Measures Of Social Functioning Research Articles

Psychometric properties of the 10-item Autism Quotient in an acute psychiatric sample

PurposeDiagnoses of autism spectrum disorder (ASD) are commonly missed among psychiatric patients. As such, a brief screening tool that reliably captures ASD symptoms could help to facilitate access to diagnosis. We evaluated the factor structure, internal consistency, and convergent validity of the 10-item Autism Spectrum Quotient (AQ-10; Allison et al., 2012) in a diagnostically diverse sample of patients with acute mental illness. MethodsParticipants (n = 305) were patients with a variety of mood, anxiety, personality, and psychotic-spectrum disorders seeking treatment at a cognitive-behavioral therapy partial hospital program. They completed the AQ-10 on their second day of the treatment program. ResultsResults suggests that a unifactorial structure of the AQ-10 had poor model fit and internal consistency. A modified, 5-item version (AQ-5) demonstrated acceptable unidimensional model fit and internal consistency; however, the items exclusively assess the social aspects of ASD and neglect restricted, repetitive patterns of behaviors, interests, or activity, therefore limiting validity. Indeed, while the AQ-5 and the AQ-10 demonstrated similar convergent validity with measures of social functioning, the AQ-5 demonstrated poor convergent validity with overall functional impairment relative to the AQ-10. ConclusionOur findings highlight that the AQ-10 may not be well suited to assess ASD symptoms among patients with acute mental illness.

Abstract A106: Examining the role of social connection on allostatic load and quality of life in African American prostate cancer survivors

Abstract Background. Racial disparities in prostate cancer (PC) survivorship persist despite clinical advancements. Chronic stress may contribute to these disparities, with allostatic load (AL) considered a measure of such stress. Associations between AL and survivorship outcomes such as quality of life (QoL) are documented, yet less is known about factors influencing these relationships. Social connections (SC) (e.g., social networks, social support) are associated with improved QoL in survivors, yet which aspects of SC and which pathways linking SC to QoL remain unclear. Additionally, little is known about the SC of African American PC survivors (AAPCS) and how these relate to QOL, stress, and AL. This study explores the relationship between SC, stress (perceived and AL) and QOL in in 48 AAPCS enrolled in Men Moving Forward, a randomized trial to improve body composition through lifestyle change. Methods. At baseline, participants completed surveys including: the Cohen Social Network Index assessing 3 aspects of social networks: network size (# of ties with regular contact), diversity (# of roles with regular contact) and embeddedness (# of domains with 4 or more regular contacts); Patient-Reported Outcomes Measurement Information System (PROMIS) measures of social support (companionship, emotional and informational support); the perceived stress scale, and PROMIS measures of physical function, anxiety, depression, fatigue, sleep disturbance, social function, and pain intensity. The latter were used to generate summative physical (PQOL) and mental (MQOL) health standardized T-scores (U.S. population mean=50, SD=10). AL scores used 15 criterion reflecting neuroendocrine, cardiovascular, immune, and metabolic systems. Each criterion was assigned a score of 0 or 1: 1 if in the high-risk range based on clinical guidelines. An index score was generated by summing high-risk indicators. Pearson correlations were used to explore the relationship between aspects of SC and QOL and SC and stress variables. Results. The average AL score was 5.8 (SD ± 2.3) of a maximum 15. No significant correlations were found between any SC domains and AL. However, negative associations were identified between network size (r=-.313, p=0.030), emotional support (r=-.319, p = 0.027), companionship (r=-.313, p=0.030) and perceived stress. A positive association was found between loneliness and perceived stress (r=.521, p<0.000). MQOL was positively related to network size (r=.364, p=0.011), emotional support (r=.366, p=0.011), and companionship (r=.288, p=0.047). Loneliness was negatively associated with MQOL (r=-.626, p<0.000) and PQOL (r=-.407, p=0.006). Conclusions. These findings suggest SC has a positive impact on survivorship in AAPCS, and that structural and functional aspects of SC may be involved. Currently, limited resources are available for PC survivors, and even fewer are tailored for AAPCS. Future efforts to improve survivorship for AAPCS should consider assessing social networks and access to social support when initiating survivorship care. Citation Format: Iwalola A. Awoyinka, Kathryn Flynn, Deepak Kilari, Kathryn Bylow, Jennifer Knight, Jamila Kwarteng, Anjishnu Banerjee, Kirsten M. Beyer, Staci Young, Patricia Sheean, Paula Papanek, Melinda Stolley. Examining the role of social connection on allostatic load and quality of life in African American prostate cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A106.

Social participation of school-aged survivors of pediatric brain tumors: A daily diary report.

Difficulties with social functioning are common among survivors of pediatric brain tumors. Social participation is an understudied measure of social functioning that is associated with emotional health across the lifespan. This paper uses a diary method to assess the social participation of survivors of pediatric brain tumors in middle childhood. Survivors of pediatric brain tumors (N=47; age 10.6±1.4years; 51.1% male, 89.4% White) who were 5.3 (SD=2.4, range: 2-9.9) years post therapy completed a daily diary assessment of social interaction (5-7days) and an objective measure of facial affect recognition. The participant's caregiver completed the NIH Toolbox Emotion Measures and a background information questionnaire. Overall, frequency and quality of reported social interactions were low for survivors, with a large subset of survivors (n=16, 34%) endorsing fewer than 10 social interactions over the course of a typical school week, and almost half of parents (48.9%) reporting that their child participates in zero social activities outside of school during a typical week. Participants engaged in more positive social participation exhibited stronger social skills (facial affect recognition (F(2,44) =4.85, p<.05). School-aged survivors of pediatric brain tumors seemed to be infrequently engaged in social participation and quality interaction with peers. More specifically, the interactions most commonly reported on the diary assessment are not indicative of friendship development and maintenance. Survivors of pediatric brain tumors would likely benefit from interventions designed to increase quality time spent with peers.

A network analysis of pain intensity and pain-related measures of physical, emotional, and social functioning in US military service members with chronic pain.

The purpose of this study was to apply network analysis methodology to better understand the relationships between pain-related measures among people with chronic pain. We analyzed data from a cross-sectional sample of 4614 active duty service members with chronic pain referred to 1 military interdisciplinary pain management center between 2014 and 2021. Using a combination of Patient-Reported Outcomes Measurement Information System measures and other pain-related measures, we applied the "EBICglasso" algorithm to create regularized partial correlation networks that would identify the most influential measures. Pain interference, depression, and anxiety had the highest strength in these networks. Pain catastrophizing played an important role in the association between pain and other pain-related health measures. Bootstrap analyses showed that the networks were very stable and the edge weights accurately estimated in 2 analyses (with and without pain catastrophizing). Our findings offer new insights into the relationships between symptoms using network analysis. Important findings highlight the strength of association between pain interference, depression and anxiety, which suggests that if pain is to be treated depression and anxiety must also be addressed. What was of specific importance was the role that pain catastrophizing had in the relationship between pain and other symptoms suggesting that pain catastrophizing is a key symptom on which to focus for treatment of chronic pain.

Functional brain connectivity during social attention predicts individual differences insocial skill.

Social attention involves selectively attending to and encoding socially relevant information. We investigated the neural systems underlying the wide range of variability in both social attention ability and social experience in a neurotypical sample. Participants performed a selective social attention task, while undergoing fMRI and completed self-report measures of social functioning. Using connectome-based predictive modeling, we demonstrated that individual differences in whole-brain functional connectivity patterns during selective attention to faces predicted task performance. Individuals with more cerebellar-occipital connectivity performed better on the social attention task, suggesting more efficient social information processing. Then, we estimated latent communities of autistic and socially anxious traits using exploratory graph analysis to decompose heterogeneity in social functioning between individuals. Connectivity strength within the identified social attention network was associated with social skills, such that more temporal-parietal connectivity predicted fewer challenges with social communication and interaction. These findings demonstrate that individual differences in functional connectivity strength during a selective social attention task are related to varying levels of self-reported social skill.

Corpus callosum microstructural organization mediates the effects of physical neglect on social cognition in schizophrenia

Exposure to early life adversity is associated with both increased risk of developing schizophrenia and poorer performance on measures of social cognitive functioning. In this study, we examined whether interleukin-6 (IL-6) and Corpus Callosum (CC) microstructure mediated the association between childhood physical neglect and social cognition. Fifty-eight patients with a diagnosis of schizophrenia were included. The CANTAB emotion recognition task (unbiased hit rate) was used to assess social cognition. We found that the microstructural organization of the CC significantly mediated the association between physical neglect and emotion recognition. Furthermore, in a sequential mediation analysis that also considered the role of inflammatory response, the association between physical neglect, and lower emotion recognition performance was sequentially mediated by higher IL-6 and lower fractional anisotropy of the CC. This mediating effect of IL-6 was only present when simultaneously considering the effects of CC microstructural organization and remained significant while controlling for the effects of sex, BMI and medication dosage (but not age). Overall, the findings suggest that the association between physical neglect and poorer emotion recognition in schizophrenia occurs, at least in part, via its association with white matter microstructure.

Association between patient-reported social and behavioral risks and health care costs in high-risk Veterans health administration patients.

Social risks complicate patients' ability to manage their conditions and access healthcare, but their association with health expenditures is not well established. To identify patient-reported social risk, behavioral, and health factors associated with health expenditures in Veterans Affairs (VA) patients at high risk for hospitalization or death. Prospective cohort study among high-risk Veterans obtaining VA care. Patient-reported social risk, function, and other measures derived from a 2018 survey sent to 10,000 VA patients were linked to clinical and demographic characteristics extracted from VA data. Response-weighted generalized linear and marginalized two-part models were used to examine VA expenditures (total, outpatient, medication, inpatient) 1 year after survey completion in adjusted models. Among 4680 survey respondents, the average age was 70.9 years, 6.3% were female, 16.7% were African American, 20% had body mass index ≥35, 42.4% had difficulty with two or more basic or instrumental activities of daily living, 19.3% reported transportation barriers, 12.5% reported medication insecurity and 21.8% reported food insecurity. Medication insecurity was associated with lower outpatient expenditures (-$1859.51 per patient per year, 95% confidence interval [CI]: -3200.77 to -518.25) and lower total expenditures (-$4304.99 per patient per year, 95% CI: -7564.87 to -1045.10). Transportation barriers were negatively associated with medication expenditures (-$558.42, 95% CI: -1087.93 to -31.91). Patients with one functional impairment had higher outpatient expenditures ($2997.59 per patient year, 95% CI: 1185.81-4809.36) than patients without functional impairments. No social risks were associated with inpatient expenditures. In this study of VA patients at high risk for hospitalization and mortality, few social and functional measures were independently associated with the costs of VA care. Individuals with functional limitations and those with barriers to accessing medications and transportation may benefit from targeted interventions to ensure that they are receiving the services that they need.

Content comparison of the EORTC CAT Core, SF-36, FACT-G, and PROMIS role and social functioning measures based on the International Classification of Functioning, Disability and Health.

In line with the World Health Organizations' health definition, patient-reported outcome (PRO) measures frequently cover aspects of social health. Our study aimed to evaluate the role functioning (RF) and social functioning (SF) contents assessed by PRO measures commonly used in cancer patients. We analysed the item content of the SF and RF domains of the EORTC CAT Core, the EORTC QLQ-C30, the SF-36, and the FACT-G aswell as the PROMIS item bank covering the Ability to Participate in Social Roles and Activities. Following an established methodology we linked item content to the International Classification of Functioning, Disability and Health (ICF) framework. The content of 85 items was assigned to three ICF components ('Activities and Participation', 'Body Functions', and 'Environmental Factors'). The EORTC CAT Core RF items were mostly related to the first-level ICF categories'Domestic life' and 'Community, social and civic life', while its SF item bankfocused on 'Interpersonal interactions and relationships'. These three categories were also covered by the PROMIS social participation item bank. TheFACT-G Social/Family scale focused on environmental factors ('SupportandRelationships' and 'Attitudes') while the SF-36 Role-physical/emotional scales had a stronger focus on 'General tasks and demands' and 'Major life areas'. Our results highlight conceptual overlap and differences among PRO measures for the assessment of social health in cancer. This information may help toselect the most appropriate measure for a specific setting or study purpose and to better understand the possibilities of linking scores across different PRO measures.

The Mediating Effect of Social Functioning on the Relationship between Catastrophizing and Pain among Patients with Chronic Low Back Pain.

Pain catastrophizing can be characterized as an interpersonal form of coping used to elicit support or empathy from others. Despite intentions of increasing support, catastrophizing can impair social functioning. While considerable work has addressed the relationship between catastrophizing and pain, limited empirical work has examined this relationship within a social context. First, we examined the role of catastrophizing as a potential contributor to group differences (cLBP vs. pain-free controls) in social functioning. Then, we conducted a follow-up, exploratory analysis to examine the relationships between catastrophizing, social functioning, and pain within the subgroup of participants with cLBP. In this observational study, participants with cLBP (N = 62) and pain-free controls (N = 79) completed validated measures of pain, social functioning, and pain catastrophizing. A mediation analysis was conducted to examine whether catastrophizing mediated group differneces (cLBP vs. controls) in social functioning. A follow-up, exploratory mediation analysis then tested whether social functioning mediated the association between catastrophizing and pain within the subgroup of cLBP participants. Participants with cLBP reported higher levels of pain, impaired social functioning, and higher catastrophizing compared to pain-free controls. Catastrophizing partially mediated the group difference in impaired social functioning. Additionally, social functioning mediated the association between higher catastrophizing and greater pain within the subgroup of cLBP participants. We showed that impaired social functioning was driving the relationship between higher pain catastrophizing and worse pain among participants with cLBP. Interventions, such as cognitive behavioral therapy, should address catastrophizing in individuals with cLBP, while simultaneously improving social functioning.

Longitudinal outcomes for educational placement and quality of life in a prospectively recruited multinational cohort of children with cochlear implants

The aim of this study was to report on the educational placement, quality of life and speech reception changes in a prospectively recruited group of children after they received a cochlear implant (CI). Data was collected on 1085 CI recipients of as part of a prospective, longitudinal, observational, international, multi-centre, paediatric registry, initiated by Cochlear Ltd (Sydney, NSW, Australia). Outcome data from children (≤10 years old) implanted in routine practice was voluntarily entered into a central, externally hosted, e-platform. Collection occurred prior to initial device activation (baseline) and at six monthly follow-up intervals up to 24 months and then at 3 years post activation. Clinician reported baseline and follow up questionnaires and Categories of Auditory Performance version II (CAP-II) outcomes were collated. Self-reported evaluation forms and patient information were provided by the parent/caregiver/patient via the implant recipient baseline and follow up, Children Using Hearing Implants Quality of Life (CuHIQoL) and Speech Spatial Qualities (SSQ-P) Parents Version questionnaires. Children were mainly bilaterally profoundly deaf, unilaterally implanted and used a contralateral hearing aid. Prior to implant 60% used signing or total communication as their main mode of communication. Mean age at implant was 3.2±2.2 years (range 0-10 years). At baseline 8.6% were in mainstream education with no additional support and 82% had not yet entered school. After three years of implant use, 52% had entered mainstream education with no additional support and 38% had not yet entered school. In the sub-group of 141 children who were implanted at or after three years of age and were thus old enough to be in mainstream school at the three-year follow up, an even higher proportion (73%) were in mainstream education with no support. Quality of life scores for the child improved statistically significantly post implant compared to baseline and continued to improve significantly at each interval up to 3 years (p<0.001). Parental expectation scores reduced statistically significantly from baseline compared to all intervals (p<0.028) and then increased significantly at 3 years compared to all post baseline follow-up intervals (p<0.006). The impact on family life was reduced post implant compared to baseline and continued to reduce between annual intervals (p<0.001). At three years post follow up median CAP II scores were 7 (IQR 6-7) and mean SSQ-P scores were 6.8 (SD1.9) 6.0 (SD1.9) and 7.4 (SD 2.3) for speech spatial and qualities scales respectively. SSQ-P and CAP II scores improved statistically and clinically significantly compared to baseline by one year post implantation. CAP II scores continued to improve at each test interval up to three years post implant. Speech and Qualities scores improved significantly between years 1 and 2 (p<0.001), but only the Speech scores improved significantly between years 2 and 3 (p=0.004). Mainstream educational placement was achievable for most of the children, including those implanted at an older age. Quality of life for the child and the wider family improved. Future research could focus on the impact of mainstream school placement on children's academic progress, including measures of academic attainment and social functioning.

Executively-mediated language skills are related to performance-based social functioning in the early psychosis spectrum

Social impairment is a core deficit in psychotic spectrum disorders (PSDs). Prior work shows that language abnormalities can predict psychosis onset and are related to social outcomes in PSDs. Few studies have investigated nuanced relationships between language/verbal abilities and social functioning in the early psychosis spectrum, including at-risk (schizotypy) and first episode of psychosis (FEP) individuals. This study aimed to examine the relationship to between language/verbal performance and performance-based and examiner-rated social functioning. We also aimed to replicate prior models that demonstrate neurocognition is related to social functioning through negative symptoms and social cognition. Low schizotypy (n = 42), high schizotypy (n = 44), and FEP (n = 15) participants completed a battery of language/verbal, social cognition, and social functioning measures. Regression analyses revealed that Proverb Test performance was uniquely and significantly associated with performance-based but not examiner-rated social functioning. Other language/verbal measures were not significantly related to social functioning. In mediational analyses, language/verbal performance was indirectly related to social functioning through negative traits, and also through social cognition. Findings extend support for negative symptom and social cognitive intervention in the early psychosis spectrum, and uniquely suggest that executively-mediated language skills may be an additional target to improve social functioning.

Cognitive, social, and health functioning of children with TBI engaged in a formal support program.

Students with traumatic brain injury (TBI) often demonstrate difficulties that impact their successful return to school (RTS). To explore injury severity, age at injury, and time since injury as predictors for performance on measures of cognitive, social and health functioning for students' participating in a formal RTS cohort at the time of their enrollment in the School Transition After Traumatic Brain Injury (STATBI) research project. Outcome measures across cognitive, social, and health domains were analyzed for association with the explanatory variables of interest using quantile regressions and ordinary least squares regression, as appropriate. Students (N = 91) injured after age 13 showed significantly lower cognitive outcomes than students whose injury occurred earlier. Additionally, students more than one-year post-injury demonstrated poorer social outcome on one measure compared to students whose injury occurred more recently. Health outcomes showed no significant association to any predictors. The results of this analysis provide a baseline for a group of students with TBI as they enter a RTS research study. This data can now be paired with longitudinal measures and qualitative data collected simultaneously to gain a deeper understanding of how students with TBI present for RTS.

The Impact of Co-occurring ADHD on Social Competence Intervention Outcomes in Youth with Autism Spectrum Disorder.

The co-occurrence of autism spectrum disorder (ASD) and attention- deficit/hyperactivity disorder (ADHD) is significant and associated with a host of negative outcomes. Studies investigating social functioning in the presence of the ASD/ADHD co-occurrence have produced mixed findings. The present study further evaluated the impact of co-occurring ADHD on social functioning among youth with ASD and compared treatment response to a social competence intervention between youth with ASD and ASD + ADHD. Two-way repeated measures analyses of variance (ANOVAs) were computed with diagnostic group and time as the independent variables and measures of social functioning as dependent variables. Group and Time effects and Group by Time interactions were examined. Youth with co-occurring ADHD displayed more impairments related to social awareness, but not in other social areas. Participants in both the ASD and ASD + ADHD groups demonstrated significant improvement following a social competence intervention. Co-occurring ADHD did not negatively affect treatment response. Youth with ASD + ADHD may benefit highly structured interventions with a scaffolded teaching design.

Sick Leave Due to Ear Diagnoses, a Nationwide Representative Registry of Mexico.

Sickness absence from work is a measure of both poor health and social functioning. In order to assess the frequency of sick leave due to ear-related diagnoses, we performed a retrospective analysis on the registry of paid sick leave certificates supplied by the main social security institution in Mexico during the years 2018 and 2019, just prior to the SARS-CoV-2 pandemic. We observed that, in the two years, 22,053 sick leave certificates due to ear-related diagnoses were provided to 18,033 workers. The most frequent ear-related diagnoses were those of vestibular disorders (94.64%); among them, the most common diagnosis was Benign Paroxysmal Positional Vertigo (75.16%), followed by Labrynthitis and Meniere's disease (circa 8% each). A total of 4.63% of the diagnoses were related to external and middle ear disorders, and 0.71% were mainly related to hearing. Consistently, the highest cumulative days of sick leave required were given for the group of diagnoses related to vestibular disorders; although the less frequent diagnoses required the highest cumulative days per case (e.g., ototoxicity). During 2018 and 2019, the most frequent diagnoses of ear-related sick leave were due to vestibular diagnoses (particularly Benign Paroxysmal Positional Vertigo).

Using the Social Skills Improvement System (SSiS) Rating Scales to assess social skills in youth with Down syndrome.

This study provides preliminary data on the Social Skills Improvement System (SSiS) Rating Scales Parent Form to measure social skills in a sample of 124 children and adolescents with Down syndrome (DS) ages 6-17 years. Overall, participants demonstrated relatively mild symptoms, with the sample's average standard score falling within 1 standard deviation from the mean of the normative sample for the social skills (M = 92, SD = 15) and problem behaviors (M = 104, SD = 12) domains (normative sample M = 100, SD = 15 for both domains). However, a wide range of scores was observed across the sample for the composite and subscale scores. Differential patterns were also observed by subscale. For some subscales (i.e., Cooperation, Assertion, Responsibility, Engagement, Externalizing, Hyperactivity/Inattention, and Autism Spectrum), a disproportionate number of participants scored in the below average (i.e., lower levels of social skills) or above average (i.e., more symptomatic in problem behaviors or autism spectrum) range relative to the normative sample; for other subscales (i.e., Communication, Empathy, Self-Control, Bullying, and Internalizing), participants' score distribution aligned more closely to that of the normative sample. SSiS composite scores correlated in the expected directions with standardized measures of autism characteristics, executive function, and expressive language. This study provides some of the first evidence validating the use of the SSiS in youth with DS, filling a gap in standardized measures of social functioning in this population.

Exploring the trajectory and correlates of social isolation for veterans across a 6-month period during COVID-19.

Social isolation is a relevant problem for veterans who are at risk for disengaging from others as a function of transition stress from military life to civilian life, and given high rates of exposure to trauma and psychological distress. Few researchers have examined social isolation in veterans over time, particularly during COVID-19 that led to significant barriers and restrictions on social interactions. The purpose of this longitudinal study was to assess veterans' experience of social isolation and its mental health and social functioning correlates during a 6-month period of the COVID-19 pandemic. Participants were 188 United States veterans of the Iraq and Afghanistan wars. A total of four assessments were administered: one every two months for a total duration of six months. The average number of completed assessments across all participants was 3.70 (SD = 0.75) with 159 participants (84.13%) completing all four timepoints. Surveys included measures of global mental health and social functioning as indicated by perceived emotional support, quality of marriage, and couple satisfaction. Multilevel modeling was used to assess 1) growth models to determine whether social isolation changed over time and the trajectory of that change (i.e., linear or quadratic); and 2) whether social isolation was related to both concurrent and prospective indicators of mental health and social functioning. All analyses included person mean centered and grand mean centered isolation to assess for within-and between-person effects. Veterans reported a quadratic trajectory in social isolation that decreased slightly and stabilized over time. Findings indicate that higher social isolation, at both the within- and between-person level, was negatively associated with concurrent emotional support, mental health, quality of marriage, and couple satisfaction. However, all prospective effects were nonsignificant at the within-person level. Results suggest although isolation may decrease over time, veterans report worse mental health and social functioning during times when they report higher levels of social isolation compared to themselves and others. Future work is needed to determine if interventions can be applied during those times to prevent or target those negative associations.

Context and Expectations Matter: Social, Recreational, and Independent Functioning among Youth with Psychosis in Chennai, India and Montreal, Canada.

Most cross-cultural psychosis research has focused on a limited number of outcomes (generally symptom-related) and perspectives (often clinician-/observer-rated). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to patient-reported measures of social, recreational, and independent functioning. Addressing this gap, this study aimed to compare these outcomes in first-episode psychosis at a high-income site and a lower middle-income site. Patients receiving similarly designed early intervention for psychosis in Chennai, India (N = 164) and Montreal, Canada (N = 140) completed the self-reported Social Functioning Scale-Early Intervention, which measures prosocial, recreation, and independence-performance functioning. Their case managers rated expected independence-performance functioning. Both sets of assessments were done at entry and Months 6, 18, and 24. Linear mixed model analyses of differences between sites and over time were conducted, accounting for other pertinent variables, especially negative symptoms. Linear mixed models showed that prosocial, recreation, and independence-performance functioning scores were significantly higher in Montreal than Chennai and did not change over time. Expected independence-performance was also higher in Montreal and increased over time. Negative symptoms and education independently predicted prosocial, recreation, and expected independence-performance functioning. When added to the model, expected independence-performance predicted actual independence-performance and site was no longer significant. At both sites, prosocial and recreation scores were consistently lower (<40%) than independence-performance (40-65%). This is the first cross-cultural investigation of prosocial, recreation, and independent functioning in early psychosis. It demonstrates that these outcomes differ by socio-cultural context. Differing levels of expectations about patients, themselves shaped by cultural, illness, and social determinants, may contribute to cross-cultural variations in functional outcomes. At both sites, social, recreational, and independent functioning were in the low-to-moderate range and there was no improvement over time, underscoring the need for effective interventions specifically designed to impact these outcomes.

Application Effect of Clinical Nursing Pathway Combined with Individualized Nursing Intervention in Patients with Active Pulmonary Tuberculosis

Tuberculosis is a serious infectious disease, which affects the health and quality of life of patients seriously. The purpose of this study is to study the clinical nursing pathway combined with individualized nursing intervention in patients with active pulmonary tuberculosis. A prospective study design was used to select samples of 100 patients with active tuberculosis. Patients’ clinical data and assessment data on the quality of life were collected and statistically analyzed to evaluate the effect of clinical care pathway combined with individualized care intervention. The research results showed that clinical nursing pathways combined with individualized nursing intervention significantly improved clinical symptoms and quality of life in patients with active pulmonary tuberculosis. To be specific, the treatment group got significantly higher score than the control group on measures of symptom reduction, physical recovery, mental state, social functioning and ability to live daily. In addition, the effect of individualized nursing interventions is influenced by a variety of factors, including age, severity of the condition, and treatment compliance. In conclusion, clinical nursing pathway combined with individualized nursing intervention is an effective nursing model, which can significantly improve the clinical effect and quality of life of patients with active pulmonary tuberculosis.

Evaluating the mechanisms of social cognition intervention in schizophrenia: A proof-of-concept trial

BackgroundSocial cognition interventions have shown promise for improving social functioning in people with schizophrenia. However, it is unclear how changes in social cognition affect social functioning. This study evaluates the impact of a social cognition intervention (GRASP - GRoup trAining for Social skills in Psychosis) on social cognition and social functioning outcomes and explores how two mechanisms, affect and physiological arousal, may drive changes. MethodA two-arm single blind (assessor) randomized pilot trial comparing GRASP plus treatment-as-usual (TAU) with TAU alone in people with a diagnosis of schizophrenia. Participants were assessed with measures of social cognition, social functioning, and symptoms. All participants undertook a week-long mobile health assessment (experience sampling method) measuring social behavior and affect and used a wearable device recording autonomic activity. Assessments were performed at baseline and at week 10. ResultsForty-eight participants were randomly allocated to the treatment or control condition. Individuals randomized to GRASP did not show improvements on experience sampled social behavior and social cognition measures compared to controls. However, participants in the GRASP group enjoyed social contact more and had lower levels of negative affect and higher levels of positive affect compared to controls. There was no evidence of autonomic changes (i.e., electrodermal activity) associated with social behavior resulting from the therapy. ConclusionSocial cognition interventions may be helpful in improving the quality of social contacts in people with schizophrenia by decreasing negative affect. Increase in social behavior may require longer periods to be evident. Future studies should consider how social cognition interventions may alter qualitative aspects associated with social behavior.

Association of cannabis and/or opioid with quality of life and healthcare utilization in patients with chronic pain.

Opioids have been commonly used to treat chronic pain, but they are associated with significant morbidity and mortality. Cannabis has been advocated as an alternative; however, a growing number of patients are now using a combination of opioid and cannabis and the impact of this combination is not well-studied. We characterized use of opioid and/or cannabis in patients with chronic pain; and compared utilization of healthcare resources. We conducted a cross-sectional study to determine if measures of physical, psychological and social functioning differed among patients according to whether they used opioids and/or cannabis. We used our learning healthcare system - CHOIR - to capture NIH Patient Reported Outcomes Measure Information System surveys, and legacy pain and treatment specific questions. Patients who report use of opioid and/or cannabis experience higher levels of physical, psychological and social distress. After adjusting for inversed weight of propensity scores, they have higher odds of visiting an emergency room, staying overnight at the hospital, and visiting a physician. Our results show that use of opioid and/or cannabis is associated with worse baseline characteristics and outcomes. Our study however cannot determine if worse outcomes are due to the opioids and/or cannabis or simply that these patients are worse off before using opioids and/or cannabis. Thus, it is important to characterize the trajectory of these patients in a prospective longitudinal study.