Health-related Domains Research Articles

Common Patient-Reported Outcomes Within the Food and Drug Administration Voice of the Patient Reports

ObjectivesProponents of disease-specific patient-reported outcome measurements (PROMs) often argue disease-agnostic measures do not adequately capture their patient population’s experience. Patient-Reported Outcomes Measurement Information System (PROMIS) provides a disease-agnostic domain set that may adequately cover many diseases. This study seeks to investigate whether PROMIS’s quality of life domain coverage can span patient-reported outcomes (PROs) elicited from patients across unrelated diseases. MethodsThe Food and Drug Administration Voice of the Patient reports were an initiative to elevate patient voices regarding their condition and associated treatments. Two reviewers extracted patient-reported health-related (quality of life) domains from the reports and categorized them into PROMIS domains or non-PROMIS domains. Domain coverage was summarized for each report. Any extracted PROs not covered by PROMIS domains were placed in an “other” category and analyzed for common themes. ResultsAcross 26 reports, PROMIS covered 216 of 374 (70%) of the reports’ PRO domains. The heritable bleeding disorders report had the highest coverage (82%). Human immunodeficiency virus had the lowest coverage (50%). The most common PROMIS domain, “ability to participate in social roles,” appeared in 25 reports (96%). The most common domains not included in PROMIS were stigma, sensitivities, and sensory deficits as evident in 19 (73%), 18 (69%), and 18 reports (69%), respectively. If the top 3 unincluded domains were amended into PROMIS, the total domain coverage would increase to 84%. ConclusionsPRO domains elicited in the Food and Drug Administration Voice of the Patient reports were widely captured by PROMIS, suggesting domains patients experience contain enough overlap to be recorded by appropriate PROMIS domains. PROMIS could increase its coverage by adding domains.

Correlation Between Functional Strength of Lower Limb, Sit to Stand and Functional Ambulation Capacity in Stroke Patients: an ICF Perspective

Stroke is one of major global public health problems responsible for increased morbidity, predisposing an individual to disability. The International Classification of Functioning, Disability and Health (ICF) is the classification of health and health-related domains and has been commended as a framework to structure rehabilitation establishing a common language between different health professions. Supporting evidence linking the three domains of ICF will help in improving the compliance of therapists towards ICF. This study aimed to determine an association between functional strength, sit to stand and functional ambulation capacity as domains of ICF thereby interlinking the three domains.

Caregiver Expressed Emotion, Quality of Life and Medication Adherence among People Living with Schizophrenia in Nigeria

Background: People Living with Schizophrenia (PLWS) are expected to live longer than before the advent of psychotropic drugs. Relationship of Caregiver Expressed Emotion and Medication Adherence to Quality of Life in African PLWS is not known. The aim of the study was to determine the relationship between the levels of caregiver expressed emotion, quality of life and medication adherence among people living with schizophrenia. Method: Data were collected on Socio-demographic and Schizophrenia Clinical Characteristic, Quality of Life, Caregiver Expressed Emotion (EE) and Medication adherence using Socio-demographic and Schizophrenia Clinical Characteristics questionnaire, World Health Organization Quality of Life (WHOQoL) - Brief, Caregiver Level of EE scale and Morisky Medication Adherence Scale (MMAS) respectively. Results: Caregiver EE was significantly associated with the physical and environmental domains of QoL (p = 0.011 and p = 0.001 respectively). Poor medication adherence correlated positively with the negative attitude and low tolerance sub-scales of the level of EE scale (p = 0.019 and p < 0.001). Medication adherence related significantly to the overall, health-related and physical domains of QoL (p < 0.001, p = 0.017 and p = 0.031). Medication adherence was also a positive predictor of overall QoL (p < 0.001). Conclusion: The High EE has been found to be closely related to the patients’ QoL. The role of medication adherence in promoting QoL among PLWS has been re-emphasized by the findings.

Interventions for Health and Well-Being in School-Aged Children and Adolescents: A Way Forward

The health and well-being of school-aged children has received little attention compared with younger children aged < 5 years and adolescents. In this final article in a supplement of reviews that have assessed the effectiveness of interventions for school-aged children across a variety of health-related domains (including infectious diseases, noncommunicable diseases, healthy lifestyle, mental health, unintentional injuries, and sexual and reproductive health), we summarize the main findings and offer a way forward for future research, policy, and implementation. We complement this evidence base on interventions with a summary of the literature related to enabling policies and intersectoral actions supporting school-aged child health. The school represents an important platform for both the delivery of preventive interventions and the collection of data related to child health and academic achievement, and several frameworks exist that help to facilitate the creation of a health-promoting environment at school.

Examining Health Conditions, Impairments, and Quality of Life for Pediatric Feeding Disorders.

By understanding health conditions, impairments, and impact on quality of life for pediatric feeding disorders, assessment and treatment approaches can target multiple levels of health-related domains that improve child health and well-being. The purpose of this study was to characterize medical diagnoses and feeding impairments for children with feeding disorders; examine child quality of life and caregiver impact; and compare quality of life differences between children with feeding disorders and children with other conditions. A cross-sectional study was conducted in the Greater Boston Area, between October 2017 and June 2018. Fifty children with a feeding disorder diagnosis, ages 2-5years, were enrolled. Demographic and clinical data were abstracted from the electronic health record to characterize medical diagnoses and impairments. Parents completed the Pediatric Quality of Life Generic Core Scales 4.0 (PedsQL) and the Feeding/Swallowing Impact Survey (FS-IS) to understand child quality of life and caregiver impact. We calculated descriptive statistics across the medical diagnosis and impairment groups, and for the surveys. Children presented with heterogeneous medical diagnoses and feeding impairments. We found a mean (SD) total score of 72.82(19.21) on the PedsQL and 2.33(0.89) on the FS-IS demonstrating that children with feeding disorders presented with poor quality of life and their caregivers were negatively impacted by their feeding difficulties. By understanding medical diagnoses, impairments, and quality of life, assessment and treatment methods can be tailored to children's specific needs, as well as address the overall wellbeing of children and their families.

A deep learning relation extraction approach to support a biomedical semi-automatic curation task: The case of the gluten bibliome

Discover relevant biomedical interactions in the literature is crucial for enhancing biology research. This curation process has an essential role in studying the different processes and interactions reported that affect the biological process (e.g., genome, metabolome, and transcriptome). In this sense, the objective of this work is twofold: reduce the manual effort required to curate and review the existing biochemical interactions reported in the gluten-related bibliome, while proposing a novel vector-space integrated into a deep learning model to assists manual curators in a real curation task by learning from their previous decisions. With this objective, the present work proposes a novel vector-space that combine (i) high-level lexical and syntactic inference features as Wordnets and Health-related domain ontologies, (ii) unsupervised semantic resources as word embedding, (iii) semantic and syntactic sentence knowledge, (iv) abbreviation resolution support, (v) several state-of-the-art Named-entity recognition methods, and, finally, (vi) different feature construction and optimization techniques to support a semi-automatic curation workflow. Therefore, the application of the proposed workflow over a classified set of 2,451 relevant gluten-related documents produces a total of 8,349 relevant and 471,813 irrelevant relations distributed in thirteen domain health-related categories. Experimental results showed that the proposed workflow is a valuable approach for a semi-automatic relation extraction task. It was able to obtain satisfactory results in the early stages of a real-world curation task and saved manual annotation efforts by learning from the decisions made by manual curators in iterative annotation rounds. The average F.score for the proposed relation categories was 0.731, being the lowest F.score at 0.47 and the highest F.score at 0.929. The different resources used in this work as well as the manually curated corpus are public available on our GitHub repository.

What\u2019s important to you? Socioeconomic inequalities in the perceived importance of health compared to other life domains

BackgroundPressing issues, like financial concerns, may outweigh the importance people attach to health. This study tested whether health, compared to other life domains, was considered more important by people in high versus low socioeconomic positions, with future focus and financial strain as potential explanatory factors.MethodsA cross-sectional survey was conducted in 2019 among N=1,330 Dutch adults. Participants rated the importance of two health-related domains (not being ill, living a long life) and seven other life domains (e.g., work, family) on a five-point scale. A latent class analysis grouped participants in classes with similar patterns of importance ratings. Differences in class membership according to socioeconomic position (indicated by income and education) were examined using structural equation modelling, with future focus and financial strain as mediators.ResultsThree classes were identified, which were defined as: neutralists, who found all domains neutral or unimportant (3.5% of the sample); hedonists, who found most domains important except living a long life, work, and religion (36.2%); and maximalists, who found nearly all domains important, including both health domains (60.3%). Of the neutralists, 38% considered not being ill important, and 30% considered living a long life important. For hedonists, this was 92% and 39%, respectively, and for maximalists this was 99% and 87%, respectively. Compared to belonging to the maximalists class, a low income predicted belonging to the neutralists, and a higher educational level and unemployment predicted belonging to the hedonists. No mediation pathways via future focus or financial strain were found.ConclusionsLower income groups were less likely to consider not being ill important. Those without paid employment and those with a higher educational level were less likely to consider living a long life important. Neither future focus nor financial strain explained these inequalities. Future research should investigate socioeconomic differences in conceptualisations of health, and if inequalities in the perceived importance of health are associated with inequalities in health. To support individuals dealing with challenging circumstances in daily life, health-promoting interventions could align to the life domains perceived important to reach their target group and to prevent widening socioeconomic health inequalities.

Trends in College Student-Athlete Mental Health in the National College Health Assessment (NCHA), 2011-2019.

Recently the athletic training community has paid increased attention to college student-athlete mental health, treatment-seeking, and impacts on athletic and academic performance. Ongoing efforts to better-educate and equip athletic trainers to help student-athletes in this regard should result in improved mental health-related outcomes. Examine changes in student-athlete mental health over the past decade compared to non-athlete students. Cross-sectional study. United States colleges and universities. Varsity athletes (n=54,479) and non-athlete students (n=448,301) who completed the National College Health Assessment (NCHA) between 2011 and 2019. Survey responses (self-report) to questions in five mental health-related domains: symptoms, diagnoses, treatment-seeking, institutional information distribution, and academic impacts. Student-athletes consistently reported significantly lower symptom and diagnose rates than non-athletes, except for attempted suicide, substance abuse, and eating disorders. Diagnoses increased over time in both groups, but remained lower in athletes. Treatment-seeking and openness to future treatment increased over time in both groups, but remained lower in athletes. Student-athletes received more information on stress reduction, substance abuse, eating disorders, and handling distress/violence than non-athletes. Both groups received information more frequently over time. Athletes reported lower academic impacts, especially for depression and anxiety, but impacts grew over time in both groups. Impacts of injuries and extracurricular activities on academic performance were higher in athletes than in non-athletes. Athletes reported overall lower levels of symptoms, diagnoses, and academic impacts than non-athletes. While non-athlete rates climbed over the past decade, athletes' rates broadly remained flat or climbed less rapidly. Increasingly positive attitudes toward treatment are encouraging, but the deficit relative to non-athletes remains. Ongoing efforts of athletic trainers to educate athletes and guide them to mental health resources are needed in order to continue (or, better yet, accelerate) the observed positive trends in information dissemination and treatment-seeking.

Regression model for predicting low work ability among sedentary aging workers.

Work ability is the physical and psychological capacity of workers to meet the demands of a job; it declines with age, and the effect is multiplied in a sedentary job. Early detection of workers at risk would help to improve their functional capacity and work efficiency. To identify factors and develop a prediction model for low work ability among sedentary aging office workers. In this case-control study, work ability among sedentary aging workers was evaluated using a Work Ability Questionnaire (WAQ). The worker's age, gender, BMI, marital status, years at work, diabetes, hypertension, diagnosed medical condition, musculoskeletal problems, medicine intake, menopause, physical activity, sedentary work behaviour and six job-related tasks were recorded. Multiple logistic regression was performed, and the odds ratio was calculated for the variables assessed. One hundred and fifty seven sedentary aging workers were assessed for 19 independent factors. BMI and years at work in the demographic domain, diagnosed medical condition and intake of medicine in the health-related domain and handgrip strength in the task domain were found to have a statistically significant odds ratio for poor work ability. The study identified factors influencing work ability among sedentary aging workers and a prediction model was developed.

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy.

Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. Systematic review. Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. CRD42020156763.

The Use of Big Data to Improve Human Health: How Experience From other Industries Will Shape the Future.

‘Data science’ represents a set of mathematical and software development related techniques that are applied across a wide range of problems and industries. Practitioners of data science in human health-related domains typically see a world that differs substantially from practitioners in other domains such as advertising, finance, e-commerce, manufacturing, or social networking. This commentary discusses what those differences are (Project vs Product Focus, Independent vs Integrated Efforts, Causality vs Prediction Driven, Statistical vs Machine Learning Centricity) why they exist, and the future convergence that we believe is on the horizon. The concepts discussed can provide a starting point in which health and human performance-focused stakeholders can begin to align well-established data science applications from other domains to further enable innovative health and performance solutions.

Keeping up with the Joneses: Examining relative concerns in health related domains

People care about relative position and are willing to engage resources to be above others or at least not below them. Nevertheless, the scarce existing evidence suggests that health is a less positional good: people prefer to be healthy even if others are healthier than them. Unlike previous literature, we use a survey-based study to explore the positionality of several health-related dimensions (e.g., health care reimbursement, cosmetic surgery) in a Choice versus Happiness condition. We find that agents exhibit mainly egalitarian preferences, namely they take into account others' situations but prefer everybody to receive the same amount of health attributes. Moreover, when health attributes are related to physical appearance, agents express significantly higher levels of positional preferences. We draw several policy implications from these egalitarian preferences.

Explainable deep learning ensemble for food image analysis on edge devices

Food recognition systems recently garnered much research attention in the relevant field due to their ability to obtain objective measurements for dietary intake. This feature contributes to the management of various chronic conditions. Challenges such as inter and intraclass variations alongside the practical applications of smart glasses, wearable cameras, and mobile devices require resource-efficient food recognition models with high classification performance. Furthermore, explainable AI is also crucial in health-related domains as it characterizes model performance, enhancing its transparency and objectivity. Our proposed architecture attempts to address these challenges by drawing on the strengths of the transfer learning technique upon initializing MobiletNetV3 with weights from a pre-trained model of ImageNet. The MobileNetV3 achieves superior performance using the squeeze and excitation strategy, providing unequal weight to different input channels and contrasting equal weights in other variants. Despite being fast and efficient, there is a high possibility for it to be stuck in the local optima like other deep neural networks, reducing the desired classification performance of the model. Thus, we overcome this issue by applying the snapshot ensemble approach as it enables the M model in a single training process without any increase in the required training time. As a result, each snapshot in the ensemble visits different local minima before converging to the final solution which enhances recognition performance. On overcoming the challenge of explainability, we argue that explanations cannot be monolithic, since each stakeholder perceive the results’, explanations based on different objectives and aims. Thus, we proposed a user-centered explainable artificial intelligence (AI) framework to increase the trust of the involved parties by inferencing and rationalizing the results according to needs and user profile. Our framework is comprehensive in terms of a dietary assessment app as it detects Food/Non-Food, food categories, and ingredients. Experimental results on the standard food benchmarks and newly contributed Malaysian food dataset for ingredient detection demonstrated superior performance on an integrated set of measures over other methodologies.

What is important to you? Socioeconomic inequalities in the relative importance of health

Abstract Pressing issues, like financial concerns, may outweigh the importance people attach to health. This study tested the hypothesis that health is considered more important by people in high than low socioeconomic positions, with future focus and financial strain as potential explanatory factors. A cross-sectional survey was conducted in 2019 among N = 1,334 Dutch adults aged 25-60. Participants rated the importance of two health-related domains (not being ill, living a long life) and six other life domains (e.g. work, family) on a five-point Likert scale. A latent class analysis grouped participants in classes with similar patterns of importance ratings. Differences in class membership according to socioeconomic position (indicated by income and education) were examined using structural equation modelling, with future focus and financial strain as mediators. Three classes were identified: neutralists found all domains neutral or unimportant (3.5% of the sample); hedonists found most domains important except living a long life, work, and religion (36.2%); and maximalists found nearly all domains important, including both health domains (60.3%). Low income predicted belonging to the neutralists, and high education and unemployment predicted belonging to the hedonists (both compared to belonging to maximalists). No mediation pathways via future focus nor financial strain were found. People with lower incomes were less likely to consider health important. Neither future focus nor financial strain explained these inequalities. Future research should further investigate socioeconomic differences in conceptualisations of health, and if and how inequalities in the importance of health are associated with inequalities in health. Key messages This study identified small socioeconomic inequalities in the perceived importance of health. Neither future focus nor financial strain contributed to these inequalities.

Socioeconomic inequalities in health: the role of daily hassles and the importance of health

Abstract A low socioeconomic position (SEP) adversely affects health outcomes and is associated with a lower perceived importance of health. It has been suggested that people with a low SEP disproportionately face daily hassles, as a result of which health may be perceived as less important for those with a low SEP compared to those with a high SEP. A lower perceived importance of health likely influences health-related behaviours that affect health outcomes. This study examines whether socioeconomic inequalities in self-assessed health are mediated by daily hassles and/or the perceived importance of health, and whether there is sequential mediation of daily hassles and perceived importance of health. A cross-sectional survey was conducted in 2019 among N = 1,334 Dutch adults. Participants rated the extent of eleven commonly experienced daily hassles (e.g., financial hassles, legal issues), and indicated the perceived importance of two health-related domains (not being ill, living a long life). Inequalities in self-assessed health according to SEP (indicated by income and education) were examined using structural equation modelling, with daily hassles and perceived importance of not being ill or living long a life either as single or sequential mediators. Daily hassles and perceived importance of health individually mediated the relationship between SEP and self-assessed health, but importance of health did not mediate the association between by daily hassles self-assessed health. Socioeconomic inequalities in self-assessed health were explained by the experience of daily hassles, and by differences in the perceived importance of health individually, but the perceived importance of health did not explain the influence of the experience of daily hassles. Addressing the challenging circumstances (e.g., financial or housing hassles) associated with a low SEP, may contribute to improving self-assessed health. Further research should examine how daily hassles affect health. Key messages Daily hassles and the perceived importance of health mediated the relationship between socioeconomic position and health. There was no association between daily hassles and the perceived importance of health.

Racial disparities in psychological distress in post-apartheid South Africa: results from the SANHANES-1 survey.

PurposeSouth Africa has long endured a high prevalence of mental disorders at the national level, and its unique social and historical context could be a contributor to an increased risk of mental health problems. Our current understanding is limited regarding the relative importance of various social determinants to mental health challenges in South Africa, and how existing racial inequities may be explained by these determinants.MethodsThis study attempted to elucidate potential social determinants of mental health in South Africa using data from the nationally representative South African National Health and Nutrition Examination Survey (SANHANES-1). The main outcome of interest was psychological distress, measured with the Kessler-10 scale. Hierarchical linear regression models included covariates for demographic and socioeconomic factors, count of traumatic events, and a series of stress-related constructs. Analyses were conducted on two populations: the entire sample (n = 15,981), and the African subpopulation (n = 10,723).ResultsRegression models on the entire sample indicated racial disparities in psychological distress, with Africans experiencing higher distress than White and Coloured individuals. Results within the African sub-population indicated geo-spatial disparities, with Africans in formal urban settings experiencing higher psychological distress than those living in formal and informal rural locales. Across both samples, results indicated a cumulative association between count of stressors and traumatic events and distress.ConclusionWe found racial disparities across several mental health-related domains. Africans had greater exposure to traumatic events, social stressors, and psychological distress. This research is a necessary foundation for public health interventions and policy change to effectively reduce inequities in psychological distress.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00127-021-02175-w.

Racial Disparities in Health Risk Indicators Reported by Alabamians Diagnosed with COPD.

Chronic Obstructive Pulmonary Disease (COPD) is a growing public health problem in the southern United States, particularly in Alabama. However, very little is known about specific health risk factors disproportionately impacting Alabamians with COPD. We conducted a latent class analysis of 2015–2019 Behavioral Risk Factor Surveillance System data from 4057 Alabamians with COPD (White = 2947, Black = 873, Other = 237). Eighteen risk indicators were examined across three health-related domains: (1) comorbidities, (2) limited healthcare access, and (3) substance use/abuse. Racial disparities between Black and white Alabamians with COPD were assessed using configural similarity analysis. Findings showed that almost one-third (31%) of Alabamians with COPD were in the high-risk class for eight comorbidities, and nearly one-half (48.88%) belonged to the high-risk class for limited healthcare access. Black Alabamians with COPD who did not have health insurance were much more likely to be at high risk for limited healthcare access (94.44%) when compared to their counterparts with insurance (5.56%), χ2(df = 2) = 1389.94, p < 0.0001. Furthermore, the proportion of high-risk, uninsured Black Alabamians with COPD (94.44%) substantially exceeded the percentage of high-risk, uninsured white Alabamians with COPD (59.70%). Most Alabamians with COPD (82.97%) were at low risk for substance use/abuse. Future research should explore new mechanisms for facilitating better healthcare access among high-risk Alabamians living with COPD and other prevalent comorbidities. Greater attention should be focused on Black Alabamians with COPD who cannot afford adequate health insurance.

Different Methods for Traumatic Brain Injury Diagnosis Influence Presence and Symptoms of Post-Concussive Syndrome in United States Veterans.

Common methods for evaluating history of traumatic brain injury (TBI) include self-report, electronic medical record review (EMR), and structured interviews such as the Head Trauma Events Characteristics (HTEC). Each has strengths and weaknesses, but little is known regarding how TBI diagnostic rates or the associated symptom profile differ among them. This study examined 200 Veterans recruited within the VA Portland Health Care System, each evaluated for TBI using self-report, EMR, and HTEC. Participants also completed validated questionnaires assessing chronic symptom severity in broad health-related domains (pain, sleep, quality of life, post-concussive symptoms). The HTEC was more sensitive (80% of participants in our cohort) than either self-report or EMR alone (40%). As expected from the high sensitivity, participants screening positive for TBI through the HTEC included many people with mild or no post-concussive symptoms. Participants were grouped according to degree of concordance across these diagnostic methods: no TBI, n = 43; or TBI-positive in any one method (TBI-1dx, n = 53), positive in any two (TBI-2dx, n = 45), or positive in all three (TBI-3dx, n = 59). The symptom profile of the TBI-1dx group was indistinguishable from the no TBI group. The TBI-3dx group had the most severe symptom profile. Our results show that understanding the exact methods used to ascertain TBI is essential when interpreting results from other studies, given that results and conclusions may differ dramatically depending on the method. This issue will become even more critical when interpreting data merged from multiple sources within newer, centralized repositories (e.g., Federal Interagency Traumatic Brain Injury Research [FITBIR]).

Feasibility of implementing a same-day electronic screening tool for clinical assessment to measure patient-reported outcomes for eliciting actionable information on adherence to HIV medication and related factors in a busy Canadian urban HIV clinic.

An optimal adherence to antiretroviral therapy (ART) is fundamental for suppression of HIV viral load and favourable treatment outcomes. Patient-reported outcomes (PROs) are effective tools for improving patient-provider communication and focusing providers' awareness on current health problems. The objectives of this analysis were (1) to determine the feasibility of implementing an electronic screening tool to measure PROs in a Canadian HIV clinic to obtain information on ART adherence and related factors and (2) to determine the factors related to sub-optimal adherence. This implementation research with a convenience sample of 600 people living with HIV (PLWH) was conducted in a busy, academic, urban HIV clinic in Toronto, Canada. PLWH were approached to participate in PRO assessments just prior to their in-clinic appointments, including health-related domains such as mental health, housing, nutrition, financial stress and medication adherence, and responses were summarized on a single sheet available for providers to review. Feasibility of implementing PROs was assessed by quantifying response rate, completion rate, time taken and participation rate. Medication adherence was elicited by self-report of the percentage of prescribed HIV medications taken in the last month. Unadjusted and adjusted odds ratios were estimated from logistic regression models to identify factors associated with adherence of <95%. Of the 748 PLWH invited to participate, 692 (participation rate: 92.5%) completed the PRO assessments as standard of care in clinic. Of these, 600 consented to the use of their PRO results for research and were included in this analysis. The average response rate to the ART-related questions was 96.8% and mean completion rate was 95.5%. The median time taken to complete the assessment was 12.0 (IQR = 8.4-17.3)min, adjusted 8.7 (IQR = 7.2-10.8)min. 445 (74.9%) of participants were male, and 153 (26.2%) reported dissatisfaction with ART. 105 (19.7%) of the PLWH reported ART adherence of <95%. Multivariable logistic regression identified the following risk factors for sub-optimal adherence: dissatisfaction with ART (OR = 2.30, 95% CI 1.38-3.83), not having a family doctor or not visiting a family doctor in last year (OR = 1.69, 95% CI 1.02-2.79). Collecting self-reported health information from PLWH through PROs in a busy urban clinic was feasible and can provide relevant information to healthcare providers on issues related to adherence. This has a potential to help in individualizing ambulatory care.

The association between mental health and shift work: Findings from the Atlantic PATH study

We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00–1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14–1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.