High Psychological Burden Research Articles

One year of COVID-19 in dental health services in Norway: psychological impact, risk perceptions and vaccination status

BackgroundIncreased psychological pressure on oral healthcare professionals (OHP) due to COVID-19 has been shown, yet little is known about the long-term psychological impacts. We aimed to study the psychological impact of COVID-19 and associated factors including perceived risk and preparedness and vaccination status among OHP in the first year after the lockdown period in Norway.MethodsA structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired experiences and perceptions during the second year following the outbreak in Norway. The questionnaire comprised a COVID-19 fear scale and questions about risk perception, preparedness and vaccination status. Exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used to assess psychological impact, perception of risk and preparedness according to vaccination status of the respondents.ResultsThe majority of the 708 respondents were female (92.8%), had ten or more years of work experience (67.1%), and worked in public dental clinics (95.9%). Fears and concerns related to COVID-19 were common, 72.6% feared getting infected and 85.4% feared infecting others. Of the 642 respondents who agreed that their workplaces handled the situation well, 55.6% were fully vaccinated. Three factors were retrieved from EFA: Insecurity, Instability and Infection. SEM showed that females were more concerned with Infection, and respondents with long clinical experience were less likely to express fear about Instability. Fully vaccinated individuals felt more insecure about becoming infected, and those agreeing that their workplaces handled the current situation well were concerned with Insecurity.ConclusionsDespite widespread perception of adequate preparedness and high vaccine coverage, a considerable psychological impact and high levels of fear of COVID-19 were observed among the majority of OHP. Fully vaccinated individuals had a larger psychological burden than not fully vaccinated and those with unknown vaccination status. These findings can inform means and interventions to reduce negative impacts of fear in populations with a high psychological burden.

Understanding the impact of pediatric single large-scale mtDNA deletion syndromes on caregivers: Burdens and challenges.

Single large-scale mitochondrial deletion syndromes (SLSMDS) are ultra-rare, progressive multi-system diseases that make children largely dependent on their caregivers for both medical and non-medical needs. Yet, few studies have examined the burden felt among caregivers. As part of a larger research study, 42 caregivers of children with SLSMDS completed two surveys to assess caregiver burden. The Mitochondrial Care Network Patient Needs Survey (MCN-PNS) is a novel assessment that examines the logistical, time, and financial costs experienced by caregivers of children with SLSMDS. The Zarit Burden Interview (ZBI-22) is a validated assessment that examines caregivers' psychological health. Results demonstrate the unique burden experienced by caregivers of children with SLSMDS. One notable finding was the high psychological burden. Nearly 90% of caregivers experience psychological burden, with 20% of caregivers at risk for anxiety and depression. Caregivers were primarily concerned about what the future held for their child. Additional burdens included the time required to coordinate the child's healthcare visits and financial strains. Caregivers reported minimal delays in establishing care with a mitochondrial care specialist and felt confident in their understanding of their child's disease and treatment(s). Overall, there is a need for expanded logistical, financial, and psychological support from mitochondrial disease centers and advocacy groups for caregivers of children with SLSMDS.

Mental Health among Geriatric Healthcare Workers in Italy during the COVID-19 Pandemic: Results from a National Survey

ObjectivesThis study aimed to investigate the psychological impact of the COVID-19 pandemic on healthcare workers (HCWs) in geriatric settings.DesignOnline cross-sectional survey.Settings and Participants394 geriatric HCWs in Italy.MeasurementsThe survey was developed by a multidisciplinary team and disseminated in April 2022 to the members of two geriatric scientific societies (Italian Society of Geriatrics and Gerontology and Italian Association of Psychogeriatrics). The survey examined the experiences related to the COVID-19 pandemic, as well as psychological burden and support. Work-related anxiety and distress related to the pandemic were studied using the SAVE-9 scale (Stress and Anxiety to Viral Epidemics).ResultsThree hundred sixty-four participants (92.4%) changed their job activity during the pandemic and about half (50.9%) failed to cope with this change, 58 (14.7%) had increased work-related anxiety, and 39 (9.9%) work-related stress levels. Three hundred forty (86.3%) participants reported acute stress reaction symptoms, including irritability, depressed mood, headache, anxiety, and insomnia, and 262 (66.5%) required psychological support, mainly from friends/relatives (57.9%) and/or colleagues (32.5%). Furthermore, 342 participants (86.8%) recognized they would benefit from informal and formal psychological support in case of future similar emergencies.ConclusionsThis study highlights the high psychological burden experienced by geriatric HCWs in Italy during the COVID-19 pandemic and emphasizes the need for supportive interventions.

Bayesian model averaging for predicting factors associated with length of COVID-19 hospitalization

IntroductionThe length of hospital stay (LOHS) caused by COVID-19 has imposed a financial burden, and cost on the healthcare service system and a high psychological burden on patients and health workers. The purpose of this study is to adopt the Bayesian model averaging (BMA) based on linear regression models and to determine the predictors of the LOHS of COVID-19.MethodsIn this historical cohort study, from 5100 COVID-19 patients who had registered in the hospital database, 4996 patients were eligible to enter the study. The data included demographic, clinical, biomarkers, and LOHS. Factors affecting the LOHS were fitted in six models, including the stepwise method, AIC, BIC in classical linear regression models, two BMA using Occam's Window and Markov Chain Monte Carlo (MCMC) methods, and GBDT algorithm, a new method of machine learning.ResultsThe average length of hospitalization was 6.7 ± 5.7 days. In fitting classical linear models, both stepwise and AIC methods (R2 = 0.168 and adjusted R2 = 0.165) performed better than BIC (R2 = 0.160 and adjusted = 0.158). In fitting the BMA, Occam's Window model has performed better than MCMC with R2 = 0.174. The GBDT method with the value of R2 = 0.64, has performed worse than the BMA in the testing dataset but not in the training dataset. Based on the six fitted models, hospitalized in ICU, respiratory distress, age, diabetes, CRP, PO2, WBC, AST, BUN, and NLR were associated significantly with predicting LOHS of COVID-19.ConclusionThe BMA with Occam's Window method has a better fit and better performance in predicting affecting factors on the LOHS in the testing dataset than other models.

Cognition and psychological well-being in adults with post COVID-19 condition and analyses of symptom sequelae

Objective As the coronavirus disease 2019 (COVID-19) pandemic moves into its fourth year, gaining a better clinical understanding of individuals with post COVID-19 condition is paramount. The current study examined the neurocognitive and psychological status of adults with post COVID-19 condition, as well as explored the impact of high psychological burden on objective neurocognitive functioning and the relationship between subjective cognitive concerns and objective neurocognitive findings. Method Valid neuropsychological assessments were completed with 51 symptomatic adults who were 297.55 days, on average, following a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participants completed brief self-report depression, anxiety, and PTSD questionnaires, a questionnaire with subjective ratings of cognitive abilities, and standardized neurocognitive tests that examined performance validity, attention, processing speed, verbal learning and memory, naming, visual construction, and executive functioning. Results The participants were mostly Caucasian (80.39%), middle-aged (average 47.37 years), women (82.35%), who were never hospitalized (86.27%). Despite all individuals reporting cognitive problems in daily life, mean performances on objective testing did not reveal any neurocognitive deficits (at or below the 8th percentile) at a group level. Approximately half (49.02%) of the participants reported co-occurring mental health symptoms that were considered clinically elevated based on questionnaire results. High psychological symptom burden was associated with greater subjective cognitive difficulties but did not result in neurocognitive dysfunction on objective testing. Conclusions This study contributes to the literature regarding post COVID-19 condition in adults including the relationship between the cognitive and psychological symptoms. Results are summarized in key clinical learning points.

Symptom burden and end of life care in patients with acute myeloid leukemia undergoing intensive induction chemotherapy in a rural setting.

e24117 Background: Patients with acute myeloid leukemia (AML) who receive intensive induction chemotherapy (IC) face a prolonged hospitalization and a life-threatening illness. As a result, patients experience a high physical, psychological, and emotional symptom burden which can significantly affect their quality of life (QOL).1 There is also a high mortality rate associated with IC, with one study showing 12.3% chance of in-hospital death and 3.7% discharge to hospice.2 Early integration of palliative care (IPC) has shown improvements in QOL, decrease in psychological stress and improved end-of-life care.3 The aim of this study was to examine the historic use of IPC during IC and assess the symptom burden in a rural healthcare setting and to provide a rationale for early incorporation of palliative care into IC. Methods: We performed an IRB approved retrospective study of all patients with AML who were admitted to Gundersen Health System for IC from January 2013 to September 2021. Data collection included basic demographics, disease and treatment specific variables, and admission variables. Symptom burden was also assessed by reviewing daily progress notes. Statistical analysis included descriptive statistics, Wilcoxon signed-rank test, and Fisher’s exact test and was performed in SAS version 9.4 at a significance level of 0.05. Results: Our study included 33 patients with an average age of 62 years. Our sample was 100% white, 58% male, 82% married and 58% former smokers. Average length of stay was 29 days and 5 (15%) patients died during this time. Individuals experienced an average of 9.8 (range 4-17) of the 20 recorded symptoms, most commonly pain (97%), fevers (88%), edema (73%), anorexia (67%), rash (61%), and diarrhea (61%). Only 6 patients (18%) received a palliative care consultation during IC. For patients without a palliative care consultation during IC, advanced care planning (ACP) documents were found in only 37% during or before IC. However, when palliative care was consulted, ACP documentation increased to 83% demonstrating a trend towards significance (p = 0.07). There was a significant difference between the number of symptoms observed in those who received a palliative care consultation (median = 13 symptoms) and those who did not (median = 9 symptoms, p = 0.007). Conclusions: Despite our patients experiencing a high symptom burden and a significant chance of death, there was a low rate of early integration of palliative care. This retrospective study was unable to determine if IPC improved symptom burden, but we did find that IPC increased the rate of ACP documentation from 37% to 83%. The presence of ACP documentation has been shown to significantly reduce ICU utilization and improve the quality of care at the end of life.4 Given these findings; we plan to move forward with routine integration of palliative care into the management of patients undergoing IC for AML.

Prevalence and characteristics of paediatric X-linked hypophosphataemia in Australia and New Zealand: Results from the Australian and the New Zealand Paediatric Surveillance Units survey

BackgroundX-linked hypophosphataemia (XLH) is the most common heritable form of rickets. Prevalence data varies across the literature between 1 in 20,000 and 1 in 200,000 per population. MethodsAustralian and New Zealand Paediatric Surveillance Units collected cross-sectional data from paediatricians on existing cases to estimate prevalence and characteristics of paediatric XLH in Australia and New Zealand. ResultsSeventy-five cases in Australia and 18 cases in New Zealand were identified. Estimated minimum prevalence based on these cases was 1.33 (1.04–1.66) per 100,000 and 1.60 per 100,000 (95%CI 0.97–2.58) in Australia and New Zealand respectively, with actual prevalence likely higher due to incomplete ascertainment. Despite a family history in most cases, delayed diagnosis was common, with 49 % diagnosed after 2 years of age. Delayed diagnosis was more common in sporadic versus familial cases. Most common clinical characteristics included leg bowing (89 %), bone and joint pain (68 %), abnormal gait (57 %) and short stature (49 %). There was a significant burden of orthopaedic disease and surgeries and a high rate of complications of nephrocalcinosis and hyperparathyroidism (32 % and 20 % respectively). Additionally, while guidelines stress the importance of multidisciplinary care, many did not have access to recommended health professionals, with only 3 % seeing a psychologist and 68 % seeing a dentist. This is despite the high psychological burden of XLH and a significant proportion (41 %) of this cohort having dental issues (tooth abscess, dental capping, tooth extraction).There were two cases from NZ without data available. Of the 91 cases with data collected, 46 % were on burosumab therapy. Consistent with clinical trials, those on burosumab had a higher serum phosphate levels (p < 0.001) at most recent follow-up. Three cases reported cancellation of orthopaedic surgery due to improvement in lower limb deformity after commencement of burosumab. ConclusionThese data describe the multisystem burden of disease for children with XLH with care impacted by delayed diagnosis and a lack of access to many health professionals, especially psychological support.

Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study.

Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients' homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits. Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson's Chi-square test. Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life. We conclude that the distance of IDHwt glioma patients' homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care.

Real-world systemic treatment of patients with psoriasis: A retrospective study based on German claims data.

Psoriasis is a common skin disorder with a high physical and psychological burden for patients. Up to 30% of the patients are candidates for a systemic treatment. The aim of this study was to describe the characteristics and the real-world systemic treatment of psoriasis patients. This study was based on German medical claims data. A cross-sectional analysis observed all psoriasis patients in 2020. A longitudinal analysis was conducted, addressing psoriasis patients who newly started a systemic treatment. In total, 116,507 prevalent psoriasis patients and 13,449 newly treated patients were followed. Of all prevalent patients, 15.2% received systemic treatment in 2020 (8.7% systemic corticosteroids). Of the newly treated patients, 95.2% started with conventional treatment (79.2% systemic corticosteroids), 4.0% with biologics and 0.9% with apremilast. The rate of treatment discontinuation/switch after one year was highest for corticosteroids (91.3%) and lowest for biologics (23.1%). Around 15% of psoriasis patients in Germany received a systemic treatment, with >50% of these prescribed systemic corticosteroids. Therefore, we conclude that systemic treatment is not in line with guideline recommendations in a substantial number of observed patients. The lowest discontinuation/switch rates for biologics support their wider use.

Influence of resilience on perceived stress and depression among Taiwanese army military personnel.

Resilience has been reported to attenuate psychological burden and promote mental health. Military personnel constitute a population with a high psychological burden and poor sleep quality and are thus at a high risk of depression. This study is aim to examine the mechanism underlying the effects of resilience on perceived stress, sleep quality, and depression among Taiwanese army military personnel. A cross-sectional survey was conducted between May 2020 and February 2021. Participants comprised 1505 voluntary army military service personnel aged 20years or older; they completed self-reported questionnaires measuring their perceived stress, resilience, sleep quality, and depression. Data were analysed using structural equation modelling. The results indicated that the association between resilience and depression was partially mediated by perceived stress and sleep quality. Perceived stress is a significant mediator on the association between resilience and depression. A high level of sleep disturbance was observed in this population and results found that sleep quality showed a slight partial mediation effect on the association between resilience and depression. Resilience can alleviate the effects of stress, which in turn alleviates depression among military personnel. Promoting resilience-enhancing education and mitigating environmental barriers to sleep is essential for reducing depressive symptoms among military personnel.

MP22-16 FINANCIAL TOXICITY IN BLADDER CANCER: ASSOCIATIONS WITH QUALITY OF LIFE AND TIME SINCE CANCER DIAGNOSIS

You have accessJournal of UrologyCME1 Apr 2023MP22-16 FINANCIAL TOXICITY IN BLADDER CANCER: ASSOCIATIONS WITH QUALITY OF LIFE AND TIME SINCE CANCER DIAGNOSIS Stephanie Banks, Weizhou Tang, Kailyn Koh, Leora Steinberg, John L. Gore, Siamak Danneshmand, Ricky Bluthenthal, Reginald Tucker-Seeley, and Sumeet K. Bhanvadia Stephanie BanksStephanie Banks More articles by this author , Weizhou TangWeizhou Tang More articles by this author , Kailyn KohKailyn Koh More articles by this author , Leora SteinbergLeora Steinberg More articles by this author , John L. GoreJohn L. Gore More articles by this author , Siamak DanneshmandSiamak Danneshmand More articles by this author , Ricky BluthenthalRicky Bluthenthal More articles by this author , Reginald Tucker-SeeleyReginald Tucker-Seeley More articles by this author , and Sumeet K. BhanvadiaSumeet K. Bhanvadia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Financial toxicity (FT) in cancer survivors is associated with low quality of life and poor cancer outcomes. Although bladder cancer is a common malignancy that usually involves costly treatment over a long period of time, there is limited data characterizing the nature of FT in these patients. Our objective was to investigate the relationship between FT and quality of life and assess if FT grew with time since cancer diagnosis. METHODS: Bladder cancer patients were prospectively recruited from an NCI-designated cancer center. Validated measures of the Comprehensive Score for Financial Toxicity (COST) and Bladder Cancer-specific Functional Assessment of Cancer Therapy (FACT-Bl) were used to assess FT and health-related quality of life (HRQOL), respectively. Additional demographic and clinical data were collected from medical records. Bivariate and multivariable logistic regression analyses were used to examine associations between questionnaires and sub-components. Logistic regression analysis was used to assess the relationship between FT and time since cancer diagnosis. RESULTS: 100 patients completed baseline questionnaires. We defined a prior high financial hardship as >75th percentile of COST and used the study mean for FACT-Bl. On bivariate analyses, COST scores were negatively correlated with the FACT-Bl total score (r=-.345, p=.0005), physical domain (r=-.287, p=.004), social domain (r=-.341, p=.0005), and functional domain (r=-.217, p=.032). Logistic regression analysis showed low physical well-being (physical domain of FACT-Bl) was associated with high FT-related psychological burden (psychological domain of COST) after adjusting for age, sex, race, education, and working status (OR: 3.556 CI: 1.128, 11.218; p<.05). Finally, patients over 1 year from diagnosis were more likely to endorse not feeling in control of their finances (single COST item) when controlling for race, sex, language, education, and treatment facility (OR 2.936, CI 1.010, 8.538; p<.05) on logistic regression analysis. CONCLUSIONS: High FT is associated with low HRQOL. Specifically, patients experiencing high psychological aspects of FT are more likely to experience low levels of physical wellbeing. Furthermore, as time since cancer diagnosis grows, patients are less likely to report feeling in control of their financial situation, reinforcing the uniquely high burden of survivorship in bladder cancer. Source of Funding: Grants from the Bladder Cancer Advocacy Network and the Wright Foundation/Southern California Clinical and Translational Science Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e303 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephanie Banks More articles by this author Weizhou Tang More articles by this author Kailyn Koh More articles by this author Leora Steinberg More articles by this author John L. Gore More articles by this author Siamak Danneshmand More articles by this author Ricky Bluthenthal More articles by this author Reginald Tucker-Seeley More articles by this author Sumeet K. Bhanvadia More articles by this author Expand All Advertisement PDF downloadLoading ...

Novel Symptom Subgroups in Individuals With Irritable Bowel Syndrome Predict Disease Impact and Burden

Current classification systems based on bowel habit fail to capture the multidimensional nature of irritable bowel syndrome (IBS). We previously derived and validated a classification system, using latent class analysis, incorporating factors beyond bowel habit. We applied this in another cohort of people with IBS to assess its ability to capture the impact of IBS on the individual, the health care system, and society. We collected demographic, symptom, and psychological health data from adults in the community self-identifying as having IBS, and meeting Rome IV criteria. We applied our latent class analysis model to identify the 7 subgroups (clusters) described previously, based on overall gastrointestinal symptom severity and psychological burden. We assessed quality of life, health care costs (£1 = $1.20), employment status, annual income, work productivity, and ability to perform work duties in each cluster. Of 1278 responders, 752 (58.8%) met Rome IV criteria. The 7-cluster model fit the data well. The patients in the 4 clusters with the highest psychological burden, and particularly those in cluster 6 with high overall gastrointestinal symptom severity and high psychological burden, showed lower educational levels, higher gastrointestinal symptom-specific anxiety, were more likely to have consulted a gastroenterologist, and used more drugs for IBS. IBS-related and generic quality of life were impaired significantly in these 4 clusters and significantly fewer individuals reported earning ≥£30,000 per year. Productivity and the ability to work, manage at home, engage in social and private leisure activities, and maintain close relationships all were impacted significantly, and IBS-related health care costs over the previous 12 months were highest in these 4 clusters. In those in cluster 6, costs were more than £1000 per person per year. Our clusters identify groups of individuals with significant impairments in quality of life, earning potential, and ability to work and function socially, who are high utilizers of health care.

The Partner Perspective on Autologous and Implant-Based Breast Reconstruction.

Partner involvement in the decision-making process concerning breast reconstruction (BR) after a breast cancer diagnosis may be very supportive for the patient. So far, no study evaluates partner satisfaction with the outcome after BR and the relationship to patient satisfaction. The aim of this study was to assess and compare partner satisfaction of BR with autologous tissue (ABR) and prosthetic implants (IBR), respectively, and compare it to patient-reported outcomes. All patients undergoing ABR and IBR between January 2014 and December 2020 were asked to participate with their partners. Patient and partner satisfaction with breast reconstruction, overall outcome as well as patient's perceived and self-reported psychosocial well-being were evaluated using the Breast-Q and a modified partner questionnaire, respectively. Fifty-three couples participated (IBR: n=30, ABR: n = 23). Patient and partner satisfaction with breast (r = 0.552), outcome (r = 0.465) as well as patient's perceived and self-report psychosocial well-being (r = 0.495) were highly correlated with partners scoring significantly higher (p<0.001). In terms of partner satisfaction, both reconstructive procedures achieved satisfactory results. ABR scored higher in terms of softness of breast and how natural the breast feels to touch whereas IBR was rated superior evaluating the breast size. Both reconstructive procedures achieve satisfactory results in terms partner satisfaction whereas patient's psychosocial well-being was highly overestimated by their partners. Hence, partner inclusion in the regular psycho-oncological support might further sensitize them of the high psychological burden of a breast cancer diagnosis and therefore stabilize patients private support system. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Die unsichtbaren Verantwortlichen: Angehörige in der Berichterstattung über Demenzen

Dementia is a challenge for society, and care provision in particular is a major task. People with dementia are often cared for at home, and the professional care situation in Germany is tensed – for example, relatives are often involved in care themselves or provide care alone, which means a high physical and psychological burden. Despite their important role in care, they have no established lobby to represent them in health and social policy. An important channel for raising public awareness nonetheless is media coverage, through which the general public can be reached. Therefore, this study addresses the question whether relatives of people with dementia are visible in the coverage or which actors are visible in general. For this purpose, a quantitative content analysis of German print coverage was conducted. The results show that relatives tend to be underrepresented and appear more as case studies; structurally, they are not represented at all in the media coverage by associations or institutions. This is where future communication measures can come in to increase visibility in a targeted manner.

Quality of Life Assessments Utilized in Vitiligo Clinical Trials

Introduction. Vitiligo is an acquired autoimmune disease associated with high psychosocial burden. As novel treatments are being developed in clinical trials, assessing vitiligo disease burden extends beyond physical manifestations. Including quality of life (QoL) measures in vitiligo clinical trials can better capture disease‐specific psychosocial concerns and facilitate cross comparisons amongst interventions. Objective. To determine the frequency and types of QoL measures utilized in vitiligo clinical trials and comment on how this has changed longitudinally. Methods. A search of vitiligo clinical trials using clinicaltrials.gov was conducted. Phase 2 and phase 3 trials published in English from January 2000 to July 2023 were eligible for this review. Characteristics of clinical trial parameters were compared to those of non‐QoL reporting clinical trials using Pearson’s χ2 tests (or Fisher’s if low n). Results. A total of 60 clinical trials were eligible for this review, of which 40% included a QoL measure in their study design. Phase 3 clinical trials (p = 0.002), larger (100+ participants) trials (p = 0.063), U.S. trials (p = 0.029), and pharmaceutical interventions (p = 0.022) were more likely to include QoL measures in their design. The number of clinical trials has been increasing over time, with 8 trials from 2000 to 2010, 32 total trials from 2011 to 2020, and 20 trials from 2021 to 2023. The most commonly used QoL measures were the Dermatology Life Quality Index (DLQI, 55.2%), Children′s Dermatology Life Quality Index (CDLQI, 13.8%), and Vitiligo‐specific quality of life instrument (VitiQoL, 13.8%). Over time, the VitiQoL and CDLQI have been used more frequently. Conclusion. Although vitiligo is associated with high psychological and emotional burden, less than half of vitiligo trials utilize QoL measures. The general dermatology QoL measures, namely the DLQI and CDLQI, are the most commonly used QoL assessments. As the number of clinical trials is increasing, vitiligo‐specific questionnaires may better capture unique vitiligo‐specific concerns. Standardizing the types of and implementation of QoL questionnaires in clinical trials can aid in assessing outcome measures across clinical trials worldwide and allow for better data interpretation, comparability, and clinical application of results.

Network pharmacology to explore the mechanism of traditional Chinese medicine in the treatment of ground glass nodules.

Ground glass nodules (GGNs) in the lung are considered to be a high-risk factor of lung adenocarcinoma. Immediate surgery is not recommended for GGNs patients, and low-dose computed tomography (CT) is often used for observation and follow-up, which brings high psychological and economic burden to the patient. Three traditional Chinese medicine (TCM) prescriptions for the treatment of GGNs were found through database including PubMed, Google Scholar, and China National Knowledge Infrastructure (CNKI), Scopus and so on. The possible targets of the active ingredients of the TCM preparations and the gene targets of GGNs were screened out from Traditional Chinese Medicine Systems Pharmacology (TCMSP), UniProt and GeneCards. Network visualization was realized via STRING, Cytoscape 3.7.2, Evenn, DAVID and Hiplot. Finally, molecular docking Vina and PyMOL software were performed to further explore the possibility of drug-target interactions using PubChem compounds, protein data bank (PDB) database, Autodocktools and Autodock. Three TCM preparations could target the same 13 potential therapeutic targets in GGNs. From network pharmacology, 14 signaling pathways, the functions of the significant targets, an effective ingredient in TCM prescriptions and its functions were obtained. Chinese herbal formulas containing quercetin could be a potential treatment for GGNs, targeting C-reactive protein (CRP), tumor necrosis factor (TNF), interferon gamma (IFN-γ), intercellular adhesion molecule 1 (ICAM-1), and vascular endothelial growth factor A (VEGFA) through the hypoxia-inducible factor 1 (HIF-1) pathway, mitogen-activated protein kinase (MAPK) signaling pathway, and leukocyte transendothelial migration.

The Effect of Metabolic Persian Diet on Ovulation Induction in Infertile Women.

Infertility is an important issue with a high social and psychological burden. From the perspective of Persian Medicine (PM), uterine cold temperament is one of the important causes of female infertility. The aim of this study was to study the effect of PM or Iranian traditional medicine on improving ovulation and fertility. From January 2017 to August 2017, sixty infertile women with eugonadotropic ovulation disorder were randomly divided into two groups. Both groups were treated with clomiphene citrate, except that the intervention group also received metabolic Persian diet (MPD). In each cycle, the dominant follicles and endometrium were investigated with ultrasound. At the end of the cycle, beta human chorionic gonadotropin (β-HCG) was evaluated and if positive, another ultrasound was performed two weeks later to confirm early pregnancy. The number of dominant follicles from the first to third cycle increased from 2.15 ± 1.14 to 2.28 ± 0.61 in the intervention group and decreased from 1.86 ± 0.79 to 1.30 ± 0.47 in the control group. The dominant follicle size changed from 16.00 ± 4.08 to 18.78 ± 2.78 and from 15.05 ± 3.11 to 15.80 ± 3.89 in the intervention and control groups, respectively. But endometrial thickness did not change significantly in the intervention group. Pregnancy results based on β-HCG and ultrasound findings were positive in 19 and 16 patients in the intervention group and in 10 and 7 patients in the control group, implying significantly higher numbers in the first group. It seems that MPD may be effective in the success of ovulation induction.

Alternative Psychotherapeutic Approaches to the Treatment of Eczema.

Patients with eczema suffer from high psychological burden, often caused and exacerbated by chronic pruritus, which leads to a vicious itch-scratch cycle. Although much of the literature focuses on treating the physiological factors that lead to pruritus, little attention has been given to the cognitive, behavioral, and social factors associated with the itch-scratch cycle. We conducted a literature review to investigate whether treatments aimed at psychosocial factors could be effective for patients with eczema. A systematic literature review was conducted through PubMed and EMBASE. Original investigative articles that focused on psychotherapeutic interventions for eczema and/or eczema-related psychological morbidities were reviewed. Psychotherapeutic interventions alongside standard medical care are shown to be beneficial compared to conventional treatments alone, both for eczema and for eczema-associated psychological symptoms. Such interventions include meditation and mindfulness, stress-reduction, habit-reversal training, hypnotherapy, music therapy, massage therapy, and standard psychological treatments such as cognitive behavioral therapy. It is important to recognize the reciprocal relationship between eczema and psychosocial distress. Alternative treatment options to address psychological factors associated with eczema can improve disease trajectory and quality of life.

Positive mental health and mindfulness as protective factors against addictive social media use during the COVID-19 outbreak.

The outbreak of COVID-19 caused high psychological burden for many people. Some people tend to excessive social media use (SMU) to escape the negative emotions which can foster addictive tendencies. The present study investigated positive mental health (PMH) and mindfulness as protective factors that could reduce the risk for addictive SMU. Data of 1,049 participants from Germany were assessed via online surveys in autumn 2021. The current results reveal a positive relationship between COVID-19 burden and addictive SMU. Both were negatively linked to PMH and mindfulness. In a moderated mediation analysis, the relationship between COVID-19 burden and addictive SMU was mediated by PMH. Mindfulness moderated the association between PMH and addictive SMU. The COVID-19 situation can be burdensome and contribute to dysfunctional coping strategies such as addictive SMU. However, PMH and mindfulness serve as protective factors. The protective effect of mindfulness could be especially important for persons with low PMH.

Gaps in the Assessment and Monitoring of Cardiovascular Risk and Psychological Burden in Polycythemia Vera: Landmark 2.0, a Worldwide Health Survey

INTRODUCTION: Patients (pts) with polycythemia vera (PV) have a significantly higher risk of thrombosis than the general population, and cardiovascular (CV) events are the main cause of death. Pts with PV also report reduced quality of life (QoL) due to high symptom and psychological burden. This analysis of the LANDMARK 2.0 survey examines patterns related to assessments of CV risk and PV-related psychological burden in pts with PV. METHODS: LANDMARK 2.0 is an online survey of MPN pts and treating physicians that was conducted in 11 countries between April 2021-May 2022. This analysis included pts with PV aged 18-89 years (yrs), and physicians who were actively managing PV pts within 12 months (mos) prior to the survey. Pts were stratified into 3 therapy (tx) stages: currently receiving first-line cytoreductive tx for ≤1 yr (PV-C), currently receiving second-line tx for ≤1 yr (PV-I), or currently receiving any line of tx for >1 yr (PV-M). RESULTS: Overall, 133 physicians and 274 pts with PV (PV-C, n=86; PV-I, n=26; PV-M, n=162) completed the survey. At survey completion, the median age of pts was 63, 59, and 64 yrs in the PV-C, PV-I, and PV-M groups, respectively, and the median time since PV diagnosis was 10.8, 39, and 91 mos, respectively. Most common treatments across all tx stages were hydroxyurea and ruxolitinib. Phlebotomies were received by 53%, 31%, and 29% pts in PV-C, PV-I, and PV-M stages, respectively, with a mean number of 4.2, 3.4, and 4.6 phlebotomies, respectively, in the past 12 mos. During routine visits, basic CV assessment (e.g. blood pressure and cholesterol) was ever performed by 53% of physicians treating PV-M pts, 77% physicians treating PV-C pts, and 62% physicians treating PV-I pts, and comprehensive CV assessment (i.e. electrocardiogram and/or echocardiogram) was ever performed by 32%, 60%, and 47% of physicians, respectively (Fig 1). Among physicians who never conducted basic (n=21) or comprehensive (n=40) CV assessments, 38% and 43%, respectively, considered the assessment unnecessary, 38% and 15%, respectively, cited insufficient time as reason, and 36% and 19%, respectively, cited insufficient resources. Among all physicians, 68% and 63%, respectively, did not think that basic or comprehensive CV tests could be used more effectively in pt management. In contrast to physicians' responses, only 55% of pts across tx stages reported having ever received basic CV tests during routine visits. Fewer pts in PV-M received advice on reducing CV risk (45% in the last 12 mos) vs pts in PV-C and PV-I (73% and 69%, respectively, in the last 6 mos). When asked about the burden of PV on QoL on a scale of 1 (no impact) to 5 (significant impact), a large proportion of pts reported an impact of 3-5 on emotional well-being and mental health, in particular those in PV-C (66%) and PV-I (80%). Overall, 38% of pts rated the impact of phlebotomy on QoL as 3-5, but only around a third of physicians (PV-C, 33%; PV-I, 28%; PV-M, 36%) reported ever having assessed the emotional burden of phlebotomy. Among respondents who had ever carried out/received a psychosocial burden assessment during routine visits, there was a discordance in the perceived frequency of these tests, with fewer pts than physicians reporting the assessment being performed 'always' or 'often' (discordance of -32%, -75% and -23% in the PV-C, PV-I, and PV-M groups, respectively; Fig 2). With respect to the support received for PV-related psychological burden, only 52% of pts reported being 'somewhat' or 'very' satisfied. More pts vs physicians reported a lack of communication on self-help strategies in PV-I (36% vs 12%) or on the rationale for having performed specific tests in PV-I (20% vs 8%) and PV-C (24% vs 9%). CONCLUSIONS: Whilst international recommendations recognize the need to control CV risk factors, there is no standard recommendation on how to monitor CV risk in PV, highlighting an unmet need. These results show that CV-risk testing and education on CV-risk minimization are not routinely performed throughout the treatment continuum, in particular in pts who are stabilized on long-term maintenance tx. Additionally, our findings indicate a discordance between pts and physicians in the perceived importance of PV-related QoL assessments. Pt care may be enhanced with regular assessments throughout treatment and increased communication between pts and physicians. Study funding: Novartis Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal