Health Comorbidities Research Articles

Rural Health Disparities during the COVID-19 Pandemic in the United States: A Scoping Review

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The objective of the scoping review was to review peer-reviewed literature and identify gaps to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Articles for review were included if published between the 1st of January 1998 and to the 30th of December 2022. Keys words and phrases such as “COVID-19”, “Rural”, “Preventative Measures”, “heart disease”, “Diabetes”, “Substance Use”, “Access to Healthcare”, “Telehealth”, “Mental Health” and “Vaccines”. Articles that did not match and/or were published outside of history range were excluded. Databases utilized to generate results included PubMed, Web of Science, Scopus, USDA, Economic Research Service, Johns Hopkins University Center for system Science and Engineering, U.S. Department of Commerce, Bureau of Census, Current Population Survey, and annual American Community Survey estimates. Seventy-six articles or resources were generated between July 2022 and February 2023 and deemed appropriate for reference in this review. Pertinent results and findings were thoroughly discussed within the paper alongside figures. Limitations of evidence within this review were due to a lack of studies conducted on the impact of COVID- 19 in rural America specifically. Key findings were that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Important lessons include that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for evaluating healthcare in rural communities’ Future studies should seek to identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p <0.001) and GCS <15 on admission (OR 7.21, p <0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90. Conclusions: The significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

Predictors of Patient-Initiated Discharge From an Inpatient Withdrawal Management Service: A Sex-Based Study.

The purpose of this study was to examine sex-stratified independent predictors of patient-initiated discharge from an inpatient withdrawal management service and to determine whether those predictors differed by sex. This study compared people who had self-initiated versus planned discharges and used sex-stratified generalized estimating equations models to identify independent predictors of patient-initiated discharge. Predictors examined included age, ethnicity, substance of concern, tobacco use, mental health comorbidities, day of discharge, referral source, children, and social assistance funds. Among females, there were 722 discharges, 116 of which were patient initiated. Among females, increasing age was associated with lower odds of patient-initiated discharge (OR = 0.97, 95% CI [0.95, 0.98]). Racialized females were nearly 2 times more likely to experience patient-initiated discharge compared with White females (OR = 1.8, 95% CI [1.09, 3.00]). Compared with weekdays, weekends were associated with over 4 times the odds of patient-initiated discharge (OR = 4.77, 95% CI [2.66, 8.56]). Having one or more mental health comorbidities was associated with lower odds of patient-initiated discharge compared with having no mental health comorbidities (OR = 0.51, 95% CI [0.32, 0.82]). Among males, there were 1,244 discharges, 185 of which were patient initiated. Among males, increasing age was associated with decreased odds of patient-initiated discharge (OR = 0.97, 95% CI [0.95, 0.98]). Compared with weekdays, weekends were associated with nearly 15 times the odds of patient-initiated discharge (OR = 14.9, 95% CI [9.11, 24.3]). Males and females have shared and unique predictors of patient-initiated discharge. Future studies should continue to examine the influence of sex and gender on engagement with addictions care.

Investigating the Relationship between Oral Health and Severe Mental Illness: Analysis of NHANES 1999-2016.

To explore whether: (i) people with severe mental illness (SMI) experience worse oral health than the general population, and (ii) the risk factors for poor oral health in people with SMI. Cross-sectional data were extracted from the National Health and Nutrition Examination Survey (1999-2016), including on self-rated oral health, oral pain, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. Ordinal logistic regression and zero-inflated negative binomial models were used to explore predictors of oral health outcomes. There were 53,348 cases included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.60, 95% CI: 1.34-1.92). In people with SMI, risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes. People with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Performing regular physical exercise and flossing may lower the risk of poor oral health, while smoking and diabetes may increase the risk. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes in people with SMI.

Problematic smartphone use and mental health outcomes among Singapore residents: The health and lifestyle survey

BackgroundThe excessive use of smartphones and its association with adverse outcomes has been widely reported, with several studies showing an association between smartphone overuse, depression, anxiety, and sleep-related problems. MethodsThe study used data from the Health and Lifestyle Survey, a nationwide population survey. It examined the prevalence of Problematic Smartphone Use (PSU) and its association with mental health outcomes among Singapore residents aged 15–65 years. ParticipantsParticipants were assessed for PSU using the Smartphone Addiction Scale-Short Version, psychological distress with the Patient Health Questionnaire-9, and Generalised Anxiety Disorder −7 questionnaire, sleep problems using the Insomnia Severity Index, and positive mental health with Rapid Positive Mental Health Instrument. ResultsIn all, 6509 participants completed the survey, giving a survey response rate of 73.2 %. The prevalence of PSU was 30.2 % in the population. Individuals with PSU were more likely to have symptoms of moderate or severe depression (OR: 3.2, 95 % CI: 2.4–4.4), anxiety (OR: 3.4, 95 % CI: 2.4–4.8), insomnia (OR: 3.4, 95 % CI: 2.8–4.2), and poorer positive mental health (β: −0.3, 95 % CI: −0.4 to −0.2). ConclusionsThe study is the first to examine PSU in a national sample of Singaporeans across a wide age range. It provides valuable insights into mental health comorbidities among those with PSU, which is useful for practitioners.

(115) SEXUAL SELF-ESTEEM IN TWO SAMPLES OF ADOLESCENT AND YOUNG ADULT CANCER SURVIVORS: A QUALITATIVE INVESTIGATION

Abstract Introduction As rates of survival from cancer continue to increase in adolescents and young adults, long term physical and psychological impacts are likely to rise. For those diagnosed with cancer during childhood or adolescence, one such late effect may be delayed sexual development. Delayed sexual development may manifest as issues of sexual functioning (i.e., the ability to successfully complete the sexual response cycle) as well as issues of sexual self-concept (i.e., how one navigates the world as a sexual being). These issues may, in turn, impact survivors’ self-esteem. These concerns are likely to be exponentially exacerbated when survivors identify as a member of a sexual and/or gender minority (SGM) group. Objective Based on empirical research and two studies from our team, we examine variables that impact the sexual self-esteem of AYA cancer survivors, particularly those that identify as members of an SGM group. Methods In our small pilot project, we conducted cognitive interviews to assess whether a novel model, adapted from sexual health frameworks established by Woods (1995) and Evan et al. (2006), applied to AYA cancer survivors. Following analysis of these interviews, we refined our model, and received funding for a larger qualitative study (n = 30) tailored to AYA cancer survivors who identify as members of an SGM group. Results Four cisgender female cancer survivors participated in this small qualitative study, which provided preliminary validation that variables such as body image, amount of sexual education, quality of interpersonal relationships, and sexual functioning, were all tied into one’s perception of their sexual self-esteem. Several additional potential variables were identified from these interviews, including amount of sexual equity (how much participants felt that their sexual activity was balanced between them and a partner), religiosity, negative self-evaluative emotions (e.g., guilt and shame), and SGM identity, that could influence sexual self-esteem. Preliminary analyses of our SGM-focused qualitative study have revealed high levels of asexuality and mental health comorbidities that may be affecting sexual self-esteem. Recruitment and analysis for this study is ongoing. Conclusions Results from these two studies will provide some of the first empirical research on sexual self-esteem in a population for which sexual health is vastly under researched. We anticipate that this work will lay the foundation for novel measurements and interventions for these individuals. By providing a voice to those who are underrepresented in research, we hope that this research may have high-impact in informing future interventions to become more holistic and culturally-informed to allow for studies to ensure they are reflecting all identities of cancer survivors. Finally, we anticipate that this research may be of significant benefit to oncology providers and clinicians to overhaul and adapt sexual education for patients in treatment, as well as inform areas of concern and assessment for these providers and clinicians, particularly among their SGM patients and survivors. Disclosure No.

Cannabis use among correctional workers in Ontario, Canada: Prevalence, mental health comorbidities, and risk and protective factors associated with cannabis use.

Cannabis use among correctional workers in Ontario, Canada: Prevalence, mental health comorbidities, and risk and protective factors associated with cannabis use.

Supplemental Material for Cannabis Use Among Correctional Workers in Ontario, Canada: Prevalence, Mental Health Comorbidities, and Risk and Protective Factors Associated With Cannabis Use

Supplemental Material for Cannabis Use Among Correctional Workers in Ontario, Canada: Prevalence, Mental Health Comorbidities, and Risk and Protective Factors Associated With Cannabis Use

Sex differences in houselessness, injection drug use, and mental health conditions among people newly diagnosed with HIV in Manitoba, Canada from 2018 to 2021: a retrospective cohort study

Manitoba saw the highest number of new HIV diagnoses in the province's history in 2021 and is the only Canadian province not meeting any of the previous UNAIDS 90-90-90 targets. Our goal was to describe sex differences and syndemic conditions within an incident HIV cohort in Manitoba, and the HIV treatment initiation and undetectable viral load outcomes. This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2021. Data was collected as follows: before HIV diagnosis: chlamydia, gonorrhoea, syphilis, and/or hepatitis C antibodies. At the time of HIV diagnosis: age, sex, gender, race/ethnicity, sexual orientation. During follow-up: CD4 counts, viral load, HIV treatment, hospitalizations, and number of visits to HIV care. Main exposures evaluated: methamphetamine use, injection drug use, houselessness, and mental health conditions. Outcomes: started antiretroviral treatment and achieved an undetectable viral load. A descriptive statistical analysis was used. There were 404 new HIV diagnoses in Manitoba from 2018 to 2021; 44.8% were female, 55.2% male; 76.% self-identified as Indigenous, 13.4% white/European, 4.7% African/black; 86.6% cis-gender; 60.9% heterosexual, 13.4% gay, bisexual and men who have sex with men, and 1.7% lesbian. Injection drug use was reported by 71.8% and 43.5% of females and males respectively. Methamphetamine was the most frequently injected drug (62.4%). Amongst females, 81.8% experienced at least one of the following: houselessness (43.1%), mental health comorbidities (46.4%), and injection drug use (71.8%). Only 64.9% of all individuals had an undetectable viral load (61.1% females and 67.9% males), 56.5% among people experiencing houselessness, 59% among young people (≤29 years), and 60.1% among people who inject drugs. People newly diagnosed with HIV in Manitoba are disproportionately experiencing houselessness, mental illness, and injection drug use (mostly methamphetamine). This pattern is more pronounced for female individuals. These findings highlight the need for syndemic and gender-specific approaches, simultaneously addressing social and health conditions, to treat HIV. This work was supported by the Canadian Institutes of Health Research, The Manitoba Medical Service Foundation, The James Farley Memorial Fund and the Canada Research Chairs Program.

Generalized genetic liability to substance use disorders.

Lifetime and temporal co-occurrence of substance use disorders (SUDs) is common and compared with individual SUDs is characterized by greater severity, additional psychiatric comorbidities, and worse outcomes. Here, we review evidence for the role of generalized genetic liability to various SUDs. Coaggregation of SUDs has familial contributions, with twin studies suggesting a strong contribution of additive genetic influences undergirding use disorders for a variety of substances (including alcohol, nicotine, cannabis, and others). GWAS have documented similarly large genetic correlations between alcohol, cannabis, and opioid use disorders. Extending these findings, recent studies have identified multiple genomic loci that contribute to common risk for these SUDs and problematic tobacco use, implicating dopaminergic regulatory and neuronal development mechanisms in the pathophysiology of generalized SUD genetic liability, with certain signals demonstrating cross-species and translational validity. Overlap with genetic signals for other externalizing behaviors, while substantial, does not explain the entirety of the generalized genetic signal for SUD. Polygenic scores (PGS) derived from the generalized genetic liability to SUDs outperform PGS for individual SUDs in prediction of serious mental health and medical comorbidities. Going forward, it will be important to further elucidate the etiology of generalized SUD genetic liability by incorporating additional SUDs, evaluating clinical presentation across the lifespan, and increasing the granularity of investigation (e.g., specific transdiagnostic criteria) to ultimately improve the nosology, prevention, and treatment of SUDs.

Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire.

Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ. We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity. We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity. Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.

Cognitive therapy for depression in tuberculosis treatment: protocol for multicentre pragmatic parallel arm randomised control trial with an internal pilot

Introduction and objectivesThere is an unmet need to develop high-quality evidence addressing tuberculosis (TB)-related mental health comorbidity, particularly in the context of lower-middle-income countries. This study aims to examine the...

Intersecting Realities: Body Dysmorphic Disorder and Substance Abuse in Women – A Holistic Treatment Approach

The intersection of Body Dysmorphic Disorder (BDD) and substance abuse in women presents a clinical tableau rich with complexity and challenges. This review explores the intricate relationship between BDD—a disorder characterized by an obsessive preoccupation with perceived physical flaws—and substance abuse, where women may turn to drugs or alcohol as a maladaptive coping mechanism to alleviate the distress associated with BDD. A literature-focused methodology was employed in the study. In this context, databases such as PubMed, DergiPark, WoS, and ScienceDirect were utilized to explore the relevant literature. The analysis delves into the unique manifestation of BDD in women, influenced by societal, cultural, and psychological factors that often impose stringent beauty standards and exacerbate body image concerns. Patterns of substance abuse among women are discussed, highlighting the rapid progression from usage to dependency, known as telescoping, and the impact of societal stigma that compounds the struggles of women with addiction. Risk factors for both conditions are examined, with a focus on shared contributors such as trauma, mental health comorbidities, and societal pressures. Current treatment approaches are reviewed, advocating for an integrated model that combines psychotherapy, pharmacotherapy, and holistic or alternative interventions. The review emphasizes the importance of Cognitive Behavioral Therapy for BDD and Medication-Assisted Treatment for substance abuse, as well as the inclusion of mindfulness, meditation, and gender- The conclusion reinforces the imperative of a cohesive treatment strategy, underscoring the need for gender-specific, trauma-informed care that understands and addresses the complex interplay between BDD and substance abuse in women. This comprehensive approach promises more effective support and a hopeful pathway to recovery for women entangled in the web of these co-occurring disorders.

Prenatal Exposures, Diagnostic Outcomes, and Life Experiences of Children and Youths with Fetal Alcohol Spectrum Disorder.

Children and youths diagnosed with FASD may experience a range of adverse health and social outcomes. This cross-sectional study investigated the characteristics and outcomes of children and youths diagnosed with FASD between 2015 and 2018 at the Sunny Hill Centre in British Columbia, Canada and examined the relationships between prenatal substance exposures, FASD diagnostic categories, and adverse health and social outcomes. Patient chart data were obtained for 1187 children and youths diagnosed with FASD and analyzed. The patients (mean age: 9.7 years; range: 2-19) had up to 6 physical and 11 mental health disorders. Prenatal exposure to other substances (in addition to alcohol) significantly increased the severity of FASD diagnosis (OR: 1.18): the odds of FASD with sentinel facial features (SFF) were 41% higher with prenatal cigarette/nicotine/tobacco exposure; 75% higher with exposure to cocaine/crack; and two times higher with exposure to opioids. Maternal mental health issues and poor nutrition also increase the severity of FASD diagnosis (60% and 6%, respectively). Prenatal exposure to other substances in addition to alcohol significantly predicts involvement in the child welfare system (OR: 1.52) and current substance use when adjusted for age (aOR: 1.51). Diagnosis of FASD with SFF is associated with an increased number of physical (R2 = 0.071, F (3,1183) = 30.51, p = 0.000) and mental health comorbidities (R2 = 0.023, F (3,1185) = 9.51, p = 0.000) as compared to FASD without SFF adjusted for age and the number of prenatal substances. Screening of pregnant women for alcohol and other substance use, mental health status, and nutrition is extremely important.

"Finding my voice again" - women's experiences of psychological therapy in perinatal secondary care settings: a qualitative study.

Although women often experience mental health comorbidities in the perinatal period, the evidence-base for psychological therapy across diagnostic boundaries in the perinatal period remains limited. As there is a need to understand experiences of therapy, irrespective of diagnosis, to inform intervention provision, the aims of this study were to explore women's experiences of psychological therapy for perinatal mental health difficulties and to identify the mechanisms that women attributed to the most significant therapeutic change for themselves and/or the mother-infant relationship. Semi-structured interviews were conducted with 16 women who received therapy within specialist perinatal community mental health settings in the Northwest of England, the UK. Interview data were analysed using reflexive thematic analysis. One overarching theme entitled participant life stories were at the heart of therapy was identified alongside three other main themes: 1.) We're in this together - therapeutic bond and establishing a coherent sense of self, 2.) Surfing the urge to 'fix' feelings - Sitting with emotions improved regulation and 3.) Seeing myself in a new light - Shifting self-blame to self-compassion enhanced self-efficacy. Theme 1 consisted of three subthemes. Participants described the quality of the therapeutic relationship as the fundamental foundation to (re)connecting with their needs, values and boundaries, which improved their sense of agency, self-esteem, therapeutic engagement and self-understanding. Shifting emotional avoidance to emotional engagement improved their self-regulation. Considering alternative factors that could have contributed to their experiences helped them to defuse self-blame and enhance self-compassion. Finally, changes in their mental health led to positive relational changes in their relationship with their infant and improved communication with partners. Sensitivity, engagement and responsivity experienced in the therapist-woman relationship was reported to be mirrored in the mother-infant relationship. Developing a coherent sense of self and self-regulation skills both appeared to heighten women's self-compassion and empathy for their infants, which also seemed to improve their ability to tolerate uncertainty and mixed emotions within themselves and their infants. The mechanisms of change in the perinatal period are important to consider at a stakeholder, therapist and service management level to parsimoniously and best meet the needs of women and the mother-infant relationship.

Prehospital Care for Persons Experiencing Homelessness: A Cross-Sectional Survey of the Challenges, Experiences, and Perspectives of Operational EMS Agency Medical Directors

Objective Persons experiencing homelessness (PEH) are among the most vulnerable populations and experience significant health disparities. Nationally, PEH utilize Emergency Medical Services (EMS) at disproportionately higher rates than their housed peers. Developing optimal strategies to care for PEH has become critically important. However, limited data exists on best practices, challenges, and experiences of providing care to PEH. The objective of this study was to describe the experiences, challenges and perspectives of operational EMS agency medical directors in Los Angeles (LA) County as they confront the homelessness crisis. Methods We performed a cross-sectional survey of 9-1-1 operational EMS agency medical directors in LA County, which has one of the largest populations of PEH nationally. Twenty-nine 9-1-1 operational EMS agencies operate in LA County. The link to an anonymous, web-based survey examining documentation, training, resources, operational impact, and care challenges was emailed to medical directors with three reminders during the study period (4/19/2023-9/15/2023). Results Three quarters (75.9%; 22/29) of operational EMS agencies responded to the survey, with all questions answered in 69% (20/29) of surveys. Of these, 68.2% (15/22) of agencies document housing status and 75% (15/20) agreed or strongly agreed that homelessness presents operational challenges. No operational EMS agency reported adequate EMS clinician training on homelessness. Operational EMS agencies most commonly utilized domestic violence resources (43%, 9/21), social services (38%, 8/21), and law enforcement (38%, 8/21) services to assist PEH. Referrals were limited by accessibility (86%, 18/21), time (52%, 11/21), lack of awareness (52% 11/21) and lack of mandates (52%, 11/21). All operational EMS agencies agreed or strongly agreed that mental health and substance use disorders are major issues for PEH. The most common daily challenges reported were mental health (55%, 11/20), substance use (55%, 11/20), and patient resistance (35%, 7/20). Conclusion In LA County, EMS agencies experience important operational and clinical challenges in caring for PEH, with limited resources, minimal training, and high rates of substance use disorders and mental health comorbidities. Further prehospital research is essential to standardize documentation of housing status, to identify areas for intervention, increase linkage to services, and define best practices.

A Systematic Narrative Review of Recent Obesity Interventions with Black Women in the United States.

This study is to comprehensively review recent obesity interventions for Black women in the United States. We searched PubMed and EBSCOhost for articles published between 2013 and 2022 using a comprehensive search strategy. Two reviewers screened titles, abstracts, and full texts. Data from the included articles were extracted.Qualitative themes related to the intervention designs were identified across studies. Fifty-two studies were included in the review. Interventions typically aimed to reduce weight by targeting diet and/or physical activity. Intervention activities were delivered virtually and in-person via several formats including didactic content and interactive sessions. Outcomes were assessed through a variety of research designs. Across papers, we identified six key themes of intervention design: integration of technology, centering community and culture, personalization of content, use of social support, skill-building through intervention activities, and addressing comorbid health conditions. To address the obesity epidemic, future research can build upon key lessons learned from recent interventions tailored to Black women.

High-intensity interval training in patients with glaucoma (HIT-GLAUCOMA): protocol for a multicenter randomized controlled exercise trial.

Glaucoma stands as a prominent global cause of irreversible blindness and the primary treatment approach involves reducing intraocular pressure (IOP). However, around one-third of patients exhibit disease progression despite effective IOP reduction. Microvascular endothelial function, chronic inflammation, and oxidative stress are known to affect retinal neuronal networks and have been associated with disease severity and progression. Exercise training has the potential to counteract these mechanisms as add-on treatment to usual care. The HIT-GLAUCOMA study will investigate the effects of a 6-month high-intensity interval training (HIIT) on intermediate endpoints such as local retinal microvascular and systemic large artery function, inflammation, and oxidative stress as well as clinical endpoints such as visual field indices, optic nerve rim assessment, retinal nerve fiber layer thickness, IOP, number of eye drops, vision-related quality of life and ocular surface disease symptomatology. The study is a multi-center randomized controlled clinical trial in patients with both normal tension and high-tension primary open angle glaucoma. Across two study centers, 128 patients will be enrolled and randomized on a 1:1 basis into an exercise intervention group and a usual care control group. The primary microvascular endpoints are retinal arteriolar and venular flicker light-induced dilation at 6months. The primary endpoint in the systemic circulation is brachial artery flow-mediated dilation at 6months. We hypothesize that exercise therapy will improve retinal microvascular function and thus ocular blood flow in patients with glaucoma. As clinical outcomes, we will investigate the effect of exercise on visual field indices, optic nerve rim assessment, retinal nerve fiber layer thickness, IOP, number of eye drops, vision-related quality of life and ocular surface disease symptomatology. HIT-GLAUCOMA is a blueprint trial design to study the effect of exercise training on neurodegenerative and cardiovascular diseases. Importantly, patients are also expected to benefit from improvements in general health and cardiovascular co-morbidities. If proven effective, exercise may offer a new add-on treatment strategy to slow glaucoma progression. The trial is registered at Clinicaltrials.gov under the identifier NCT06058598 and is currently in the recruitment stage.

Predictors for interest to participate in digital mental health therapy: a cross-sectional survey of individuals with anxiety and depression

BackgroundDue to a multitude of factors, the onset of the COVID-19 pandemic resulted in a significant increase in mental health issues within society, including depression and anxiety. Due to the increased trend of mental health disorders in society, digital mental health therapies are more useful than ever. With the emergence of programs utilizing Internet Cognitive Behavioral Therapy (iCBT), mental health resources are easily accessible and can be widely implemented to those in need.The aim of this study was to identify predictors for interest to participate in SilverCloud digital mental health therapy among individuals with mild to severe anxiety and/or depression based on preliminary findings from the COVIDsmart study.MethodsCOVIDSmart participants who had moderate to severe anxiety and/or depression based on the PHQ-9 and GAD-7 scores, and who consented to be contacted for future studies, were invited to complete a needs assessment survey via Research Electronic Data Capture (REDCap). This assessment used self-reported measures including medical diagnoses, mental health services received, reasons for anxiety and/or depression, the use of coping strategies, suicidal ideology using the Ask Suicide Questions tool, and whether they would be interested in receiving free digital mental therapy. Descriptive statistics were used to report participants’ demographics and a logistic regression was used to find predictors for interest in participation in SilverCloud. SAS 9.4 was used and p values < 0.05 were considered significant.ResultsOut of the original 782 COVIDsmart participants, 634 consented to be contacted for future studies, 280 were subsequently invited to complete the SilverCloud needs assessment, and 120 individuals completed it. The largest demographic among these participants were females (70.83%) who identified as White (80.83%). The mean age was 48.74 years (SD = 14.66). Results revealed that having a mental health comorbidity significantly predicted the likelihood of interest in participating in the SilverCloud digital mental health program (p = 0.027).ConclusionsIn this study, mental illness comorbidities predicted the interest to participate in digital mental therapy. Fragmented healthcare and perceptions of unmet care needs are likely contributor factors. Further research with a diverse sample of participants is necessary for generalizability. Findings may have important implications for healthcare best practices.

Mental health after the COVID-19 pandemic among Finnish youth: a repeated, cross-sectional, population-based study

High levels of mental health problems among young people were reported during the COVID-19 pandemic, but studies of the post-pandemic period are scarce. We assessed mental health problems among Finnish youth before, during, and after the COVID-19 pandemic using nationwide population-based samples. Our aim was to examine in which direction the heightened levels of adolescent mental health problems have developed after the pandemic. In this national, repeated cross-sectional, population-based study in Finland, we recruited students at lower and upper secondary level (aged 13-20 years) who were taking part in the Finnish School Health Promotion (SHP) survey in 2015-23 (119 681-158 897 participants per round). The SHP is based on total sampling and conducted biennially between March and May. Self-reports covered the seven-item Generalized Anxiety Disorder Scale; the two-item Patient Health Questionnaire for depression; the Mini Social Phobia Inventory for social anxiety; the Short Warwick-Edinburgh Mental Wellbeing Scale for mental wellbeing; loneliness; the Sick, Control, One Stone, Fat, Food measure for disordered eating; and suicidality (suicidal ideation, deliberate self-harm, and suicide attempts). Scales were dichotomised using validated cutoffs. Presence of any and comorbid mental health problems was assessed. Logistic (for dichotomised outcomes) and linear (for Short Warwick-Edinburgh Mental Wellbeing Scale) mixed effects models were used to analyse the effect of survey year on mental health, controlling for sociodemographic background factors and stratified by gender and school level. Cisgender and transgender youth were compared. Between 2015 and 2023, the SHP study recruited 722 488 students (371 634 [51·6%] girls and 348 857 [48·4%] boys) with a mean age of 15·8 years (SD 1·3) who were either in the eighth and ninth grades of comprehensive school or the first and second years of general and vocational upper secondary schools in Finland. The proportion of participants with generalised anxiety, depression, and social anxiety symptoms above the cutoff increased from pre-COVID-19 levels to 2021 and remained at these higher levels in 2023 among all study groups. Among girls in lower secondary education, prevalence of generalised anxiety, depression, and social anxiety symptoms increased from 2021 to 2023, as did social anxiety among girls in upper secondary education. Among boys, the proportion with social anxiety symptoms decreased between 2021 and 2023. Mental wellbeing scores decreased in all groups between 2021 and 2023, and disordered eating increased in girls, and in boys in lower secondary education. Suicidality increased in girls but not in boys. Loneliness was the only measure to show improvement in all groups from 2021 to 2023. In 2023, 55 895 (72·6%) of 76 994 girls and 22 718 (32·8%) of 69 205 boys reported at least one mental health problem, and 37 250 (48·4%) girls and 9442 (13·6%) boys reported comorbid mental health problems. Among both transfeminine and transmasculine youth, the prevalence of generalised anxiety and depression symptoms decreased from 2021 to 2023, but compared with cisgender youth, the proportions were significantly higher throughout. The effects of the COVID-19 pandemic on youth mental health could be long lasting. In this study, the substantial change for the better among transgender youth was a positive exception. Providing adequate support and treatment for young people with poor mental health is essential, but solutions to the mental health crisis need to address a wider societal perspective and should be developed in partnership with young people. NordForsk, Research Council of Finland. For the Finnish and Swedish translations of the abstract see Supplementary Materials section.