Health-related Measures Research Articles

A health system assessment approach to analysis of political parties' health proposals, Portugal.

Comparing health policy measures before elections and identifying potential gaps in the health policy debate can be challenging. We explored the use of the Health System Performance Assessment for Universal Health Coverage framework to analyse health policy proposals by classifying health policy measures outlined in political manifestos into four health system functions: governance, financing, resource generation and service delivery. As a case study, we analysed the political manifestos of all Portuguese parties with parliamentary representation ahead of the election in March 2024. We calculated the share of measures per health system function for individual political manifestos and identified potential gaps in the health policy debate. When required, we used additional classification criteria and local expertise on political and institutional knowledge. A snap general election was announced in Portugal in November2023, following an alleged corruption scandal, and political parties began publishing their manifestos on their websites in January2024. We identified and classified 350 health-related measures across the four functions: governance, 29.7% (104 measures); financing, 16.9% (59 measures); resource generation, 33.4% (117 measures); and service delivery, 20.0% (70 measures). These findings enabled characterization of the priorities of parties, facilitated cross-party comparisons and identified missing topics in the political debate. We show that the framework can be adapted to analyse political manifestos, providing a systematic method for comparing and synthesizing health policy proposals. We further demonstrate the potential for extending the framework's applicability beyond health system performance assessment, opening new avenues for policy analysis.

The Effects of Omega-3 Supplementation on the Omega-3 Index and Quality of Life and Pain Scores in Dogs.

This study in dogs had two objectives: first, to determine whether a daily supplement of marine omega-3 (EPA and DHA) would (1) increase red blood cell EPA + DHA levels (i.e., the Omega-3 Index derived from dried blood spot analysis) and (2) impact health-related measures. Dogs were recruited from five private veterinary clinics in the United States and supplemented with about 70 mg of EPA + DHA per kg body weight (BW) for 16 weeks. Health-related outcomes included quality of life (QOL) and pain scores using validated questionnaires. Twenty-nine dogs (8.4 ± 3.6 years old) finished this study. After 16 weeks of supplementation with 68 ± 19 mg EPA + DHA/kg/day, the O3I increased from 1.4% ± 1.0% at baseline to 3.3% ± 1.1% (p = <0.0001). Concomitantly, overall pain scores declined from 7.4 ± 5.8 to 6.2 ± 5.4 (p = 0.012), primarily in small and medium-sized dogs. QOL scores improved slightly but only in small dogs (p = 0.03). Thus, supplementation with about 70 mg of EPA + DHA/kg/day improved the O3I and, in smaller dogs, pain and QOL scores. Future studies are needed to more clearly define doses of EPA + DHA that would improve the health of dogs.

Students’ Perceptions of Food Offer in Portuguese Canteens and Adherence to Mediterranean Diets

Abstract Adherence to healthy eating behaviors, as in the Mediterranean Diet, is related to a better quality of life, better educational performance, and reduced risk of physical illness among higher education students. The provision of good quality and sustainable food is imperative in university environments. Nevertheless, the availability of healthy options tends to be limited across campuses (e.g., affordable fast food; the convenience of high-sugary foods in vending machines), including university canteens. Understanding students’ views on canteens and the factors that prevent them from embracing healthy eating habits may help to improve the food supply on campuses. In the present study, we aimed to examine students’ perceptions of canteen services and its food supply and to verify students’ knowledge and promptness to comply with a Mediterranean Diet menu. A large sample of academic students from Portuguese universities answered an online survey with a mixed approach. Specifically, participants were requested to characterize their dietary practices and report their perceptions about food services and offers in campus canteens. Additionally, students were asked about their knowledge, perceptions, and adherence to Mediterranean Diet. Our findings allow us to map perceptions and attitudes regarding food offered in university canteens and to identify the potential to adhere to more sustainable and healthier food patterns according to individual. Moreover, we identified the main psychological and environmental barriers to adhering Mediterranean Diet. Correlational data indicated a relationship between health-related measures and food-related factors. Advancing data about modifiable factors associated with better adherence to healthy dietary habits in the university context informs the development of actions/interventions to prevent unhealthy food choices and overcome limited and unhealthy food offers in canteen campuses.

Climate change health challenges – a study on heat health-related adaption measures in Germany

Abstract Problem Increasing extreme heat events of summer 2003, 2010 and 2015 induced a rising impact on heat health morbidity and mortality in Germany. A considerable proportion of urban population is affected by thermal discomfort due to the urban heat island burden during summer, particularly vulnerable people at risk. Concerted action to develop appropriate heat health adaptation measures is needed. Description As part of the National Adaptation Strategy to Climate Change an expert working group published ‘Recommendations for Action for the Preparation of Heat Action Plans’ for Germany in 2017. A first country-wide project had been conducted between 2019 and 2023 which investigated the status and impact of current or planned Heat Health Action Plans (HHAP), and adaptation measures appropriate to protect and prevent human health. As part of this project an online survey was conducted in May/June 2020 on the awareness and degree of use of the 2017 recommendations and the development and implementation of HHAP. Results This survey had been carried out to assess the current state of affairs as well as factors of success and barriers in the development and implementation of HHAP, with a particular focus on municipal environment and health administrations. In total 116 questionnaires had been responded, mainly by participants from the environment sector (53%), and 32% from the public health sector. More than half of the respondents indicated to be aware of the recommendations (very well-known at the federal state level: 90%, at county level known by 43%), which were identified as very helpful by 81%. Respondents from large cities (&amp;gt; 100 000 inhabitants) were main contributors to the study (41 of 81 large cities replied; 34 rural counties responded). Key messages • The 2017 recommendations had been identified and used to start with HHAP. • Decision makers should develop structures for regulations that anchor HHAP as a nationwide instrument to be established timely.

Individuals' top values and health behavior engagement: results of a National US Survey.

Although linked with subjective wellbeing, little research has examined relations of values with health behaviors and health. Because values are principles that guide behavior across situations, this exploratory retrospective study examined how individuals' highest value relates to their health behaviors and health. Participants were 3865 (aged 18-89 years) adults who completed the Health Information National Trends Survey (HINTS), a nationally-representative survey administered by the US National Cancer Institute. HINTS 5 Cycle 4 data were collected early in 2020. Participants selected the value most important to them in their day-to-day life from a set of seven values. Five categories of health-related measures were assessed in relation to values: substance use, physical activity, cancer screening, general health, and coping. Top values were safety of family (29.9%), happiness (20.9%), and autonomy (14.1%). Findings indicated that some top values, such as health and religion, were associated favorably with some health behaviors, while other top values, such as happiness or autonomy, were in some instances associated with poorer health behaviors. These results, while exploratory, suggest that individuals' highest value may be meaningfully related to their health behaviors and self-reported health status. Future research into values and health appears warranted.

Investigating the effects of indoor lighting on measures of brain health in older adults: protocol for a cross-over randomized controlled trial

BackgroundThe worldwide number of adults aged 60 years and older is expected to double from 1 billion in 2019 to 2.1 billion by 2050. As the population lives longer, the rising incidence of chronic diseases, cognitive disorders, and behavioral health issues threaten older adults’ health span. Exercising, getting sufficient sleep, and staying mentally and socially active can improve quality of life, increase independence, and potentially lower the risk for Alzheimer’s disease or other dementias. Nonpharmacological approaches might help promote such behaviors. Indoor lighting may impact sleep quality, physical activity, and cognitive function. Dynamically changing indoor lighting brightness and color throughout the day has positive effects on sleep, cognitive function, and physical activity of its occupants. The aim of this study is to investigate how different indoor lighting conditions affect such health measures to promote healthier aging.MethodsThis protocol is a randomized, cross-over, single-site trial followed by an exploratory third intervention. Up to 70 older adults in independent living residences at a senior living facility will be recruited. During this 16-week study, participants will experience three lighting conditions. Two cohorts will first experience a static and a dynamic lighting condition in a cluster-randomized cross-over design. The static condition lighting will have fixed brightness and color to match lighting typically provided in the facility. For the dynamic condition, brightness and color will change throughout the day with increased brightness in the morning. After the cross-over, both cohorts will experience another dynamic lighting condition with increased morning brightness to determine if there is a saturation effect between light exposure and health-related measures. Light intake, sleep quality, and physical activity will be measured using wearable devices. Sleep, cognitive function, mood, and social engagement will be assessed using surveys and cognitive assessments.DiscussionWe hypothesize participants will have better sleep quality and greater physical activity during the dynamic lighting compared to the static lighting condition. Additionally, we hypothesize there is a maximal threshold at which health-outcomes improve based on light exposure. Study findings may identify optimal indoor lighting solutions to promote healthy aging for older adults.Trial registrationClinicalTrials.gov Identifier: NCT05978934.

Gender and age specific dynamics of health-related postoperative outcome measures following the laparoscopic sleeve gastrectomy

BackgroundA variety of bariatric surgical techniques have been implemented to manage obesity, including the laparoscopic sleeve gastrectomy (LSG).The aim of the study was to compare the pre and postoperative features of patients undergoing LSG, analyze the dynamics of BMI and BAROS indices and to assess the impact of body appearance concern on the postoperative outcomes. MethodsA total of 591 participants were divided into 3 age groups (20–39, 40–59 and over 60 years of age). The Charlson Comorbidity Index was used to assess comorbidity in patient groups. The rate of complications, assessment of psychological well-being and number of hospital days for patients were used to compare the features of postoperative recovery in different age groups. ResultsIn the young and middle-aged groups, the BMI reduction speed was similar, and significantly higher than in the elder group with a faster rate of BMI reduction in female participants. Higher scores of BAROS were revealed in the young and middle-aged groups for the 0–1 and 1–6 month periods. The 12-month assessment revealed much higher BAROS scores for male subgroups, compared to female participants. The BAROS scores decreased gradually in female groups within the assessment periods and was the lowest in the third assessment. ConclusionsThe pattern of BAROS reduction can be the result of lower psychological and social well-being scores in female participants who reported significant weight reduction in 6–12 month period with paradoxically decreased quality of life scores explained by the impact of body appearance concern on the postoperative outcomes.

Effectiveness of an affect-adjusted, supervised, multimodal, online and home-based exercise group protocol for major depression: A randomized controlled trial

This randomized controlled trial investigated the effectiveness of an affect-adjusted, supervised, multimodal, online, and home-based exercise group protocol as an adjunct therapy to antidepressants on depressive symptoms, cardiorespiratory fitness, and side effects related to antidepressants in adults with major depression (MDD, diagnosed by a clinician). Depressive symptom scales were administered by a psychiatrist and self-reported. A health-related measure (i.e., cardiorespiratory fitness), was also administered. The exercise intervention was adjusted by perceived effort and affect (pleasure and enjoyment) toward exercise and lasted 12 weeks. In total, 59 adults with MDD were divided into two groups: the exercise-group (EG; exercise + pharmacotherapy) with 26-patients (76.9 % females, mean age 28.5 years) and the control-group (CG, pharmacotherapy) with 33-patients (78.7 % females, mean age 25.6 years). The EG had a lower dropout rate (15.3 %) than CG and an increase in cardiorespiratory fitness (CRF), which was not observed in the CG. Both groups showed a decrease in self-reported depressive symptoms. However, the EG had significantly lower depressive symptom scores at t1 and t2. The EG also had higher remission rates (t1, EG: = 42.3 % and CG = 27.2 %) and remission rates (t2, EG: = 72.7 % and CG = 48.1 %) than CG, which were maintained during the four month follow-up. Side effects from anti-depressant medication were larger in the EG compared to CG. Complementing usual care for MDD with exercise resulted in better clinical outcomes and supports the use of this type of exercise protocol in the clinical management of depression.

Expanding a cohort of children who had a response to the Household Food Security Survey Module: A novel approach using linked ICES administrative data

ObjectiveThe Canadian Community Health Survey (CCHS) is a national cross-sectional survey, rich with household, health-related measures. Through linkage with administrative health services data, we aimed to investigate the relationship between household food-insecurity in childhood, and incident health conditions (asthma and diabetes). Linking mothers with children and children with siblings, provided a unique opportunity to expand our child cohort. ApproachWe linked five cycles of the CCHS with ICES administrative databases, to conduct longitudinal cohort studies of children &lt;18 years who had a household response to the Household Food Security Survey Module (HFSSM). Three approaches were used to increase our sample of children: we included children who personally completed the HFSSM; the children of mothers who completed the HFSSM (via a unique database linking mothers with biological children); and the siblings of children who completed the HFSSM. We examined the characteristics of children from food secure and insecure households, accounting for the clustering of children living within the same home. In addition, we investigated the incidence of health outcomes using marginal time-to-event regression analysis to adjust for clinical and socio-economic confounders. Results and ConclusionsUsing novel linkages and multiple data sources we were able to study a large cohort of children (20,023 children whose mothers completed the HFSSM, 5,199 siblings of child respondents, 8,820 children who personally responded to the survey). This creative approach built capacity to investigate household-level determinants of health in a large cohort of Canadian children.

Differences by Sexual Orientation in Patient-Centered Care Outcomes for Veterans Utilizing Primary Care Services at the Veterans Health Administration.

Purpose: This study examined the differences by sexual orientation in patient-centered care outcomes (including health care experiences and health-related screening) of veterans utilizing Veterans Health Administration (VHA) primary care. Methods: VHA's adapted version of the Consumer Assessment of Healthcare Providers and Systems was used to compare the health care experience of primary care services among sexual minority (SM) and heterosexual veterans. Health care experience measures were dichotomized to "always" versus "less" and stratified by SM status. Health-related screening measures were dichotomous. Survey data were weighted using provided sample weights. Descriptive statistics were performed on sociodemographic characteristics. Logistic regression coefficients were represented as adjusted odds ratios (aORs). A total of 66,348 veterans were included in the analytic sample, of which 2.9% (n = 1,935) identified as SM. Sexual orientation was ascertained by self-report measures by veterans. Results: SM veterans were significantly younger (56.95 years vs. 63.43 years, p < 0.001), were less likely to report that their provider showed respect for what they had to say (aOR: 0.76; 95% confidence interval [CI]: 0.61-0.95), that they were asked about difficulties taking care of their health (aOR: 0.81; 95% CI: 0.67-0.96), and their provider listened carefully to them (aOR: 0.71; 95% CI: 0.57-0.87) compared to heterosexual veterans. Conclusion: Health care experiences differed between SM and heterosexual veterans who sought VHA primary care, suggesting the need to increase provider trainings, which may improve cultural competency and promote a more welcoming and inclusive environment.

The Role and Importance of Quality of Life among Preschool Children as a Prerequisite for a Positively Oriented Upbringing

The aim of this study was to evaluate the health-related quality of life (QoL) in a sample of healthy preschool children in the Republic of Croatia and comment on whether and how the research results open the preconditions for positive individual scenarios of the future related to positively oriented upbringing. The Pediatric quality of life inventory generic core scales (PedsQLTM) was completed by 230 healthy preschool children (5-6 years old) and their parents as a proxy-report. The data was descriptively analysed first. Reliability was assessed by Cronbach’s alpha. The statistically significant difference between the PedsQLTM scales (physical, emotional, social, kindergarten and psychosocial functioning) for preschool children and their parent’s proxy-report were analysed. The PedsQLTM scale score means for children’s self-report ranged 71.32-76.49, with the total score was 74.53. Score means for their parent’s proxy-report scale ranged 73.59-85.46, with the total score of 80.93. All the self-report and proxy-report scales showed satisfactory reliability with Cronbach’s alpha varying between 0.64 and 0.89. Statistically significant difference between scales in self-report and proxy-report was for physical (t=-7.12, p&lt;0.01), social (t=-6.42, p&lt;0.01) and school functioning (t=-2.62, p&lt;0.01) as well as psychosocial (t=-4.82, p&lt;0.01) and total health (t=-6.85, p&lt;0.01). The Croatian PedsQLTM is valid and reliable generic pediatric health-related QoL measurement that can be recommended for children’s self-reports and their parent’s proxy-reports. The results of the research open a precondition for positive individual scenarios of the future related to positively oriented upbringing.

Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury.

Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.

Measuring the effect of the anti-nerve growth factor antibodies bedinvetmab and frunevetmab on quality of life in dogs and cats with osteoarthritis using a validated health-related quality of life outcome measure: an observational real-world study.

Osteoarthritis causes chronic pain, impaired joint function, decreased mobility and negatively impacts quality of life (QOL). Anti-nerve growth factor antibodies bedinvetmab for dogs and frunevetmab for cats are licensed for the alleviation of osteoarthritis pain but their QOL impact is unreported. Our aim was to determine if these therapeutics improve QOL using a validated health-related QOL measure that generates scores in four domains of QOL-energetic and enthusiastic (E/E), happy and content (H/C), active and comfortable (A/C) and calm and relaxed (C/R)-in the dog and three in the cat-vitality, comfort and emotional wellbeing (EWB). Summary scores for physical wellbeing (PWB) and emotional wellbeing (EWB) for dogs and PWB for cats are calculated from the domain scores. Animals received bedinvetmab (dogs) at 0.5-1 mg/kg or frunevetmab (cats) at 1-2.8 mg/kg by subcutaneous injection on days 0, 28 and 56 and owners completed QOL assessments within 48 hours of day 0 and on days 14, 28, 56, 63 and 70 using a study-specific app. Assessments were completed by 75 dog and 56 cat owners. By day 14 there was a statistically significant improvement (p ≤ 0.001) in PWB, EWB and all domains except C/R (p = 0.005) in dogs and in all domains and PWB in the cat. Subsequently there was a continued improvement in all domains and summary scores (p ≤ 0.001) except for H/C in the dog and EWB in the cat, which were excluded from the statistical model. The overall improvement in all domain scores in the cat and E/E and A/C in the dog exceeded the previously reported minimum important difference scores for the QOL measure, indicating a clinically significant change. Treatment with bedinvetmab and frunevetmab produced a significant improvement in the QOL of dogs and cats. This latest evidence for the use of these OA pain medications could be helpful in the clinical management of osteoarthritis and post-marketing clinical trials.

The Ambiguous Cue Task: Measurement reliability of an experimental paradigm for the assessment of interpretation bias and associations with mental health

Interpretation biases in the processing of ambiguous affective information are assumed to play an important role in the onset and maintenance of emotional disorders. Reports of low reliability for experimental measures of cognitive biases have called into question previous findings on the association of these measures with markers of mental health and demonstrated the need to systematically evaluate measurement reliability for measures of cognitive biases. We evaluated reliability and correlations with self-report measures of mental health for interpretation bias scores derived from the Ambiguous Cue Task (ACT), an experimental paradigm for the assessment of approach-avoidance behavior towards ambiguous affective stimuli. For a non-clinical sample, the measurement of an interpretation bias with the ACT showed high internal consistency (rSB = .91 – .96, N = 354) and acceptable 2-week test–retest correlations (rPearson = .61 – .65, n = 109). Correlations between the ACT interpretation bias scores and mental health-related self-report measures of personality and well-being were generally small (r ≤ |.11|) and statistically not significant when correcting for multiple comparisons. These findings suggest that in non-clinical populations, individual differences in the interpretation of ambiguous affective information as assessed with the ACT do not show a clear association with self-report markers of mental health. However, in allowing for a highly reliable measurement of interpretation bias, the ACT provides a valuable tool for studies considering potentially small effect sizes in non-clinical populations by studying bigger samples as well as for work on clinical populations, for which potentially greater effects can be expected.

Anaemia and quality of life in chronic kidney disease: a consensus document from the European Anaemia of CKD Alliance.

Anaemia is common in chronic kidney disease (CKD) and has a significant impact on quality of life (QoL), work productivity and outcomes. Current management includes oral or intravenous iron and erythropoiesis-stimulating agents (ESAs), to which hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been recently added, increasing the available therapeutic options. In randomised controlled trials, only intravenous iron improved cardiovascular outcome, while some ESAs were associated with increased adverse cardiovascular events. Despite therapeutic advances, several challenges and unmet needs remain in the current management of anaemia of CKD. In particular, clinical practice does not include an assessment of QoL, which prompted a group of European nephrologists and representatives of patient advocacy groups to revisit the current approach. In this consensus document, the authors propose a move towards a more holistic, personalised and long-term approach, based on existing evidence. The focus of treatment should be on improving QoL without increasing the risk of adverse cardiovascular events, and tailoring management strategies to the needs of the individual. In addition, the authors discuss the suitability of a currently available anaemia of CKD-specific health-related QoL measure for inclusion in the routine clinical management of anaemia of CKD. The authors also outline the logistics and challenges of incorporating such a measure into electronic health records and how it may be used to improve QoL for people with anaemia of CKD.

Continuous measurement of university students stress level during COVID-19 lockdown: Longitudinal study

Despite numerous studies documenting high stress levels among university students, few have explored the potential benefits of continuous and systematic monitoring of stress-related or other psychological data. The COVID-19 pandemic and policies such as lockdowns, online education, and other restrictions have made it necessary to explore the impact of these measures on students' stress levels. This study aims to describe our experience with collecting longitudinal stress data in a university setting and to investigate the impact of COVID-19 policies on students' stress levels.We employed a mixed-methods approach, collecting quantitative data using the Arabic-translated version of the Perceived Stress Scale (PSS-14) and qualitative data through interviews. Baseline PSS data collection began on October 20, 2019, before the COVID-19 pandemic, to assess students' stress levels during different academic timeframes, such as enrollment, midterm exams, and final exams. Following the outbreak of the COVID-19 pandemic, a series of follow-up PSS collections was conducted from February 9, 2020, to November 15, 2021. After quantitative data collection ended, we conducted in-person interviews with 96 students, exploring domains such as health, academic life, sleep, diet, financial situation, living environments, work, social relationships, depression, and social thoughts.We received 404 responses with a nearly equal distribution of male and female participants. Our results revealed that female participants reported higher mean stress scores than male participants, while male participants had higher mean coping scores.Moreover, continuous and systematic monitoring of stress-related data can be valuable for coping with unpredictable events such as the COVID-19 pandemic. The mixed-methods approach enabled us to obtain a more comprehensive understanding of the complex impact of COVID-19 and lockdowns on students' stress levels. These results have important implications for developing interventions and support systems to help students manage stress during times of uncertainty and disruption.To improve health outcomes in both workplace and academic settings, we recommend integrating health-related measures. This could include the collection of diverse health-related data, such as psychological, psychometric, social, and behavioral information. Future studies should explore guidelines and standards to help organizations determine the most effective measures based on their unique environments and objectives.

A Content and Readability Analysis of Genitourinary and Sexual Health-Related Patient-Reported Outcome Measures in Gender-Affirming Care

ObjectivesTo the evaluate the readability and comprehensiveness of genitourinary and sexual health-related patient-reported outcomes (PROMs) used in gender-affirming care. MethodsCommon PROMs that measure genitourinary and sexual health-related outcomes in gender-affirming care literature were identified from six recent systematic reviews. Readability analysis was completed at the level of individual items and full scale using established readability assessment tool, including Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GF), Coleman Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index. The concepts measured by the PROMs were evaluated for comprehensiveness. Results25 PROMs were included, of which 12 assessed genitourinary outcomes and 13 assessed sexual health outcomes. A total of seven genitourinary domains and eight sexual health domains were identified during concept mapping. Readability analysis showed a median PROM grade level of 9.0 and 9.5 in genitourinary and sexual PROMs, respectively. The Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction v2.0 had the lowest median reading grade level of 5.7, and the Female Sexual Function Index has the highest median reading grade level of 13.9. No single PROM was found to be comprehensive. Multiple PROMs contained double-barreled items or used outdated terminology. ConclusionsMost PROMs used in the genital gender-affirming literature failed to meet the readability recommendations for patient-facing material and were culturally unfit for use in transgender and gender-diverse individuals. None of the PROMs were found to be comprehensive for evaluating outcomes of gender-affirming care. Validated gender-affirming care-specific PROMs that are comprehensible, comprehensive, and relevant are urgently needed.

START NOW WebApp—promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial

BackgroundAdolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled “Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions”.MethodsThe study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups.DiscussionThis study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels.Trial registration {2a and 2b}ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

FPGA-enhanced IoT methods for disease pre-screening and prediction: An energy optimization approach

The research paper has introduced a system based on the Internet of Things (IoT) that has the potential to contribute to the creation of a Consumer Electronics (CE) product. In the event that any health-related measure deviates from the normal range, this system, which is based on IoT technology, will send a notification to the user. The data collected by this system is sent to an analysis system based on a Field Programmable Gate Array (FPGA) through a mobile application, and then transferred to the cloud for storage. To display this raw data, a wearable IoT device can be utilized, and the system will process the data accordingly. The major innovation of this proposed project lies in the development of a fuzzy classifier that can accurately predict the pathological condition of an illness. By implementing a fuzzy classifier using FPGA, the execution time is greatly reduced i.e. 57.7μs compared to other algorithms. Ans also the accuracy of the proposed model is 98.8 %, which higher then other machine learning model such as 97 %, 96.5 %, 93.2 % respectively for SVM, KNN and DT models.previous models like KNN, DT, SVM, and NB (Naive Bayes).

Exploring associations of financial well-being with health behaviours and physical and mental health: a cross-sectional study among US adults

BackgroundHealth disparities exist across socioeconomic status levels, yet empirical evidence between financial well-being (FWB) and health are limited.MethodsThis cross-sectional study combined data from 25 370 adults aged ≥18 years in...