Mental Health Component Scores Research Articles

Health-related quality of life among refugees from Nagorno Karabagh resided in Kotayk, Armenia

Abstract Background In September 2023, more than 100,000 ethnic Armenians were displaced from Nagorno Karabakh (NK). This study assessed the health-related quality of life (HRQoL) and associated factors among NK refugees who settled in Kotayk province of Armenia. Methods We surveyed 197 refugees using a structured interviewer-administered questionnaire, which collected information about socio-demographics, chronic diseases, smoking status, HRQoL, utilization of healthcare services, living conditions and food access. The SF-36 Health Survey assessed HRQoL. Ophthalmic examination was conducted. Eyeglasses and medications were provided at no cost to those requiring them. Results The participants’ mean age was 64.8 years and 59.4% were retired. The most commonly reported chronic diseases were bone/joint diseases (67.5%), hypertension (55.3%) and heart diseases (24.9%). Around 48.7% of participants experienced sleeping disorders often/ very often. The mean total SF-36 score was 57.42±23.12; the mean physical (PHC) and mental health component (MHC) scores were 63.57±26.28 and 59.37±20.04, respectively. Only 28% of the participants utilized healthcare services after displacement. Most participants had consistent access to an adequate food supply. In the adjusted analysis age (B/PHC=-0.94, p < 0.001; B/MHC=-0.61, p < 0.001), sleeping disorder (B/PHC=-21.86, p = 0.011; B/MHC=-17.44, p = 0.001), use of medical service (B/PHC=-8.63, p = 0.022; B/MHC=-6.95; p = 0.015) and having more than one chronic disease (B/PHC=-17.35, p < 0.001; B/MHC=-10.90, p = 0.001) were associated with both PHC and MHC. Conclusions This study marks the first assessment of HRQoL among NK refugees. Governmental support and interventions targeting individuals with ophthalmic, sleeping, and chronic diseases might be beneficial. Follow-up assessments should track changes in both physical and mental health scores in this population, as they may fluctuate over time in response to displacement challenges. Key messages • Age, sleeping disorder, use of medical service, and the number of chronic diseases were significantly associated with decreased PHC and MHC of HRQoL • Interventions targeting individuals with restricted access to healthcare services, as well as those affected by eye diseases and chronic health issues might be beneficial.

Prevalence and Outcomes of Chronic Kidney Disease Associated Pruritus: International Results from PDOPPS.

Pruritus is common in hemodialysis (HD) patients. Less is known about the prevalence and outcomes of pruritus among patients receiving peritoneal dialysis (PD). Herein, we describe the prevalence of pruritus and its associations with patient-reported outcomes (PROs) and mortality/transfer to HD. We analyzed a multicenter, international cohort of PD patients enrolled in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014-2022. Pruritus was assessed at entry into PDOPPS with a single-question Likert Scale capturing the extent to which patients were bothered by itch ranging from 1: Not at all, to 5: Extremely. The KDQOL-36 and the Centre for Epidemiological Studies Depression Scale assessed various PROs. Moderate to extreme pruritus was defined as a Likert scale score ≥3. The associations of pruritus with PROs were assessed using linear/logistic regression where appropriate. Death or HD transfer was assessed using multivariable Cox regression models. Overall, 5535 patients from seven countries were included; 43% had moderate to extreme pruritus which was highest in Thailand (50%) and lowest in the United States (33%). The adjusted odds ratios (aOR) of moderate to extreme pruritus were higher for diabetes, low albumin, and elevated phosphorus but lower for residual urine volume (aOR= 0.98 per 200 ml increase in 24-hour urine volume, 95% confidence interval [CI]; 0.96-1.00, P=0.05). Patients with extreme pruritus had the lowest mental and physical health component scores and a higher burden of other PROs including restless legs and disturbed sleep. Overall, 899 patients died and 1221 transferred to HD. Patients with moderate to extreme pruritus were at higher adjusted risk for death or HD transfer (adjusted hazard ratio [aHR] 1.12, 95% CI 1.02-1.23, P=0.02) with similar point estimates for each subcomponent of the composite outcome. Pruritus is highly prevalent in PD and associated with poor health outcomes. Efforts to better identify and manage pruritus should be considered in this population.

Longitudinal Quality-of-Life Outcomes of Skull Base Chondrosarcoma Patients following Surgical Resection

Abstract Objective Owing to the rarity of skull base chondrosarcomas (CS), much of its natural history and long-term impact on patient quality of life (QoL) are not well studied. This novel study demonstrates QoL among CS patients following radical treatment constituting surgery and postoperative radiotherapy over 2 decades. Study Design Retrospective review and prospective data collection to obtain patient demographic, tumor characteristics, clinical symptoms, and patient-reported QoL outcomes using the 36-Item Short Form Health Survey (SF-36). Setting/Participants Patients diagnosed with CS who underwent radical intent surgical resection by the senior author and adjuvant early postoperative proton beam therapy. Results Twenty-eight skull base CS patients were identified, with 19 patients completing full treatment course. Mean long-term follow-up was 148.9 months. Diplopia symptom resolution was high. No significant deterioration in SF-36 Physical Health Component (PHC) and Mental Health Component (MHC) scores was observed at postoperative and long-term follow-up. General health was stable initially but deteriorated in long term (Δ −18.88, minimal clinically important difference [MCID]: 9.86, p = 0.04). Compared with age-matched Canadian control patients, CS patients reported similar PHC scores at baseline and follow-up. CS patients reported lower MHC scores (45.8 vs. 50.9, p = 0.13) preoperatively, which persisted at follow-up decreasing by 1.9 (43.9 vs. 53.7, p = 0.03); this difference, however, did not reach MCID threshold of Δ 5.9. Conclusion We present the longest follow-up data on CS demonstrating stable long-term QoL with aggressive surgery. Tumor control was high and preoperative tumor size did not affect long-term QoL. Preoperative QoL was lower among CS compared with Canadian normative data. Postoperatively, only the decline in physical functioning QoL scores exceeded MCID. At long-term follow-up, the decline in physical functioning, social functioning, and general health exceeded MCID. Overall, QoL among CS patients remained lower at long-term follow-up despite absence of tumor progression and resolution of symptoms.

Impact of Anxious and/or Depressive Reactive State on the Effectiveness of Rehabilitation of Patients with Multiple Sclerosis.

Background and Objectives: Rehabilitation is a part of the comprehensive treatment of multiple sclerosis (MS). If present, psychological reactive states limit the results of the rehabilitation. The objectives were to determine the impact of psychological reactive states in these patients on the functionality obtained by rehabilitation and QoL, and to determine the connection between the objective and subjective evaluation. Materials and Methods: Based on the Hospital anxiety and depression scale, the patients were divided into a group with anxious and/or depressive reactive state and a group without the reactive state. The values of functional scores-the Berg Balance Scale (BBS) and the Expanded Disability Status Scale (EDSS), as well as the parameters of the QoL-Physical health Component Score (PCS) and the Mental health Component Score (MCS)-were determined at the beginning and at the end of the rehabilitation. Results: There was a statistically significant difference between the BBS, EDSS, PCS, and MCS groups at the beginning and the end of the rehabilitation in both groups. A statistically significant difference at the beginning and the end of the rehabilitation between the groups was found only in PCS and MCS. A highly statistically significant correlation between EDSS and PCS, and EDSS and MCS, was found only in the group without the reactive state. Conclusions: Although rehabilitation leads to an objective improvement of functionality in patients with MS, the presence of the anxious and/or depressive reactive state limits the results of rehabilitation and leads to discrepancies in the aforementioned objective assessment and the patient's subjective experience through the evaluation of their QoL.

Collaborative care approaches for people with severe mental illness.

Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.

P047 Mortality in patients with rheumatic disease over a three year period encompassing the COVID-19 pandemic: clinically extremely vulnerable status and short form 12 scores are predictive

Abstract Background/Aims In the United Kingdom (UK), to combat the coronavirus disease 2019 (COVID-19) pandemic, social distancing measures were implemented to varying degrees between March-2020 and December-2021. UK policy deemed patients with rheumatic disease (RD) at higher risk from COVID-19 and many were categorised as ‘clinically extremely vulnerable’ (CEV), these patients were required to follow more stringent social distancing measures. Social isolation and loneliness are implicated as predictors of mortality; the impact of these strict social distancing measures in patients with RD on mortality is unknown. In addition, Health related quality of life (HRQoL) measures provide useful insights into a patients physical and mental wellbeing. HRQoL is recognised as an important measure of health outcomes and there is limited evidence suggesting HRQoL measures such as the Health Assessment Questionnaire (HAQ) and the Short Form-36 questionnaire (SF-36) are associated with mortality in patients with rheumatoid arthritis. The predictive value of the SF-12 (a validated, shortened version of the SF-36) in RD patient’s mortality is unknown. In this UK-based, observational cohort study we evaluated the impact of stricter social distancing measures during the pandemic on 3-year mortality and assessed the utility of the SF-12 in predicting mortality in patients with RD. Methods We distributed a web-based survey via a linked mobile-phone SMS message, to all rheumatology patients, with a validated mobile number, under follow-up at the Royal Wolverhampton Trust, April-2020. We collected demographics, CEV status, and Short Form-12 mental (MCS) and physical health component scores (PCS) for health-related quality of life. Mortality was audited July-2023. Data were analysed using SPSS version 26 and R. Results There were 7,911 active follow up patients with linked mobile numbers. Survey responses were received from 1605 (20%); responders were female (69%), white (94%), CEV (47%), had a mean age of 61years, and most had autoimmune rheumatic disease (78%). Of the responders, 58 (4%) had died by July-2023 - compared to the alive group these patients had significantly worse MCS (p < 0.001) and PCS (p = 0.004) at baseline; significantly more in those that had died were CEV (p < 0.001), and older (p < 0.001), while gender, ethnicity, and diagnosis did not differ. Conclusion These data demonstrate in a large cohort of patients with RD over a 3-year period those patients considered CEV, advised to follow more stringent social isolation measures were at significantly greater risk of death. Further, baseline SF-12 scores for both mental and physical components were lower in patients that died over a 3-year period. These data potentially highlight the utility of the SF-12 and assessing social isolation and loneliness in patients with RD to predict mortality. In addition, our methods demonstrate the merits of communicating with patients through SMS-messaging and can be used in delivering important health-care communications in future. Disclosure N. Cox: None. J. Bateman: None.

LONELINESS AND QUALITY OF LIFE IN OLDER ADULT PRIMARY CARE PATIENTS

Abstract Loneliness, defined as the perceived discrepancy in an individual’s desired and actual social relationships, is common among older adults. Loneliness among older adult primary care patients is lacking, considering the implications it has on physical and mental health. Our objective was to determine the relationship between loneliness and quality of life (QOL) in older adult primary care patients. Data come from the Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer’s disease and related dementias screening among older primary care patients and their family members. Loneliness (5-item NIH Toolbox), quality of life (QOL)—as measured by physical and mental health component scores— and depression (PHQ-9) and anxiety symptomatology (GAD-7) were measured among primary care patients aged 65 and older from April 2020 to September 2021. Spearman correlation analyses reveal that loneliness was moderately correlated with mental health (r(601) = -.43, p< 0.001), anxiety (r(601) =.44, p< 0.001), and depression (r(601) = .42, p< 0.001), while weakly correlated with physical health (r(601) = -.15, p< 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was associated with both lower mental (p< 0.001) and physical health component scores (p< 0.001). Furthermore, loneliness remained significantly associated with worse mental health when adjusting for depression, anxiety, sociodemographic characteristics, and comorbidity. Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.

Induced membrane technique versus one-stage autografting in management of atrophic nonunion of long bone in the lower limb: clinical and health burden outcomes

ObjectiveIn this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones.MethodsFrom January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year.ResultsIn total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane–Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: ¥30,432 vs. ¥56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770).ConclusionThe data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making.

A comparison of the mother-infant relationship in mothers with and without gestational diabetes mellitus: An analysis of the growing up in Scotland cohort

BackgroundThere is an increased risk of depressive symptoms in women with gestational diabetes mellitus (GDM). Poor maternal mental health can impact the mother-infant relationship which can cause problems in the perinatal period. However there is little research which examines the mother-infant relationship in women with GDM. AimsTo test the hypotheses that (1) GDM is associated with a perceived difficult mother-infant relationship in the first year of an infant's life in a cohort of women recruited in pregnancy compared to mothers who do not have GDM and (2) poor maternal mental health mediates the relationship between GDM and the mother-infant relationship Study designA retrospective analysis of a Scottish cohort database using mediation analysis. SubjectsThe dataset included 5,289 women (n = 204 GDM, n = 5,085 no GDM). Outcome measuresThe Maternal Postnatal Attachment Scale measured the mother-infant relationship. The SF-12 Mental Health Component Score measured maternal mental health. ResultsGDM does not predict maternal mental health (path a). Poor maternal mental health is significantly associated with a perceived difficult mother-infant relationship (path b). The direct effect of GDM on the mother-infant relationship (path c) was not statistically significant. The indirect effect of GDM on the mother-infant relationship via maternal mental health (mediator) was also not significant. ConclusionThis is the first robust study examining the impact of GDM on the mother-infant relationship. The study did not support the hypotheses, however the results are of theoretical value, especially in the context of limited research.

What is the Impact of Social Deprivation on Mental and Physical Health Before and After Primary Total Knee Arthroplasty?

The purpose of the present study was to investigate the relationship between socioeconomic status and Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) scores before and after primary total knee arthroplasty (TKA). We hypothesized that patients with greater social deprivation would have lower PROMIS-GH scores at 3 months and 1 year following primary TKA. We retrospectively reviewed data from patients who underwent unilateral primary TKA and completed PROMIS-GH preoperatively and at 3 months (n= 257) or 1year (n= 154) postoperatively. Area Deprivation Index (ADI), calculated from 9-digit zip codes, was used to measure social deprivation. Participants were grouped into quartiles by ADI score. Minimal clinically important difference in PROMIS-GH mental (PROMIS-MH) and physical health (PROMIS-PH) component scores were compared between ADI groups. Participants in the highest ADI quartile (most disadvantaged) had significantly lower PROMIS-MH and PROMIS-PH scores at every time point relative to the lowest ADI quartile (least disadvantaged) (P < .05 for all). Both ADI groups experienced significant improvements in PROMIS-PH following TKA (P < .001 for all), but not in PROMIS-MH (P > .05 for all) at 3-months and 1-year postoperatively. Magnitude of improvement in PROMIS-PH and rates of achievement of minimal clinically important difference did not significantly differ between ADI groups (P > .05 for all). Socially disadvantaged patients benefit equally from primary TKA but are more likely to have persistently lower 1-year postoperative PROMIS-GH scores relative to less disadvantaged patients. Social deprivation should be accounted for when using PROMIS-GH to assess clinical outcomes for research and quality measures. IV, retrospective cohort study.

Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair

To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P= .005 to P= .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P= .005) and external rotation (7.13° vs 1.65°; P= .031) ROM than the control group. Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level III retrospective comparative study.

98 Care Discontinuity in Burn Patients: Does it Impact Long-Term Outcomes?

Abstract Introduction Care discontinuity, or the care that is provided by disparate healthcare professionals when patients are readmitted to a hospital different than their original admission (non-index hospital), has been associated with worse outcomes among surgical patients. However, little is known about its effect on burn patients. Our aim was to determine the impact of care discontinuity on long-term outcomes in a national sample of burn patients. Methods The longitudinal Burn Model System National Database was queried from 1996 to 2021. All adult burn patients from participating sites were included. Care discontinuity was defined by having therapy or burn-related surgeries at non-index hospitals. The main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6 and 12 months after injury. Multivariable regression was used to examine the association between care discontinuity and long-term outcomes, adjusting for patient characteristics and burn injury severity. Results A total of 1,866 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 76% were white. Mean PCS scores were 43.56 (SD 10.95) and 45.17 (SD 11.18); and mean MCS scores were 48.00 (SD 12.60) and 48.25 (SD 12.55) at 6 and 12 months, respectively. Care discontinuity was reported in 423 (22.6%) burn patients, who reported having therapy or burn-related surgeries at a non-index hospital. In adjusted analyses, care discontinuity was associated with worse PCS at both 6 months (Coefficient -2.18, 95% Confidence Interval [CI] -3.44 – -0.91, p=0.001), and 12 months (Coefficient -2.16, 95% CI -3.50 – -0.82, p=0.002), compared to patients having therapy/surgery at index hospitals. Care discontinuity was not associated with MCS scores at 6 (Coefficient 0.54, 95% CI -0.04 – 2.03, p=0.473) and 12 months (Coefficient -0.90, 95% CI -2.49 – -0.67, p=0.262). Conclusions Care discontinuity was significantly associated with lower physical health component scores at long-term follow up, but not with mental health component scores. Future studies should focus on developing strategies to ensure continuity of care and/or identifying out of system patients to provide targeted resources. Applicability of Research to Practice Understanding the implications of care fragmentation on longitudinal outcomes may help clinicians develop strategies to ensure care continuity and consequently better outcomes.

Leveraging Mindfulness to Reduce Stress and Improve Quality of Life Among Pharmacy Students

ObjectiveMethods to improve stress and well-being for health profession trainees are limited. Mindfulness, elevating awareness to the present moment experience with compassion, has been shown to demonstrate effectiveness to enhance well-being. This research leverages techniques from mindfulness to develop and evaluate a credit-bearing longitudinal mindfulness elective, designed to teach mindfulness to improve stress and quality of life (QoL). MethodsA mindfulness elective was created for pharmacy students. A longitudinal, case-control, survey-based design was used to compare stress and QoL between mindfulness participants and nonparticipant controls. Stress was assessed by the Perceived Stress Scale (PSS) and QoL by the SF-12 v2 Health-Related QoL Scale (SF-12 v2 QoL). ResultsFour weeks after course completion, the average PSS score was lower among participants compared to controls (18.58 SD 5.85 vs 20.79 SD 6.31, Cohen’s d = 0.36). The Mental Health Component score of SF-12 v2 QoL was higher among participants versus controls (41.94 SD 8.58 vs 36.93 SD 9.59, Cohen’s d = 0.55). The Physical Health Component score of SF-12 v2 QoL was lower among participants than the control group (46.13 SD 5.48 vs 48.62 SD 6.53, Cohen’s d = 0.41). ConclusionThe results indicate small to moderate effect sizes associated with participation in a mindfulness elective, reducing stress and improving mental QoL among pharmacy students. The structure and potential benefits of the course can be extrapolated to other institutions. By offering course credit for mindfulness practice, health profession schools can support student wellness.

IMPACT OF PULMONARY DENERVATION ON QUALITY OF LIFE AFTER COMPLEX MITRAL VALVE SURGERY

Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3rd group was 100%, in the 2nd and 1st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

Long-term patient-related quality of life outcomes and ICD-10 symptom rating (ISR) of patients with pyogenic vertebral osteomyelitis: What is the psychological impact of this life-threatening disease?

PurposeWe aimed to evaluate the long-term impact of the treatment of pyogenic vertebral osteomyelitis (VO) on functional outcomes and patients' quality of life (QoL) with a special focus on psychological well-being.MethodsA total of 156 patients with VO with a minimum clinical follow-up of 12 months were retrospectively identified and asked to participate. Patient-reported outcome measures were evaluated with the EuroQol five-dimension questionnaire (EQ-5D) and German Short-Form 36 (SF-36) outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Spine-specific outcomes were assessed with the Core Outcome Measure Index and the Oswestry disability index (ODI) or the Neck disability index (NDI), respectively.ResultsFrom n = 156 eligible patients, n = 129 patients could be contacted and n = 40 returned questionnaires, yielding a response rate of 31.0%. The mean time from hospital discharge to follow-up was 83.0 ± 3.8 (13–193) months. Spine-specific outcomes showed mild to moderate disability. The mean physical health component score of the SF-36 (37.1 ± 16.7), the mean mental health component score (38.2 ± 14.0) and the mean EQ-5D VAS rating (57.1 ± 21.5) were significantly lower in comparison with the scores of an age-matched reference population (all p < 0.05). The mean total score of the ISR was 0.53 ± 0.23. On average, the cohort did not cross the threshold of clinically relevant symptom burden on any subscale.ConclusionEven almost seven years on average after completed treatment of VO, patients report impaired QoL. Assessment of psychological disorders should be implemented in clinical practice and future prospective studies.

Abstract PD8-05: Effectiveness of Electroacupuncture Versus Auricular Acupuncture in Reducing Pain and Improving Quality of Life in Breast Cancer Survivors with Chronic Musculoskeletal Pain

Abstract Introduction: Chronic musculoskeletal pain is common and debilitating among breast cancer survivors. Recently, the Personalized Electroacupuncture (EA) versus Auricular Acupuncture (AA) Comparative Effectiveness (PEACE) trial demonstrated that both acupuncture methods reduced pain more than usual care (UC) in cancer survivors. However, the comparative effectiveness between EA and AA among breast cancer survivors is unknown. Here, we report the results of subgroup analysis of breast cancer survivors enrolled in the PEACE trial. Methods: PEACE is a three-arm, parallel, single center randomized trial investigating the effectiveness of EA and AA versus UC for chronic musculoskeletal pain in 360 cancer survivors. Patients in both EA and AA received ten weekly treatments. Patients in UC could receive ten EA treatments after week 12. The primary endpoint was the change in mean Brief Pain Inventory (BPI) pain intensity from baseline to week 12; change from baseline to week 24 and change in quality of life were secondary endpoints. We analyzed the subset of 46% of trial participants with a primary diagnosis of breast cancer. We conducted constrained linear mixed model analyses, which constrained all arms to have a common pre-randomization baseline mean. Model-based mean estimates at weeks 12 and 24 were compared between arms using model contrasts. Results: Among 165 breast cancer survivors, the baseline mean pain severity was 5.35 (95% Confidence Interval [CI]: 5.04, 5.66). At week 12, the BPI pain severity score was 2.69 (2.26. 3.13) in EA, 3.60 (3.17, 4.02) in AA, and 5.06 (4.47, 5.65) in UC. At week 24, the mean BPI pain severity was 2.84 (95% CI: 2.40, 3.28) in EA and 3.67 (95% CI: 3.23, 4.10) in AA. EA reduced pain severity significantly more than AA at both week 12, (-0.90 [-1.45, -0.36], p=0.001) and week 24 (-0.82, [-1.38, -0.27], p=0.004). There were no differences between EA and AA in improvements in PROMIS physical health or mental health component scores, but both EA and AA significantly improved both PROMIS scores at week 12 compared to UC. Mild toxicities were reported, more patients dropped out of the AA arm due to ear pain. Conclusions: EA was more effective than AA at reducing pain severity, but both similarly improved physical and mental health scores. Breast cancer survivors with chronic musculoskeletal pain may consider EA before AA. Citation Format: Ting Bao, W. Iris Zhi, Raymond Baser, Qing Li, Jun Mao. Effectiveness of Electroacupuncture Versus Auricular Acupuncture in Reducing Pain and Improving Quality of Life in Breast Cancer Survivors with Chronic Musculoskeletal Pain [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-05.

The Relationship Between Loneliness and Quality of Life in Older Adults

Background/Objective: Loneliness is the self-perceived discrepancy in an individual’s desired and actual social relationships. Loneliness is common among older adults and is associated with chronic illness and poorer mental health outcomes. Our objective was to determine the relationship between loneliness and quality of life (QOL) in older adult patients, controlling for depression and anxiety.&#x0D; Methods: Secondary data analysis was conducted on baseline data from the Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) Trial, an ongoing trial evaluating benefits and risks of Alzheimer’s disease and related dementias (ADRD) screening. Patients were≥65 years old with no history of ADRD. Measures include the5-item NIH Toolbox Loneliness measure, QOL, measured by the physical (PCS) and mental health component (MCS) scores of SF-36, and depression and anxiety, measured by PHQ-9 and GAD-7, respectively. We conducted a Spearman correlation and ran unadjusted and adjusted linear regression models to assess the relationship between loneliness and QOL.&#x0D; Results: Patient mean (SD) age was73.7 (5.1) years; 44.8% male; 91.5% white; 7.5% black. We found that loneliness was moderately correlated with QOL measured by SF-36 MCS (r= -0.43, p&lt;0.001), anxiety (r= 0.44, p&lt;0.001), and depression (r= 0.42, p&lt;0.001), while weakly correlated with QOL measured by SF-36 PCS (r= -0.15, p&lt;0.001). Loneliness was associated with lower MCS (p&lt;0.001) and PCS (p&lt;0.001). After adjusting for depression and anxiety, only MCS (p&lt;0.001) was reduced by loneliness. Additionally, we found a positive association between PCS and patient report of comfortable level of income, before(p=0.002) and after(p=0.002) adjustment.&#x0D; Conclusion: We found that loneliness was significantly associated with worse quality of life as measured by mental health constructs among older adult primary care patients. Therefore, we recommend primary care providers assess loneliness with their older adult patients and if present, consider interventions aimed at reducing loneliness such as activities that maintainmeaningful social relationships

The patient burden of nocturnal polyuria in the United States: Results from the epidemiology of nocturnal polyuria (EpiNP) study.

To explore the impact of nocturnal polyuria (NP) on health-related quality of life (HRQoL), work productivity, mental health, fatigue, bother, and daytime sleepiness. This large-scale, US population-representative epidemiologic study was conducted in two parts: a web-based survey and 3-day bladder diary. Consenting participants completed the baseline Epidemiology of NP (EpiNP) survey online (Lower Urinary Tract Symptoms [LUTS] Tool, comorbidities, burden, and multiple HRQoL measures). Participants who reported ≥2 voids/night, and a random sample of 100 respondents each reporting 0 or 1 void/night, were sent urine measurement containers and asked to complete the 3-day bladder diary. NP was defined as Nocturnal Polyuria Index >0.33 (NPI33) or nocturnal urine production >90 ml/h (NUP90). Five subgroups were created: Idiopathic NP (NP with no underlying cause), NP associated with symptoms of overactive bladder (NPOAB) or bladder outlet obstruction (NPBOO; men only), NP associated with other comorbidities (NPCOM; e.g., diabetes, hypertension, heart disease, sleep apnea), and no NP (did not meet NP criteria). A total of 4893 men and 5297 women completed the EpiNP survey; mean age was 54.4 (SD = 14.7). Significantly greater patient burden (p < 0.0001) was evidenced in the nocturia group (≥2 voids/night) versus no nocturia group (0-1 void/night) on daily impact of nocturia, LUTS Bother, prostate symptoms (men only), work productivity, physical and mental health component scores, depression, fatigue, and daytime sleepiness. NP subgroup analyses showed men in the NPBOO group and women in the NPOAB group reported the greatest impact on LUTS bother, fatigue, physical health, work productivity impairment, daytime sleepiness, and depression (women only). This was the first large-scale, epidemiologic study to explore the impact of different forms of NP on patients' HRQoL. Findings demonstrate that NP associated with other urologic or comorbid conditions appears to have greater patient burden than idiopathic NP, in particular for women.

The impact of the COVID-19 pandemic and stringent social distancing measures on health-related quality of life and COVID-19 infection rates in patients with rheumatic disease: a longitudinal analysis through the pandemic.

The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and stringent social isolation measures on patients with rheumatic disease (RD) from the beginning of the pandemic (April 2020). In this UK-based single-centre, prospective, observational cohort study, all RD follow-up patients at our centre were invited by SMS text message in April 2020 to participate in the study. Participants completed questionnaires at four time points between April 2020 and December 2021. We collected demographics, clinically extremely vulnerable (CEV) status, short form 12 mental (MCS) and physical health component scores (PCS) for health-related quality of life, vaccination status, COVID-19 infection rates and incidence of long COVID. We enrolled 1605 patients (female, 69.0%; CEV, 46.5%); 906 of 1605 (56.4%) completed linked responses to our final questionnaire. MCS improved (+0.6, P < 0.05), whereas PCS scores deteriorated (-1.4, P < 0.001) between April 2020 and December 2021. CEV patients had worse mental and physical health scores than non-CEV patients at entry (PCS, 36.7 and 39.3, respectively, P < 0.001; MCS, 40.9 and 43.0, respectively, P < 0.001) and at each time point throughout the study; both mental and physical health outcomes were worse in CEV compared with non-CEV patients (P < 0.001 and P = 0.004, respectively). At study close, 148 of 906 (16.3%) reported COVID infection, with no difference in infection, vaccination or long COVID rates between CEV and non-CEV patients. Mental and physical health in RD patients has changed throughout the pandemic; outcomes for both metrics of health were worse in CEV patients, although there were no differences in infection rates between the groups. These data might assist the understanding and planning of future health-care policy and social restrictions in RD patients. ClinicalTrials.gov, www.clinicaltrials.gov, NCT04542031.

PROFILES OF PERSONAL DETERMINANTS OF HEALTH AND ASSOCIATED HEALTH OUTCOMES IN OLDER ADULTS: A LATENT CLASS ANALYSIS

Abstract Personal Determinants of Health (PDOH) are considered personal resources that contribute to successful aging. Positive PDOH factors have been associated with better health outcomes in older adults; however, research in this area is still limited. Using survey and claims data among adults age 65+ (N=2,866), profiles were identified based on five key PDOH factors (resilience, purpose in life, optimism, self-perception of aging, and social connection via loneliness) utilizing Latent Class Analysis (LCA). Differences in socio-demographics and healthcare outcomes were then explored utilizing multivariate regression models. Outcomes included emergency room (ER) visits, inpatient (IP) admissions, total medical cost, and quality of life (physical and mental health component scores). LCA models yielded three main classes within our sample: high PDOH (56%, n=1,150), moderate PDOH (40%, n=1,611), and low PDOH (4%, n=125). Those within the high PDOH class were significantly younger (Mage=75.6) compared to those within the moderate (Mage=78.2) and low (Mage=78.9) PDOH classes. In addition, the high PDOH class was significantly less likely to have an ER visit (OR=1.81, 95% CI:1.23-2.66) and had 28% better physical health and 52% better mental health components scores as compared to the low PDOH class. Results demonstrate support for the PDOH model as a potential successful aging model. Combinations used to create classes using resilience, purpose in life, optimism, self-perception of aging, and social connection via loneliness indicates that those who are positive in all five aspects show the most promising health outcomes. Future implications include targeting interventions at improving these variables for at-risk older adults.