self-Care Scale-Standard (MSCS-Standard) is a 33-item self-report questionnaire that assesses mindfulness practices in six self-care domains: (1) physical care, (2) mindful relaxation, (3) supportive structure, (4) supportive relationships, (5) mindful awareness, and (6) self-compassion and purpose. The study aimed to validate the Polish version of the MSCS-Standard.MethodThe study was performed on a sample of 774 people (646 females, 122 males, and 6 non-binary) aged 18–76 (M = 28.49, SD = 10.81). The factor structure was verified with confirmatory factor analysis. Convergent and divergent validity were assessed based on the relationship between the MSCS-Standard scores and markers of alexithymia, anxiety, depression, stress, and somatic symptoms as well as life satisfaction. We examined discriminant validity by conducting a second-order exploratory factor analysis of MSCS-Standard subscales, alexithymia traits, anxiety, depression, stress, and somatic symptoms.ResultsOur results indicated a good factorial validity, conforming to the intended 6-factor structure (χ2/df = 1352.38/477; CFI = 0.912; RMSEA = 0.051 [90% CI: 0.048; 0.055]; SRMR = 0.064). As expected, all MSCS-Standard subscales correlated in expected directions with markers of alexithymia, anxiety, depression, stress, and somatic symptoms as well as with life satisfaction. The MSCS-Standard showed a good discriminant validity in terms of measuring mindfulness practices construct that was separable from people’s current levels of alexithymia, negative affect and somatic symptoms. Internal consistency reliability was also good.ConclusionsOverall, the Polish version of the MSCS-Standard appears to have satisfactory psychometric properties.PreregistrationThis study is not preregistered.

Factors affecting quality of life in adults with HIV: A local cross-sectional study.

Understanding health-related quality of life (HRQOL) among people with HIV (PWH) can inform strategies to maintain or improve health and functioning. Most HRQOL research has focused on resource-rich settings, underrepresenting younger cohorts in low-resource settings. To assess HRQOL and associated factors in PWH visiting two primary healthcare clinics in the Western Cape, South Africa. A cross-sectional study included 48 PWH (58.3% women; mean age: 39.2 [10.3]). Health-related QOL was assessed using EQ-5D-5L descriptive domains, visual analogue scale (EQ-VAS), and index score (EQ-index). Mobility was assessed using clinical tests. Tobit regression determined associations. Mean and median EQ-VAS scores were 88.14 (16.35) and 95.00. Mean and median EQ-index scores were 0.84 (0.10) and 0.90. PWH reported problems as pain/discomfort (35.4%), depression/anxiety (25.0%), mobility (22.9%), usual activities (18.7%) and self-care (12.5%) domains. Slow chair rise (p = 0.012), low income (p = 0.030), longer HIV duration (p = 0.009) and polypharmacy (p = 0.034) were associated with lower HRQOL. Antiretroviral therapy (ART) adherence was associated with higher HRQOL (p = 0.020). Despite high overall HRQOL, specific domains presented challenges to PWH. Health-related QOL was associated with chair rise repetitions, income, HIV duration, polypharmacy, and treatment adherence. Comprehensive care and contextualised interventions to address these through rehabilitation, including health promotion, are proposed strategies for future investigation. Clinicians should be cognisant of potential physical and mental functioning problems, and factors related to drug therapy, socio-economic status and disease duration that may affect HRQOL even in seemingly unimpaired PWH.

Associations between weekend catch-up sleep and health-related quality of life with focusing on gender differences

This study investigated associations between weekend catch-up sleep (WCUS) and health-related quality of life (HRQoL) in 15,837 participants from the 7th (2016–2018) Korea National Health and Nutrition Examination Survey. We categorized WCUS durations into four groups: none (≤ 0 h [h]), short (> 0 h, ≤ 1 h), medium (> 1 h, ≤ 2 h), and long (> 2 h), and performed complex samples logistic regression and likelihood ratio χ2 test. The study found significant associations in women for the European Quality of Life-5 Dimensions (EQ-5D) index and three EQ-5D subdomains (self-care, usual activities, and anxiety/depression) with the WCUS durations, but no significant association in men. Compared to the non-WCUS, the short or medium WCUS was positively associated with the EQ-5D index and EQ-5D subdomains (usual activities and anxiety/depression) in women, while the long WCUS significantly reduced the quality of life in the self-care domain. In an additional subgroup analysis by age, middle-aged and elderly women had a more noticeable effect of WCUS on HRQoL than young women, and the short or medium WCUS improved HRQoL in middle-aged and elderly women in general. Therefore, we recommend appropriate WCUS durations to improve HRQoL, considering both gender and age.

Symptoms and Impaired Quality of Life After COVID-19 Hospitalization: Effect of Therapeutic Heparin in Non-ICU Patients in the Accelerating COVID-19 Therapeutic Interventions and Vaccines 4 Acute Trial: Effect on 3-Month Symptoms and Quality of Life

BackgroundTherapeutic-dose heparin decreased days requiring organ support in non-critically ill patients hospitalized for COVID-19 but its impact on persistent symptoms or quality of life (QoL) is unclear. Research QuestionIn the ACTIV-4a trial, was randomization of patients hospitalized for COVID-19 illness to therapeutic-dose vs. prophylactic heparin associated with less symptoms and better QoL at 90-days? Study Design and MethodsThis was an open-label randomized controlled trial at 34 hospitals in the US and Spain. 727 non-critically ill patients hospitalized for COVID-19 from September 2020 to June 2021 were randomized to therapeutic-dose vs. prophylactic heparin. Only patients with 90-day data on symptoms and QoL were analyzed. We ascertained symptoms and QoL by EQ-5D-5L at 90-day follow-up in a pre-planned analysis for the ACTIV-4a trial. Individual domains assessed by the EQ-5D-5L were mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Univariate and multivariate analysis were performed. ResultsAmong 571 patients, 288 (50.4%) reported at least one symptom. In 410 patients, 148 (36.1%) reported moderate to severe impairment in one or more domains of EQ-5D-5L. Presence of 90-day symptoms were associated with moderate-severe impairment in the EQ-5D-5L domains of mobility (adjusted odds ratio (aOR) 2.37, 95% CI 1.22-4.59), usual activity (aOR 3.66, 95% CI 1.75-7.65), pain (aOR 2.43, 95% CI 1.43-4.12), and anxiety (aOR 4.32, 95% CI 2.06-9.02), compared to patients reporting no symptoms There were no differences in symptoms or the overall EQ-5D-5L index score between treatment groups. Therapeutic-dose heparin was associated with less moderate-severe impairment in all physical functioning domains (mobility, self-care, usual activities) but was independently significant only in the self-care domain (aOR 0.32, CI 0.11-0.96). InterpretationIn a randomized controlled trial of hospitalized non-critically ill patients with COVID-19, therapeutic-dose heparin was associated with less severe impairment in the self-care domain of EQ-5D-5L. However, this type of impairment was uncommon, affecting 23 individuals. Clinical Trial RegistrationNCT04505774

Abstract 14432: Self-Care Clustering in Adults With Type 1 Diabetes

Poor glycemic control in type 1 diabetes (T1D) may result in cardiovascular disease. Self-care, or the process of maintaining health through health-promoting behaviors and managing illnesses when changes are detected, may improve glycemic control and outcomes. However, self-care in T1D is ill-defined. We examined how self-care maintenance, monitoring, and management cluster in adults with T1D and identified unique characteristics of individuals within each cluster. Adults ( n =200, 27% Black, 61% female) with T1D (median[IQR] age: 35 [22] years, T1D duration: 19 [19] years, insulin pump use: 68%) reported personal, clinical and social determinants of health (SDH; modified PRAPARE tool, scored 0-22; higher is worse) and the Self-Care of Diabetes Inventory (3 self-care scales: maintenance, monitoring, management; 1 confidence scale; scored 0-100; scores ≥ 70 are adequate). Cluster analysis was performed with self-care domains as criteria via Ward’s method. To compare clusters, Kruskal-Wallis and chi-square tests were used for continuous and categorical variables, respectively. Three self-care clusters were found and labeled: Mastery (n= 70, 70% White, insulin pump use: 63%, median [IQR] age: 41 [28] years, T1D: 22 [22] years, Self-Care Maintenance: 85.4 [10.4], Monitoring: 82.4 [8.8], Management: 72.2 [13.9], Confidence: 95.5 [11.4], SDH: 2 [2]); Inconsistent (n= 112, 75% White, Insulin Pump use: 75%, median[IQR] age: 34 [22] years, T1D: 19 [18] years, Self-Care Maintenance: 79.2 [12.5], Monitoring: 67.7 [11.8], Management: 58.3 [13.9], Confidence: 88.6 [15.9], SDH: 3 [2]); and Novice (n= 18, 39% White, Insulin pump use: 44%, median[IQR] age: 25 [9] years, T1D: 14 [10] years, Self-Care Maintenance: 53.1 [9.9], Monitoring: 52.9 [13.2], Management: 44.4 [9.7], Confidence: 64.8 [27.8], SDH: 6 [7]). Significant differences were found for age (p&lt;.001), race (p&lt;.01), insulin pump use (p&lt;.05), Self-Care Maintenance (p&lt;.001), Self-Care Monitoring (p&lt;.001), Self-Care Management (p&lt;.001), Self-Care Confidence (p&lt;.001), and SDH (p&lt;.01). No differences were found in T1D duration. Three distinct profiles of self-care were found in this sample of adults with T1D. Older patients using insulin pumps with fewer SDH risk were more likely to master self-care.

A study of disability before and after radiotherapy among head and neck cancer patients residing around atomic power plant.

Head and neck cancer (HNC) is a profoundly distressing condition that can have significant psychological implications. It has the potential to impact various fundamental aspects of an individual's life, resulting in functional impairments and structural deformities depending on the location, size, and route of spread, therefore causing significant disability. Yet, this has not been adequately studied. People residing around areas around the atomic radiation power plant are exposed to radiation, and also, contamination of water sources, including the Chambal River, which is a major source of water needs of this area, may have a role in the pathogenesis and prognosis of cancer patients. This study aimed to study disability in patients with head and neck cancer before and after radiotherapy. This prospective observational study was conducted in association with the Department of Radiotherapy of a tertiary care hospital in Rajasthan. Fifty consecutive HNC patients aged 18 to 65 years fulfilling inclusion criteria, specifically laid down for the study, constituted the sample of the study. The World Health Organization Disability Assessment Schedule version 2.0 (WHODAS-2.0) was used. The mean age of patients was 49.62 years. A statistically significant improvement after radiotherapy was found in disability scores in domains of cognition (2.39 vs. 1.88), self-care (2.39 vs. 1.78), and getting along with people domain (2.38 vs. 1.83). Disability improved significantly in patients after radiotherapy in the domains of self-care, getting along with people, and cognition.

Continuous Assessment of Function and Disability via Mobile Sensing: Real-World Data-Driven Feasibility Study.

Functional limitations are associated with poor clinical outcomes, higher mortality, and disability rates, especially in older adults. Continuous assessment of patients' functionality is important for clinical practice; however, traditional questionnaire-based assessment methods are very time-consuming and infrequently used. Mobile sensing offers a great range of sources that can assess function and disability daily. This work aims to prove the feasibility of an interpretable machine learning pipeline for predicting function and disability based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 outcomes of clinical outpatients, using passively collected digital biomarkers. One-month-long behavioral time-series data consisting of physical and digital activity descriptor variables were summarized using statistical measures (minimum, maximum, mean, median, SD, and IQR), creating 64 features that were used for prediction. We then applied a sequential feature selection to each WHODAS 2.0 domain (cognition, mobility, self-care, getting along, life activities, and participation) in order to find the most descriptive features for each domain. Finally, we predicted the WHODAS 2.0 functional domain scores using linear regression using the best feature subsets. We reported the mean absolute errors and the mean absolute percentage errors over 4 folds as goodness-of-fit statistics to evaluate the model and allow for between-domain performance comparison. Our machine learning-based models for predicting patients' WHODAS functionality scores per domain achieved an average (across the 6 domains) mean absolute percentage error of 19.5%, varying between 14.86% (self-care domain) and 27.21% (life activities domain). We found that 5-19 features were sufficient for each domain, and the most relevant being the distance traveled, time spent at home, time spent walking, exercise time, and vehicle time. Our findings show the feasibility of using machine learning-based methods to assess functional health solely from passively sensed mobile data. The feature selection step provides a set of interpretable features for each domain, ensuring better explainability to the models' decisions-an important aspect in clinical practice.