General Health Measures Research Articles

Experiences of shifts in physiotherapy for rheumatoid arthritis over time – an autoethnography

ABSTRACT Introduction Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. Objective This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author’s work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. Methods A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. Results The storyline from the 1980s to approximately the turn of the millennium is called ‘Shifts determined mainly by clinical context-driven events’ which occurred in response to medical advances and physiotherapists’ clinical experiences. These shifts were later justified by physiotherapists’ research in the clinical context. The other storyline covers mainly the 2000s and is called ‘Shifts increasingly determined by events beyond clinical physiotherapy context.’ They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. Conclusion These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities.

The Impact of Fertility Goals on Long-term Quality of Life in Reproductive-aged Women Who Underwent Myomectomy versus Hysterectomy for Uterine Fibroids

Study ObjectiveThe objective of this study is to compare quality of life (QOL) for myomectomy with hysterectomy 1 to 5 years after surgical management for fibroids. This study evaluated the difference in QOL in a population of women of reproductive age, including those who desire fertility. DesignA retrospective cohort study. InterventionsNot applicable. SettingA large academic hospital. PatientsA total of 142 women who underwent hysterectomy or myomectomy in 2015 to 2020. Included patients were women aged 18 years or older who underwent surgical intervention owing to uterine fibroids. Measurements and Main ResultsThe 36-Item Short Form Health Survey (SF-36) provides a total score as a single measure of health-related QOL. The Uterine Fibroid Symptom Quality of Life Questionnaire for Hysterectomy and Myomectomy (UFS-QOL) is a patient-reported outcome measure of fibroid symptoms and health-related QOL after hysterectomy and myomectomy. There was no significant difference in SF-36 QOL scores in women after myomectomy who desired fertility compared with those who did not desire fertility, except in the social functioning domain (p = .025). UFS-QOL scores in women after myomectomy who desired fertility were not significantly different compared with women after myomectomy who did not desire fertility (p = .37). There were no significant differences between women who underwent myomectomy and hysterectomy in overall QOL scores on the SF-36 (p = .13) and UFS-QOL scores (p = .16). ConclusionMyomectomy is not associated with significant differences in measures of general health and QOL compared with hysterectomy, making it a viable fibroid management option for women who desire fertility. Our study highlights the importance of discussing fertility goals and QOL when counseling patients for surgical fibroid treatment.

Quality of life measures in dysplastic Barrett’s oesophagus are comparable to patients with non-dysplastic Barrett’s oesophagus and do not improve after endoscopic therapy

ObjectiveBarrett’s oesophagus (BO) is a precursor lesion, via dysplastic phases, to oesophageal adenocarcinoma. Although overall risk from BO is low, it has been shown to adversely affect health-related quality of...

Impact of Elotuzumab Plus Pomalidomide/Dexamethasone on Health-related Quality of Life for Patients With Relapsed/Refractory Multiple Myeloma: Final Data From the Phase 2 ELOQUENT-3 Trial.

Triplet regimens containing immunomodulatory drugs and proteasome inhibitors (PIs) have improved outcomes and extended survival for patients with relapsed/refractory multiple myeloma (RRMM). We evaluated updated health-related quality of life (HRQoL) findings from the phase 2 ELOQUENT-3 clinical trial (NCT02654132) after 4 years of treatment with elotuzumab plus pomalidomide and dexamethasone (EPd) and assessed the impact of the addition of elotuzumab on patients' HRQoL. HRQoL was assessed as an exploratory endpoint using the MD Anderson Symptom Inventory for Multiple Myeloma (MDASI-MM), which evaluates symptom severity, symptom interference, and HRQoL, and the 3-level EQ-5D, a patient-reported measure of health utility and general health. Statistical analyses included descriptive responder, longitudinal mixed-model, and time-to-first-deterioration (TTD) analyses using prespecified minimally important differences and responder definitions. Of 117 randomized patients, 106 (EPd, n = 55; pomalidomide and dexamethasone [Pd], n = 51) were eligible for inclusion in HRQoL analyses. Completion rates at almost all on-treatment visits were ≥80%. The proportion of patients treated with EPd who improved or maintained stable HRQoL until cycle 13 ranged from 82% to 96% for MDASI-MM total symptom score and 64% to 85% for MDASI-MM symptom interference. Across measurements, there were no clinically meaningful differences in changes from baseline between treatment arms, and TTD was not significantly different for EPd versus Pd. In conclusion, HRQoL was not impacted by the addition of elotuzumab to Pd and did not significantly deteriorate in patients with RRMM previously treated with lenalidomide and a PI in ELOQUENT-3.

Energy poverty: an overlooked determinant of health and climate resilience in Canada

ObjectiveDespite Canada being an important energy producer, not all Canadians can access or afford adequate levels of energy services at home to meet their needs, maintain healthy indoor temperatures, and live a decent life—a situation known as energy poverty. Depending on the measure, 6–19% of Canadian households face energy poverty. Health risks associated with energy poverty are documented in countries with milder climates. This study explores, for the first time in the Canadian context, the association between energy poverty and health.MethodsCross-sectional data are from the 2018 Canadian Housing Survey. Analyses are conducted on a sample weighted to represent 14 million Canadian households. The associations between expenditure-based and self-reported measures of energy poverty and self-rated general and mental health were assessed using logistic regression models, adjusted for potential confounding variables.ResultsThe odds of rating one’s general (OR: 1.48; 95%CI: 1.29, 1.70) and mental (OR: 1.21; 1.04, 1.41) health as poor are significantly higher for Canadian adults in households with a high share of energy expenditure to income. The likelihood of poor general and mental health was significantly higher for those dissatisfied with the energy efficiency of their dwelling, and with their ability to maintain a comfortable temperature both in the winter and in the summer.ConclusionExposure to energy poverty is associated with significantly increased likelihood of poor general and mental health. Given the high proportion of Canadian households facing energy poverty, with demonstrated implications for population health, tackling energy poverty is essential for an equitable energy transition and for climate resilience.

Mapping of disease-specific Oxford Knee Score onto EQ-5D-5L utility index in knee osteoarthritis

BackgroundEQ5D is a generic measure of health. It provides a single index value for health status that can be used in the clinical and economic evaluation of healthcare. Oxford Knee Score (OKS) is a joint-specific outcome measure tool designed to assess symptoms and function in osteoarthritis patients after joint replacement surgery. Though widely used, it has the disadvantage of lacking health index value. To fill the gap between functional and generic questionnaires with economic value, we linked generic EQ-5D-5L to the specific OKS to give a single index value for health status in KOA patients.Questions/purposesDeveloping and evaluating an algorithm to estimate EuroQoL generic health utility scores (EQ-5D-5L) from the disease-specific OKS using data from patients with knee osteoarthritis (KO).Patients and methodsThis is a cross-sectional study of 571 patients with KO. We used four distinct mapping algorithms: Cumulative Probability for Ordinal Data, Penalized Ordinal Regression, CART (Classification and Regression Trees), and Ordinal random forest. We compared the resultant models’ degrees of accuracy.ResultsMobility was best predicted by penalized regression with pre-processed predictors, usual activities by random forest, pain/discomfort by cumulative probability with pre-processed predictors, self-care by random forest with RFE (recursive feature elimination) predictors, and anxiety/depression by CART with RFE predictors. Model accuracy was lowest with anxiety/depression and highest with mobility and usual activities. Using available country value sets, the average MAE was 0.098 ± 0.022, ranging from 0.063 to 0.142; and the average MSE was 0.020 ± 0.008 ranging from 0.008 to 0.042.ConclusionsThe current study derived accurate mapping techniques from OKS to the domains of EQ-5D-5L, allowing for the computation of QALYs in economic evaluations. A machine learning-based strategy offers a viable mapping alternative that merits further exploration.

Childhood health conditions and insomnia among adults in mid-life

BackgroundLittle is known regarding the influence of childhood health broadly and childhood health conditions specifically on insomnia throughout adulthood. MethodsHealth and Retirement Study (HRS) Baby Boomers born 1954–1965 were investigated. We fitted regression models predicting self-reported insomnia based on twenty-three retrospectively reported specific childhood health conditions (e.g., measles) and general childhood health measures and adjusted for demographics, childhood socioeconomic status, and adult socioeconomic status. ResultsNearly all the measures of childhood health significantly increased insomnia symptoms in adulthood. In a model where all measures were included, we found that respiratory disorders, headaches, stomach problems, and concussions were particularly strong predictors of insomnia. ConclusionsOur findings extend past work illustrating the “long arm” of childhood conditions for health, showing that specific health conditions in childhood may indelibly imprint insomnia risk.

PSYCHOSOCIAL AND BEHAVIORAL INDICATORS OF CHRONIC PAIN AMONG MIDDLE-AGED AND OLDER BLACK MEN

Abstract There is a lack of data describing the pain experience of Black men. This may be the result of social messaging that men are to project strength and avoid any expression of emotion or vulnerability. This avoidant behavior(s) however, often comes too late when illness/symptoms are more aggressive and/or diagnosed at a later stage. This begins to address two larger issues – the willingness to acknowledge pain and to seek medical attention when experiencing pain. To address this lack of data, this study aimed to determine the influence psychosocial indicators have in the pain experience of Black men 40+ years old. Participants from the Active & Healthy Brotherhood study were categorized based on the pain question from the Health-Related Quality of Life Questionnaire. Demographics, general health, and psychosocial measures were compared across pain groups. A multivariable logistic regression model was used to determine predictors of pain, while adjusting for other factors. Results showed that the men (n=303) were mostly married (54%) and employed (53%). Those reporting arthritis (OR=4.5; 95% CI 2.0, 10.0), good health (2.8; 1.2, 6.6), higher somatization (3.2; 1.2, 8.8) compared to excellent/very good self-rated health, were more likely to self-report pain in the past 30 days. Findings from this study show that continued efforts are needed to identify the unique pain experiences of Black men, while recognizing the impact it has on their identity as a man, a person of color, and as a person living with pain.

Quality of Life of Saudi Women With Chronic Lower Urinary Tract Symptoms.

Background Chronic lower urinary symptoms (LUTS) are reported to affect more than half of women of all ages and have a significant impact on their quality of life (QoL). We aimed in this study to assess the QoL of adult Saudi women with chronic LUTS. Methods A cross-sectional study was done on 390 female patients diagnosed with LUTS at three tertiary care hospitals in Riyadh, Saudi Arabia, from October to December 2021. LUTS are classified into three categories: symptoms related to bladder storage (increased daytime frequency, nocturia, and urinary incontinence [UI]), symptoms of bladder voiding (hesitancy, extended micturition time, and insufficient emptying), and symptoms involved in the post-urination phase such as post-micturition dribbling. The data was collected using a self-administered questionnaire which comprised demographic characteristics, International Prostate Symptom Score (IPSS) for assessment of LUTS severity, and King's Health Questionnaire (KHQ) for assessment of QoL. Results After analyzing the study results, we found that symptoms were mild, moderate, and severe in 11%, 51%, and 39% of participants, respectively. Increased age and parity were found to have a significant association with increased symptom severity (p-value <0.05). The current study reported a moderate effect of LUTS on QoL. There was a significant correlation between increased symptom severity and negative impact on QoL, excluding the personal relationships domain. The highest scores in KHQ, which indicate worse QoL, were found in the domains of incontinence impact and emotions, while the lowest scores, which indicate better QoL, were found in the domains of social limitations and severity measures. Employed females were found to have worse QoL in the severity measures domain, which refers to the degree of urinary symptoms affecting day-to-day functioning. In addition, younger age, below 45 years, was found associated significantly with better QoL, especially in the domains of general health, personal relationships, and severity measures. Conclusion In the current study, the majority of patients reported moderate symptoms severity. Chronic LUTS have a significant impact on the QoL of Saudi women in many aspects, including physical, social, and emotional health, especially for those who have moderate to severe symptoms. Healthcare providers should assess high-risk women for the presence of LUTS. Furthermore, we recommend evaluating the QoL of patients with LUTS as a part of routine management.

Acute Mesenteric Ischemia: Preexisting Comorbidity Determines Short-Term Outcome and Quality of Life in Long-Term Survivors

Introduction: Acute mesenteric ischemia (AMI), either arterial or venous, is still a devastating disease with poor prognosis. It is unknown, whether AMI is associated with impaired quality of life (QoL) in long-term survivors. Material and Methods: This retrospective analysis includes 64 patients with occlusive arterial or venous mesenteric ischemia treated operatively between 2008 and 2016 at the University Medical Center Rostock. Short-term outcome with focus on comorbidities was measured by the Charlson comorbidity index (CCI) an instrument that operationally measures comorbidity based on 17 clinical parameters including age. Operative outcome in view of enterostomy placement and long-term outcome measured as QoL by the EQ-5D in the long-term survivors were evaluated. The EQ-5D is a standardized, self-reported five-dimension QoL questionnaire built to provide a simple and generic measure of health. Results: Thirty-day mortality was 60.9%, and in-hospital mortality was 70.3% (n = 45). No patient was discharged with a stoma. Patients with a primary anastomosis after the initial operation for AMI had a high leak rate of 27% (4/15 patients) compared to no dehiscence in the group of patients who had secondary anastomosis during second or third laparotomy. The long-term survivors had significantly lower CCI compared to the 45 nonsurvivors (median 4 [3, 4, 5, 6] vs. 6 [4, 5, 6, 7]). All long-term survivors had QoL assessment. QoL score was significantly impaired compared to an age- and sex-matched reference population. This impairment was not due to disease-specific sequelae such as presence of stool deviation or intestinal failure but due to preexisting risk factors as shown by an inverse relation between the CCI and QoL score. Conclusion: Herein, we show for the first time that long-term QoL in patients with AMI is impaired but this impairment is not due to disease-specific aspects but rather general risk factors underlying the presence of a higher level of comorbidities at the time of AMI.

Sex-Differences in Distress, Quality of Life, and Depression Among People with Hemophilia

Introduction: A recently validated hemophilia-distress questionnaire (HRDq) was developed to evaluate patients’ hemophilia-specific concerns. Distress is a multi-factorial and unpleasant experience that is associated with adverse health outcomes, and it can be independent of depression. Potential sex-differences in hemophilia-related distress as well as other aspects of mental and physical well-being have not been well described. Objective: To examine self-reported hemophilia-related distress, general distress, depression, quality of life, pain, and overall health according to sex. Methods: This cross-sectional study was a planned secondary analysis of HRDq validation study data. Adults aged ≥18 years with Hemophilia A or B who were recruited from one of two hemophilia treatment centers between July 2017 and December 2019 and agreed to participate. Those who did not complete HRDq were excluded (n=6) from the study. We used a validated hemophilia-related distress questionnaire (HRDq) that asks participants to rate their level of concern across four domains 1) hemophilia management; 2) financial concerns; 3) perceived self-efficacy; and 4) daily functioning. We also examined hemophilia-related quality of life (Haem-A-QoL) and general measures of QoL (EQ-5D-5L), distress (Kessler 6+; NCCN distress thermometer), mental health (PROMIS-29 and depression with PHQ9), physical health (PROMIS-29), and overall health (EQ-5D-5L VAS). Average scores according to sex were compared with independent T-tests. Unadjusted and multivariable linear regression models were used to examine potential mediators of sex and HRDq and other scores. Results: Among 149 participants enrolled in the study, 143 completed the HRDq and were included in analyses. Approximately 82.0% were male and 18.0% were female. Most participants had Hemophilia A (89.2%), and the average age was 35.1 years [standard deviation (SD)=14.7 years]. A higher proportion of men had Hemophilia A, severe disease, an inhibitor, target joint bleeds, HIV or HCV infection, and were treated with prophylaxis compared to women (Table 1). Self-reported education, household income, health insurance, financial rating, and age were similar. Total HRDq scores and domain specific scores were similar in men and women (Table 2). Haem-A-QoL scores were significantly lower (indicating better QoL), in females than males (B=-6.57, SE=3.28; p-value=.048), but after accounting for severity, these differences were no longer statistically significant. NCCN distress thermometer, PHQ-9 depression, PROMIS-29 anxiety, and fatigue scores were significantly higher in women than men. Approximately 32.0% of woman reported moderate or severe depression compared to 15.2% of men (p-value<.001). After accounting for severity and treatment, the elevated NCCN distress, PHQ-9 depression, PROMIS-29 anxiety, and fatigue scores among females remained. There were no differences between groups in general QoL, self-reported pain intensity, nor overall health. Conclusions: Hemophilia-related distress scores were similar in men and women, despite men having more severe disease and unfavorable clinical characteristics. Men had poorer Haem-A-QoL scores, which was accounted for by disease severity. However, general measures of distress and depression were higher among women with hemophilia compared to men, which is consistent with what is observed in the general population and among people with other chronic diseases. This study highlights the need for mental health services to be integrated into the care of women with hemophilia as well as the need for future research to better understand the impact of mental health on traditional bleeding outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario, Canada.

Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown. The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures. Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting for potential confounders including education, income and employment. Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.

Post-COVID-19 Status and Its Physical, Nutritional, Psychological, and Social Effects in Working-Age Adults-A Prospective Questionnaire Study.

The main objective of this study was to evaluate the evolution of physical and daily routine, dietary habits, and mental and social health in individuals with recent COVID-19 infection. A qualitative prospective cross-sectional study was conducted from 01 October 2021 to 01 March 2022, which included 80 working-age adults from the territory of Central Serbia who had PCR-confirmed SARS-CoV-2 infection in the previous six months. Two structured pre-coded closed-ended questionnaires were submitted to the participants: a questionnaire about post-COVID-19 status (pCOVq) and a shortened version of the World Health Organization's Quality of Life Scale (WHOQOL-BREF). The presence of the COVID-19 disease in the previous period of 6 months among the working-age participants significantly affected the duration of aerobic, anaerobic, and high-intensity physical activities, but also the possibility of performing certain activities such as walking, which represents basic aerobic activity and a measure of general health among middle-aged participants. In the majority of cases (78%), in the post-COVID-19 period, participants indicated a decline in educational and productive activities. Post-COVID status in working-aged participants consists of reduced physical activity, lower quality of life, and similar nutritional habits. Health policies should be more focused on these findings.

Sleep and self-efficacy: The role of domain specificity in predicting sleep health

ObjectivesAlthough a number of empirically supported sleep interventions exist, sleep-related beliefs remain largely unexplored as clinical tools for enhancing existing interventions. The present study aimed to determine the differential associations between general and sleep self-efficacy with sleep health among a sample of adults ParticipantsParticipants were 3284 adults (Mean Age = 43 years, 48.5% female, 6.4% other-identifying, 80.8% white). MeasurementsParticipants completed measures of self-efficacy (general and sleep self-efficacy) and sleep health as part of their involvement in a larger online study. General self-efficacy and sleep self-efficacy were measured with the General Self-Efficacy and Sleep Self-Efficacy scales respectively. Sleep was assessed with the RegUlarity, Satisfaction, Alertness, Timing, Efficiency, Duration scale. A structural equation model was conducted to determine the associations between measures of general and sleep self-efficacy and sleep health, represented by 2-factors derived from the RegUlarity, Satisfaction, Alertness, Timing, Efficiency, Duration measure. ResultsThe structural model evidenced adequate to good fit to the data and indicated that both general and sleep self-efficacies were directly associated with the latent sleep quality/quantity and circadian rhythm outcomes. Higher general and sleep self-efficacies were positively associated with sleep regularity, timing, and alertness. Higher sleep self-efficacy and lower general self-efficacy were associated with higher sleep satisfaction, duration, and efficiency. ConclusionsFindings highlight the importance of domain specificity in the association between self-efficacy and sleep health outcomes. There is a need for more research into and application of interventions targeted toward increasing sleep self-efficacy as a potential avenue to improve sleep health.

The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group.

Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.

Effects of psychological distress on the general health to self-reported pain and function outcome relationship in knee arthroplasty: A causal mediation study

ObjectivesWe examined two potential causal pathways that could be intervention targets to enhance knee arthroplasty outcomes. Data from a no-effect trial of persons with moderate to high pain catastrophizing were used to determined whether pain catastrophizing, depressive symptoms causally mediate the effect of preoperative general health on postoperative knee pain and functional difficulty. MethodsWe used natural-effects models to conduct causal mediation analyses using the preoperative dichotomized EQ-5D-5L general health measure as the exposure, 2-month postoperative pain catastrophizing, depressive symptoms, and localized knee pain as potential mediators, and 12-month dichotomized Western Ontario and McMaster's University Osteoarthritis Index (WOMAC) Pain and Function scores reflecting good versus poor outcome as the outcomes. ResultsEstimates of the indirect (mediating) effect suggested that pain catastrophizing mediated the effect of preoperative general health on 12-month WOMAC pain score by increasing odds of a good outcome by 8% (natural indirect effect odds ratio ​= ​1.08, 95% CI: 0.88, 1.29). The direction of mediating effects and their magnitude were similar for depressive symptoms; Sensitivity analyses suggested similar magnitudes and mediating effects to those reported for the main analyses. ConclusionsOur findings suggested that pain catastrophizing and depressive symptoms have a mediating role on the effect of baseline general health on self-reported pain and function outcomes. These findings support the continued treatment of pain catastrophizing and depressive symptoms as viable targets for interventions to potentially enhance pain and function outcomes for patients with moderate to high levels of psychological distress prior to surgery.

Increased identification of cannabis use among drivers involved in motor vehicle collisions using an expanded cannabis inventory.

The objectives of this study were to implement and examine the potential capture rate of a novel instrument, the Expanded Cannabis Inventory, in a population of emergency department (ED) patients presenting after motor vehicle collisions (MVC). Study participants who presented to the ED after MVC were recruited from three hospitals in cannabis-legal states (Denver, CO; Portland, OR; and Sacramento, CA). Research assistants (RAs) administered the Expanded Cannabis Inventory, which includes a wide variety of products that have become readily available in states where cannabis is legal, in addition to assessments related to patient demographic characteristics, general health, cannabis attitudes, and dependency measures. RAs also obtained blood samples for delta-9-THC and metabolites. Among 692 participants who provided responses to questions about cannabis use, 292 (42%) reported past-year use. Seventy-eight (27%) of those identified as using cannabis were only captured due to items in the expanded instrument. These patients were more likely to be White and were more likely to perceive daily use to be of high risk. Fewer had Cannabis Use Disorder Inventory Test (CUDIT) scores consistent with hazardous cannabis use. However, more of the patients only captured by the expanded instrument had high measured blood levels of delta-9-THC on samples obtained in the ED. Changing cannabis use patterns must be reflected in our measurements for clinical practice, research, and surveillance. Instruments that are the current standard in clinical practice capture limited data and may no longer perform well enough to identify a complete cohort or to provide insight into the health behaviors of patients.

COVID-19 Related Mental Health Among a Sample of Families Transitioning from Homelessness Living in a Communal Housing Facility

Background: The COVID-19 pandemic has worsened the health and mental health of individuals experiencing homelessness. However, little research has investigated the pandemic’s impact on families experiencing homelessness, who likely experienced greater stressors due to the additional responsibilities of managing the needs of children. Student-run free clinics (SRFCs) can provide important needs assessment investigations and mental health interventions in underserved communities. This study examined the effect of the pandemic on the mental health of one sample of families experiencing homelessness associated with an SRFC.&#x0D; Methods: Between November and December 2020, families experiencing homelessness at a homeless shelter in San Antonio, Texas were surveyed. Twenty-one parent and 20 child questionnaire responses on the pandemic’s effect on health, depression, and anxiety were analyzed. One-sample t-test with Bonferroni correction was used for statistical analysis.&#x0D; Results: Parents experiencing homelessness reported statistically significant worsening of coping ability, stress levels, family situation, financial situation, physical health, mental health, depression, and anxiety symptoms at the time of the survey compared to prior to the pandemic. Adults reported more worsening of anxiety symptoms than depression symptoms. Loneliness was the only general health measure that was not significantly worsened. In their young children (mean age = 6.7 years), parents reported no worsening of any outcomes.&#x0D; Conclusions: Our sample of families experiencing homelessness reported significant life and mental health challenges due to the COVID-19 pandemic. People experiencing homelessness who live in a communal housing facility may protect against characteristic pandemic-related loneliness. Young children may require developmentally focused clinical assessments to adequately capture mental health challenges. SRFCs should be equipped to provide specialized mental health services and other community health services, such as vaccinations, to reduce pandemic-related morbidity and mortality.

Initial Assessment of a Brief Health, Fitness, and Spirituality Survey for Epidemiological Research: A Pilot Study.

Not many population-based health studies include items to assess both fitness and spirituality concepts. Therefore, the purpose of this study was to examine initial data of a brief health, fitness, and spirituality survey for epidemiological research. This first phase pilot study used data from N = 56 adults 18+ years of age via electronic questionnaire. Measures of general health, fitness, physical activity (PA), body mass index (BMI), religiosity, and happiness were assessed. Reliability analyses were employed for PA, religiosity, and happiness scales. Validity coefficients were computed to evaluate convergence between scale scores and related measures. Finally, difference in health was examined between different levels of fitness to evaluate known groups discrimination. Respondents were middle-aged (Mean = 50.5 yr, SD = 14.3), majority white (69.5%, SD = 6.2), with relatively low BMI (Mean = 25.3, SD = 5.3). All three scales showed internal consistency reliability of α = 0.93, α = 0.89, and KR-20 = 0.56 for religiosity, happiness, and PA, respectively. Furthermore, scores converged (ps < 0.05) between fitness and PA (r = 0.43), health (r = 0.66), BMI (r = -0.28), and happiness (r = 0.25). Finally, health scores were significantly greater for high fitness versus low fitness in both male (p < 0.001) and female (p = 0.015) populations. Results from this study indicate that a brief health, fitness, and spirituality survey can reliably measure its intended traits. A single-item of self-assessed fitness in particular has promise for large scale epidemiological research.

Is the combination of behavioral activation and attention training technique effective to reduce depressive symptomatology? A multiple case study.

BackgroundThis study tested whether the combination of BATD and Attention Training Technique (ATT) is effective to reduce depressive symptomatology and investigate the mechanisms of action underlying the effectiveness of treatment with a multiple N-of-1 trials.MethodsNine adults with depressive symptoms were randomly included in three different combinations of BATD and ATT, concurrent in Condition 1 and sequential in Conditions 2 and 3 (ATT followed by BATD and BATD followed by ATT, respectively). The sequential components allow investigating the specific changes that occur during the two distinct treatment phases. Multiple self-report and pre–post-assessments were conducted on generic mental health measures (depressive symptoms, life functioning, mood, and well-being) and intervention-specific measures (behavioral activation, behavioral avoidance, self-focused attention, cognitive control and rumination), with two-week and three-month follow-up assessments. We also measured treatment adherence with treatment attendance, homework compliance and a clinical interview.ResultsParticipants’ attendance, homework compliance and satisfaction were acceptable in the three conditions, with higher adherence in Condition 1 and Condition 3. Eight participants out of nine reported a reduction in depressive symptomatology and five an improvement in well-being. Most of their progress was maintained 2 weeks after the intervention but not 3 months later. Conditions 1 and 2 seemed to be associated with a higher response to generic mental health measures in comparison with Condition 3. The three conditions were not associated with consistent changes in intervention-specific measures, except for rumination with five participants out of nine reporting an improvement in rumination immediately after the intervention and eight participants 2 weeks after the intervention. The concurrent format was associated with a better improvement in rumination immediately after the intervention. No specific changes of self-focused attention and rumination characterized ATT, and no specific changes of behavioral activation, behavioral avoidance and rumination characterized BATD.ConclusionOur three interventions were judged acceptable and showed positive short-term benefit for generic mental health measures and rumination maintained 2 weeks later, but not 3 months later. Results suggest that five sessions of concurrent treatment could be a better option than sequential formats. However, our data did not support the specificity of ATT and BATD treatments.Clinical Trial Registration: This trial was previously registered with the ClinicalTrials.gov NCT04595539 registration number and the title “Does Attention Training Technique Enhance the Effectiveness of Behavioral Activation Treatment for Depression: A Multiple Baseline Study.”