Medical Outcomes Study Social Support Research Articles

Contributing Factors to Israeli Soldiers' Adaptation to Military Noncombat Positions.

Adjusting to a military environment is a complex process, with unique demands and various stressors placed on conscripts. In this study, we examined the unique and combined contribution of the independent variables that constitute an individual soldier's personal resources-the meaningfulness of the military role and the match between expectations and the job itself; cognitive flexibility; social support; and seeking help from a mental health officer (MHO)-to the adaptation (dependent variable) of noncombat soldiers to military service. The study group comprised 200 Israel Defense Forces noncombat soldiers aged 18-23 years (Meanage = 20.046 years, SD = 0.951). Of them, 107 (53.3%) had consulted a MHO. The remaining soldiers who had not consulted an MHO (n = 93, 46.5%) served as the comparison group. Research tools included the work and meaning questionnaire, the Cognitive Flexibility Scale, the Medical Outcomes Study (social support) questionnaire, and adaptation to the army questionnaire. Adaptation to service was found to relate positively to the meaningfulness of the military role, cognitive flexibility, and social support. Social support partially mediated the relation between cognitive flexibility and adaptation to service. Additionally, soldiers who had consulted an MHO had lower levels of cognitive flexibility and social support, and they adapted less well to service compared to the comparison group. The study indicates that soldiers who seek help have lower resources. Additional personal and environmental variables that contribute to the adjustment of soldiers in noncombat positions were also identified.

Self-reported emotional health and social support but not executive function are associated with participation after stroke

ABSTRACT Background Participation restrictions continue to be prevalent for community-dwelling stroke survivors. Research is needed to understand the associated post-stroke factors that limit or facilitate optimal participation and quality of life. Objectives To investigate emotional health, executive functioning (EF), and social support as predictors of participation restrictions post-stroke. Methods Cross-sectional data collected from participants ≥ 6 months after mild stroke with and without aphasia (N = 114) were analyzed using three participation outcome measures: Reintegration to Normal Living Index (RNL), Activity Card Sort (ACS), and the Stroke Impact Scale (SIS) Version 2.0 Participation/Role Function domain. Predictor variables investigated were emotional health (SIS Emotion domain scores), EF (Delis Kaplan Executive Function System Trail Making Condition 4: DKEFS), social support (Medical Outcomes Study Social Support Survey: MOS-SSS), stroke severity (National Institutes of Health Stroke Scale: NIHSS), and education level. Results Using multiple regression, these predictors accounted for 26.4% to 40% of the variance for the three participation outcomes. Emotional health was a significant independent predictor across all three measures. Social support was a significant predictor of participation as measured on the RNL. Executive function was not a significant predictor of participation when controlling for the other predictor variables. Conclusions Emotional health and social support should be considered as modifiable factors that could optimize meaningful participation and quality of life.

Protective factors against depressive symptoms among Brazilian healthcare workers during the initial stages of the COVID-19 pandemic: a cross-sectional study

ObjectivesThis study aims to assess the prevalence of depressive symptoms among healthcare workers and possible factors associated with this outcome (resilience, spirituality, social support, quality of life, among other individual...

Cognitive reserve and mental health in cognitive frailty phenotypes: Insights from a study with a Portuguese sample.

BackgroundResearch on prevalence of cognitive frailty phenotypes in community-dwelling older adults in different countries is important to estimate their prevalence and to determine the influence of cognitive reserve and mental health in order to prevent frailty. The aims of this study were to estimate the prevalence of reversible and potentially reversible cognitive frailty (R-CF, PR-CF) in a Portuguese sample of old adults and explore the associations between these phenotypes and demographic, comorbidity, social support, cognitive reserve and mental health factors.MethodsWe assessed frailty (Fried criteria) in 250 community-dwelling older adults (179 women) aged 60 years or over (mean 71.04 years) without dementia, neurological or psychiatric disorders. Subjective cognitive decline and Mild cognitive impairment were diagnosed according to standard criteria. The questionnaires Charlson Index, Medical Outcomes Study Social Support, Cognitive Reserve Index and General Health were used for assessing comorbidity, social support, cognitive reserve and mental health, respectively.ResultsPrevalence of R-CF was 14%, and that of PR-CF, 15.2%. Cognitive frailty profiles differed significantly in relation to education, comorbidity, mental health, and cognitive reserve, but not in age or sex. Multivariate logistic regression showed that age, sex, comorbidity, social support, mental health, and cognitive reserve together predicted R-CF and PR-CF (90% specificity 75% sensitivity) with significant OR for mental health and cognitive reserve.DiscussionCognitive reserve and mental health are important factors predicting R-CF and PR-CF. We recommend assessing these factors for early detection of cognitive frailty and promoting psychological well-being and lifestyles that increase cognitive reserve in adults.

Factors enabling comorbidities and secondary conditions in older adults with spinal cord injury

Objective: To examine the role of personal, social, and environmental factors predicting comorbidities and secondary conditions among older adults with spinal cord injury (SCI). Design: Cross-sectional study utilizing survey methods were used to collect the data analyzed with two distinct general linear models. Setting: Community-dwelling participants who resided in rural and urban areas. Participants: One hundred and eighty-three (183) participants with SCI ages 45 and over at least five years post injury. Interventions: Not applicable. Measures: Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); Comorbidities Questionnaire; Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) Basic – Mobility; Spinal Cord Injury Quality of Life (SCI-QOL) Satisfaction with Social Roles and Activities Scale (SSRA); Cohen’s Social Network-Social Integration Index, the Medical Outcomes Study (MOS) Social Support Emotional/Informational Support Scale, and the Facilitators and Barriers Survey for Mobility (FABS-Mv2). Questions were also asked from the Behavioral Risk Factor Surveillance System (BRFSS). Results: Common predictors of comorbidities and secondary conditions included age, basic mobility, primary health care payer and parking limitations. An interaction between parking and neurological classification was observed for comorbidities. Neurological classification and employment were significantly associated with comorbidities while for secondary conditions, sex, years since injury, education, satisfaction with social roles and the home environment were critical factors. Conclusions: Our study shows the effects of demographic and injury factors, physical functioning, satisfaction with social roles, access to home environment adaptations and health resources in predicting comorbidities and secondary conditions among older adults with SCI.

Increased Social Support Reduces the Incidence of Motoric Cognitive Risk Syndrome.

Background and ObjectivesThe motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and cognitive complaint. The relationship between MCR and social support—a potentially modifiable risk factor of dementia—is currently unknown. The current study aimed to determine whether MCR incidence varies as a function of social support in aging.Research Design and MethodsWe examined MCR incidence in 506 community-dwelling older adults (M Age 76.59; 57.3% female) without MCR or dementia at baseline. We quantified perceived levels of social support with the Medical Outcomes Study Social Support Survey, incorporating four different categories of support: (a) emotional/informational support, (b) tangible support, (c) affectionate support, and (d) positive social interactions. We used Cox regression analyses, adjusted for age, sex, race/ethnicity, education, marital status, comorbidities, and global cognition, to estimate hazard ratios (aHR) with 95% confidence intervals (CIs).ResultsOver a median follow-up time of 2.5 years (range = 1–7 years), 38 participants (9.8%) developed MCR. Increased tangible support decreased the risk of MCR by 30% (aHR: 0.70, 95% CI: 0.53–0.92, p = .011). Increased overall social support decreased the risk of MCR by 33% (aHR: 0.67, 95% CI: 0.46–0.98, p = .038). Other subcategories of social support were not associated with a decreased risk of MCR (p > .05).Discussion and ImplicationsHigher levels of tangible social support, as well as overall social support, were associated with reduced risk for MCR in older adults. Increasing social support may be a promising avenue of intervention for reducing the risk of MCR, dementia, and other forms of cognitive decline.

Psychological Distress and Behavioural Changes in Pregnant and Postpartum Individuals During the COVID-19 Pandemic

ObjectivesTo determine the psychological and behavioural effects of the COVID-19 pandemic on a Canadian cohort of individuals during pregnancy and the postpartum period. MethodsIn 2020, individuals between 20 weeks gestation and 3 months postpartum receiving maternity care from an urban Canadian clinic were invited to complete a questionnaire. The purpose-built questionnaire used validated scales including the Medical Outcomes Study Social Support Survey (MOS), Depression, Anxiety, and Stress Scale (DASS-21), Edinburgh Postnatal Depression Scale (EPDS), and questions from a SARS study. ResultsOne hundred nine people completed the questionnaire (response rate, 55%) of whom 57% (n = 62) were postpartum. Most respondents (107, 98%) were married and had completed post-secondary education (104, 95%). Despite these protective factors, moderate to severe levels of depression (22%), anxiety (19%) and stress (27%), were recorded using the DASS-21, and 25% of participants (26) had depression (score ≥11) using the EPDS. Despite high social support in all MOS domains (median scores 84–100), a majority of participants reported loneliness (69, 67%) and were nearly or totally housebound (65, 64%). About half of participants worried about themselves (50, 46.3%) or their baby (59, 54%) contracting COVID-19, while the majority postponed (80, 74.1%) and cancelled (79, 73.2%) prenatal appointments. Being homebound or feeling lonely / lacking support were significant risk factors for psychological distress (P = 0.02) whereas exercise and strong social support were protective (P < 0.05). ConclusionPregnant and postpartum individuals experienced moderate to severe depression, anxiety, and stress during the COVID-19 pandemic. Exercise and strong social support were protective. Health care provider enquiry of home circumstances and activity may identify individuals needing enhanced supports.

Maternal Peer Support Through a Caregroup Model Improves Complementary Feeding of Infants by Refugee Mothers in Post-Emergency Settlements in the West-Nile Region in Uganda

ObjectivesIntroduction: Infant complementary feeding in refugee settlements remains inadequate, amidst declining humanitarian aid. However, there is limited evidence for interventions to address these nutrition challenges in the refugee settlements. Objective: Examine the effects of peer-led integrated nutrition education on infant feeding by South Sudanese refugee mothers in the West-Nile region in Uganda. MethodsA community-based randomized control study enrolled 390 pregnant mothers in the 3rd trimester as baseline for a peer-led nutrition education intervention using the caregroup model. Two groups (moms-only and moms & dads combined) comprised treatments with a control group. Higher scores on the Medical Outcomes Study (MOS) Social Support Index were used as a proxy for better maternal social support. Infant complementary feeding was assessed using the 2021 WHO guidelines. Multivariable logistic regression models determined effects of the interaction of maternal social support by group over time on infant feeding practices. The models were adjusted for maternal and infant confounders. ResultsMaternal age (mean ± SD) was 27.7 ± 5.1 years while the infant birthweight was 3.1 ± 0.5 kg. Higher maternal social support positively affected timely introduction of solid and semi-solid foods in moms-only (β = 0.11, p = .011) and moms & dads (β = 0.11, p = .001) groups. Positive intervention effects were noted on infant minimum dietary diversity for both the moms-only group (β = 0.06, p = .01) and the moms & dads group (β = 0.03, p = .001), but no effect was observed between maternal social support and infant minimum meal frequency. However, higher maternal social support in both moms-only and moms & dads groups influenced meeting the minimum acceptable diet (β = 0.07, p = .016 and β = 0.04, p = .026 respectively) and consumption of eggs and/or flesh foods (β = 0.11, p < .0001 and β = 0.05, p = .004). ConclusionsA maternal peer support integrated nutrition education program improved complementary feeding of infants in post-emergency settlements. Enhanced maternal social support in nutrition-sensitive programs may benefit infants in post-emergency settlements in the West-Nile region in Uganda. Funding SourcesA grant from the Nestlé Foundation for the Study of Problems of Nutrition in the World, Switzerland.

Inadequate social support decreases survival in decompensated liver cirrhosis patients

IntroductionInadequate social support is associated with higher mortality both in the general population and in patients with chronic diseases. There are no studies that have described social support in liver cirrhosis and its impact on prognosis. ObjectivesTo analyze the impact social support has in the survival of patients with decompensated cirrhosis. MethodsProspective multicentric cohort study (2016–2019). Patients with decompensated liver cirrhosis were included. Epidemiological, clinical and social variables were collected, using the validated Medical Outcomes Study Social Support Survey, with a 12-month follow-up. ResultsA total of 127 patients were included, of which 79.5% were men. The most common etiology of cirrhosis was alcohol (74.8%), mean age was 60 years (SD 10.29), mean MELD was 15.6 (SD 6.3) and most of the patients had a Child–Pugh B (53.5%) or C (35.4%). In the assessment of social support, we observed that most of the patients (92.2%) had adequate global support. At the end of the follow-up (median 314 days), 70.1% of the patients survived. The 1-year survival rate in patients with inadequate global social support was 30%, compared to 73.5% in the presence of social support. In multivariate Cox regression analysis, inadequate social support predicted survival with an adjusted HR of 5.5 (95% CI 2,3-13,4) independently of MELD (HR 1.1, 95% CI 1–1.2), age (HR 1, 95% CI 1–1.1) and hepatocarcinoma (HR 10.6, 95% CI 4.1–27.4). ConclusionAdequate social support improves survival in liver cirrhosis, independently of clinical variables. Social intervention strategies should be considered for their management.

The role of trauma, social support, and demography on veteran resilience

ABSTRACT Background Historically, resilience has often been conceptualized as the sustained lack of symptoms following trauma exposure. In line with a novel conceptualization of resilience as being dynamic over lifespan, determined by interacting biological and environmental factors, we examined the VA Mid-Atlantic Post Deployment Mental Health Repository (PDMH) comprised of 3876 US Military Veterans with and without PTSD diagnoses. Methods We performed regression modelling to study the relationship between resilience (measured with Connor Davidson Resilience Scale; CD-RISC), posttraumatic stress disorder (PTSD) severity (Davidson Trauma Scale; DTS), social support (Medical Outcome Study Social Support Survey; MOSSS), combat exposure (Combat Exposure Scale; CES), childhood trauma (Trauma Life Events Questionnaire; TLEQ), and demographic factors. CD-RISC was positively correlated with years of education and negatively correlated with DTS, CES and TLEQ scores. Results We found an interaction between CD-RISC and CES in predicting PTSD severity (Davidson Trauma Scale). Specifically, high resilience predicted lower PTSD symptom severity than low resilience, this relationship was amplified with increasing levels of combat exposure. Structural equation modelling (SEM) identified an optimal latent variable that represents resilience and relationships between latent variables for resilience, trauma, and illness. We derived a resilience latent variable composed of age, education level, MOSSS and race. Conclusions Our results support a conceptualization of resilience as a multifactorial determinant that coexists with PTSD, a state rather than trait variable, and can be quantified by biological and behavioural metrics. HIGHLIGHTS • Historically, resilience has often been conceptualized as the sustained lack of symptoms following trauma exposure. • We examined the VA Mid-Atlantic Post Deployment Mental Health Repository (PDMH) comprised of 3876 US Military Veterans. • We found an interaction effect between CD-RISC and CES in predicting PTSD severity (Davidson Trauma Scale)

Social Support Fully Mediates the Association Between Communication Abilities and Social Participation Among Persons with Post-Stroke Aphasia

ABSTRACT Background Communication abilities have been considered to be a key influential factor for social participation in persons with post-stroke aphasia. Previous literature has shown that social support is positively associated with social participation post-stroke. However, few studies have investigated if social support mediates the negative impact of communication difficulties on social participation in persons with aphasia and without aphasia after stroke. Aims To investigate the mediation effect of social support on the association between communication abilities and social participation in persons with aphasia and without aphasia after stroke. Methods & Procedures A total of 116 participants who have had a stroke, including 60 persons with aphasia and 56 persons without aphasia, were enrolled. This study used a regression-based mediation analysis using Hayes’s PROCESS macro (SPSS model 4). Measures included the Medical Outcomes Study (MOS) - Social Support Survey as the mediator (perceived social support), the Stroke Impact Scale 2.0 (SIS) communication domain as the independent variable, and the Activity Card Sort (ACS) social activity domain as the dependent variable (social participation). Two separate models were built for persons with aphasia and without aphasia. As post hoc analyses, the four domains of MOS social support (emotional/informational support, affectional support, positive social interaction, and tangible support) were included as a mediator in four individual models. Outcomes & Results Our results showed that there was no difference in social participation between persons with aphasia and without aphasia after stroke. Perceived social support (b=0.180, 95% CI=0.054~0.352), including emotional/informational support (b=0.182, 95% CI=0.552~0.359), affectionate support (b=0.138, 95% CI=0.020~0.316), and positive social interaction (b=0.178, 95% CI=0.035~0.357), fully mediates the association between communication abilities and social participation in persons with aphasia, but did not for persons without aphasia (p>0.05). Conclusions The results indicate that perceived social support, specifically emotional/informational support, affectionate support, and positive social interaction, may be used as an intervention approach for improving social participation in persons with post-stroke aphasia.

The Relationship between Social Support and Postnatal Anxiety and Depression: Results from the Listening to Mothers in California Survey.

Perinatal mood and anxiety disorders (PMADs) impact multiple domains of maternal and child well-being. Estimates of postpartum depressive symptoms range from 6.5% to 12.9% and from 8.6% to 9.9% for postpartum anxiety. We sought to identify the role social support could play in mitigating PMADs. The data are drawn from the Listening to Mothers in California survey; results are representative of women who gave birth in 2016 in a California hospital. The Patient Health Questionnaire-4 was used to assess total symptoms of PMADs and anxiety and depressive symptoms individually. Two questions adapted from the Medical Outcomes Study Social Support Survey were used to assess emotional, practical, and functional (combined) social support. After exclusions for missing data related to PMADs or social support, we analyzed data from 2,372 women. At the time of survey administration (mean 5.7months after birth), 7.0% of respondents reported elevated PMAD symptoms and 45.9% reported that they always received functional social support. In multivariable analysis, controlling for demographic and pregnancy-related factors and prenatal anxiety and depressive symptoms, women who reported consistent support had a prevalence of elevated PMAD symptoms one-half that of those who did not (adjusted odds ratio, 0.50; 95% confidence interval, 0.34-0.74). This study suggests that consistent social support serves as a robust protective factor against postpartum symptoms of PMADs. Because many predictors of PMADs are not modifiable, social support stands out as an important target for programmatic intervention, particularly in light of increased isolation related to the COVID-19 pandemic.

Social support and cervical cancer screening among sub-Saharan African immigrant (SAI) women.

Low rates of Papanicolaou (Pap) screening among sub-Saharan African immigrant (SAI) women in the US contribute to cancer diagnoses at late stages and high mortality rates. This study was conducted to examine if social support, positively associated with preventive health practices, was predictive of Pap screening in a sample of SAI women. We conducted a cross-sectional study with SAI women who recently immigrated to the US. Participants completed a survey to assess ever having had Pap screening and social support using the Medical Outcomes Study Social Support Survey. Among the 108 SAI women in our study, Pap screening uptake was 65.7%. Affectionate and positive social support were each associated with Pap screening [adjusted odds ratio (AOR) = 1.73 (1.05, 2.87) and 1.68 (1.01, 2.78), respectively]. These findings suggest that consideration should be given to strengthening certain aspects of social support to increase uptake of Pap screening among SAI women.

The association between mental health, social support and physical health outcomes among older female cancer survivors

ObjectivePrevious research has demonstrated an individual's wellness is dependent on multiple factors; however, there has been little research focused on older cancer survivors (≥65). This study explored the association between social support, mental health, and physical health outcomes (bodily pain, physical functioning, health-related quality of life [HRQoL]) among older female cancer survivors. MethodsThis cross-sectional study involved female participants aged ≥65 years old who completed any primary cancer treatment within the last five years. Participants were recruited from the Ohio State University Comprehensive Cancer Center registry and from the Stephanie Spielman Geriatric Breast Oncology Clinic. Physical health outcomes and mental HRQoL were measured using subscales of the RAND-36. Social support was measured by the 8-item modified Medical Outcomes Study Social Support Survey (mMOS-SS). Descriptive characteristics, Pearson's correlations, Chi-square analyses, and regression analyses were used. ResultsThe mean physical functioning score (59.8/100) was low among older (≥65) female cancer survivors when compared to similar studies (p < 0.001) (n = 173). Regression analyses found that higher body mass index (BMI) (β = 0.25) and decreased physical functioning (β = 0.44) were significantly associated with increased bodily pain. Higher social support was positively correlated with higher HRQoL related to bodily pain (β = 0.49). ConclusionsMental health and social support impact the overall health of older cancer survivors. Comprehensive geriatric assessments (CGAs) may help address more than the physical health of survivors. Future research should focus on integrating CGA into clinical practice and assess the impact of CGA HRQoL in older cancer survivors.

Social support and self-management among end-stage renal disease patients undergoing hemodialysis in Indonesia.

Background: Self-management is the latest multidisciplinary intervention that empowers end-stage renal disease (ESRD) patients to be active in maintaining their health status. The implementation of self-management among ESRD patients undergoing hemodialysis in Indonesia remains relatively low, contributing to the high prevalence of complications and morbidity. The social cognitive theory proposes that social support is one of the environmental factors affecting health behavior change. Therefore, this study aimed to investigate the association between social support and self-management among ESRD patients undergoing hemodialysis in Indonesia.Design and Methods: A cross-sectional study was conducted among 107 ESRD patients selected by consecutive sampling. Data were collected online from four chronic kidney disease communities in Indonesia in June 2020. Medical Outcome Study Social Support Survey and Hemodialysis Self-Management Instrument were used to measure patients’ functional social support and selfmanagement levels. Statistical analysis using the Chi-square test was applied to evaluate the association between social support and self-management.Results: More than half of the patients had high social support (51%) and good self-management (53%). There was a significant relationship between social support and self-management (p=0.027; α=0.05; odds ratio 95% CI = 2.386).Conclusions: Social support is a potential environmental factor that can be modified to enhance health behavior change among ESRD patients in Indonesia, with the specific behavior being selfmanagement. This study recommends functional social support as an integral part of self-management intervention provided through cooperation between health workers, chronic kidney disease community, and patient companions. Significance for public health The prevalence of end-stage renal disease (ESRD) has significantly increased year over year, yet more than 50% of ESRD patients still do not comply with the recommended lifestyle modifications. Self-management is a new multidisciplinary treatment that empowers ESRD patients to monitor and participate in health care and lifestyle modifications, replacing previous compliance-based treatments. However, the implementation of self-management in Indonesia is still far from ideal. This study indicates a significant relationship between social support on self-management among ESRD patients undergoing hemodialysis in Indonesia. This study can provide new insights for health workers and social networks active in the interaction and care of ESRD patients regarding functional forms of social support that can be applied to support self-management among ESRD patients undergoing hemodialysis.

Social activity as mediator between social support and psychological quality of life among people with rare diseases: A national repetitive cross-sectional study

BackgroundConsiderable proportion of people with rare diseases (RDs) have suffered from severe mental health problems. However, specific attention on the psychological quality of life (QoL) of people with RDs is sparse. Evidence documented the benefits of social support and social activity on recipients’ mental health and overall QoL, but no corresponding study answered how both social support and social activity work on the psychological QoL among people with RDs. This study aims to report the psychological QoL and evaluate the mediating role of social activity between social support and psychological QoL among people with RDs. MethodsData were from two national repetitive cross-sectional surveys, conducted in China in February 2016 and February 2018. In this study, eligible people were those aged 18 or above and had clinical-diagnosed RDs. Psychological QoL was measured by the subdomain of World Health Organization Quality of Life: Brief Version. Social support was measured by the Medical Outcomes Study Social Support Survey. Social activity was measured with seven items selected from the measurement on leisure activities used by the Chinese General Social Survey. Using the mediation model, we assessed the direct and indirect (via social activity) association between social support and psychological QoL, both on overall and subtypes of RDs. We controlled for a variety of potential socioeconomic and demographic confounding factors. ResultsOf the 2403 adults studied, their average score of psychological QoL was 42.49 out of 100. The psychological QoL was directly associated with received emotional/information support (coefficient = 0.159, 95% CI = [0.093, 0.231], p < 0.0001) and positive social interaction (coefficient = 0.159, 95% CI = [0.097, 0.221], p < 0.0001). The psychological QoL was indirectly (via social activity) associated with received tangible support (coefficient = −0.035, 95% CI = [-0.046, −0.025], p < 0.0001) and positive social interaction (coefficient = 0.056, 95% CI = [0.040, 0.074], p < 0.0001). Above results by subtypes of RDs were also reported. LimitationsThe causal inference was not able to be investigated due to the cross-sectional study design. ConclusionPeople with RDs suffered from a low psychological QoL. Social activity mediated the association between social support and psychological QoL, but its mediating role depended on the subscales of social support as well as the subtypes of RDs. Customized measures based on the type of RDs and support that will be provided could perhaps improve the psychological QoL of people with RDs directly and indirectly.

Geriatric assessment tool application in treatment recommendations for older women with breast cancer

IntroductionTreatment of early breast cancer in older women is usually not guideline concordant owing to lack of routine evaluation of their potential frailty. We assessed the feasibility and impact of a self-administered geriatric assessment on the decision-making process in women aged 65 and above treated in a UK District General Hospital. MethodsOne hundred and one patients, aged 65 and above, with early stage, non-metastatic breast cancer were prospectively recruited between Dec-2018 and March-2021. Patients with metastatic breast cancer, a previous history of cancer and dementia were excluded. All patients had a geriatric assessment with a self-administered questionnaire (mycarg.org). All cases were discussed in the multidisciplinary meeting (MDT) and a pre geriatric assessment recommendations was made, based on the tumour grade, size, node status and receptor status. The findings of the assessment were later discussed in a second meeting and a further recommendation was made based on the geriatric assessment. Any change in the proposed treatment was recorded. Potential factors (age, Body Mass Index, co-morbidities, medications, instrumental activities of daily living, and basic activities of daily living, social support and psychological status) associated with a change in the treatment recommendation were compared using Pearson's Chi square tests for categorized data, and Mann Whitney U test for continuous data. A multivariate logistic regression was performed to test the association between geriatric assessment domains and change in treatment decision. The multivariate model was built using variables which were associated in the bivariate analysis with a p-value< 0.20. ResultsPatients aged less than 70 years were more likely to be diagnosed through screening programme as compared to older women (64.4% vs. 35.6%, p = 0.001).Self-administered geriatric assessment identified patients who were requiring assistance in their daily routine activities, and hence, were assessed to have higher morbidity status. A third of patients required assistance in their routine activities, with 18/101 patients requiring significant help during self-care. 90% patients were independent for Activity of Daily Living (ADL) at baseline and 34.76% for Instrumental Activity of Daily Living (IADL).Among the 101 patients evaluated, proposed change in the initial cancer treatment plan was made in 21.8% of patients after the second MDT. Omission of chemotherapy was recommended in 4 patients, omission of radiotherapy in 15 patients and omission of both chemo and radiotherapy in 2 patients. One patient was advised to omit Zolidronic acid, as she was noted to have renal impairment. No patient in this cohort had suggestion for omission of surgery or endocrine therapy. In the bivariate analysis, need for assistance for activities of daily living (ADLs), low physical performance (KPS), polypharmacy (3 or more medications), lack of social support as assessed using the Social Support: Medical Outcomes Study (MOS) Social Support Survey and high BMI (30 or more) all showed significance but on multivariate analysis only polypharmacy was significantly associated with change in the initial cancer treatment plan. ConclusionsThe results of this study of breast cancer patients aged 65 and above suggest that a self-administered geriatric assessment may influence treatment recommendations in a subset of patients. Recommendations that were influenced by the geriatric assessment mainly included those related to the significant morbidity that may have impacted the use of chemotherapy and/or radiotherapy.

Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool.

Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED's validity and feasibility to assess health complexity in an adult PHC population. The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as "complex". Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study-Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. 42 participants (18.3%) were classified as "complex". A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.

Vagally mediated heart rate variability, stress, and perceived social support: a focus on sex differences

Higher vagally mediated heart rate variability (vmHRV), reflecting vagal activity as indexed by heart function and lower stress vulnerability, is associated with higher perceived social support. Seeking social support is an adaptive stress response, and evolutionary theories suggest that females use this strategy more than males. The current study investigated the hypothesis that higher vmHRV is related to higher perceived social support under conditions of higher, relative to lower, stress, and that this association is most prominent in females. A healthy student sample (n = 143; 82 males, 61 females; mean age 19.9) completed the short version of the Medical outcomes study social support survey (MOS) and the Perceived stress scale (PSS). Activity in the high frequency band of heart rate variability (HF-HRV), deducted from five-minute resting electrocardiogram (ECG) recordings, indexed vmHRV. A moderation analysis was conducted, with PSS and sex as moderators of the association between vmHRV and MOS. Statistical effects were adjusted for age, education, physical activity, body mass index (BMI), alcohol and drug use, ECG-derived respiration (EDR), and mean heart rate. Higher PSS scores moderated the association between vmHRV and MOS in females but not males. Lower PSS scores did not moderate the relation between vmHRV and MOS. This suggests that higher vmHRV is associated with higher perceived social support under conditions of higher stress in females but not males, consistent with evolution of different stress management strategies in the sexes. The results may have implications for individualized intervention strategies for increasing vmHRV and perceived social support.

The psychological status of resident doctors during the COVID-19 pandemic and its association with resilience and social support: A cross-sectional study

CONTEXT: The COVID-19 pandemic has affected the psychological status of frontline medical professionals who constantly work under stressful situations. The role of social support and resilience in safeguarding the mental health of resident doctors, is an area, which has not received due attention.AIMS: To assess the psychological status (depression, anxiety, and fear of COVID-19) and its association with resilience and perceived social support in resident doctors during COVID-19 pandemic.SETTINGS AND DESIGN: A cross-sectional descriptive study was conducted among the resident doctors in a tertiary hospital in Kochi, Kerala.MATERIALS AND METHODS: A web-based survey created using Google forms was sent via social media groups to the resident doctors of a teaching hospital in Kochi between August to September 2020. Two hundred completed responses were obtained. Study tools included a sociodemographic proforma, Patient Health Questionnaire-9, Generalized Anxiety Disorder scale-7, Fear of COVID-19 scale, Brief Resilience Scale, and Medical Outcomes Study Social Support Survey.STATISTICAL ANALYSIS USED: Psychological status (depression, anxiety, fear of COVID-19) was expressed using descriptive statistics; its association with sociodemographic variables using Chi-square test and its correlation with resilience and social support using Pearson correlation.RESULTS: Depression and anxiety were reported in 69% and 59.5% of the respondents, respectively. The mean fear of COVID-19 score was 24.06 (3.220). Resilience and overall social support index showed a significant negative correlation with depression and anxiety scores (P = 0.000). Emotional social support and affectionate social support showed a significant negative correlation with fear of COVID-19 (P = 0.040; P = 0.045, respectively).Conclusion: A large proportion of resident doctors were noted to have depression, anxiety, and fear of COVID-19. Individuals with higher levels of resilience and perceived social support had lesser levels of depression, anxiety, and fear of COVID-19.