Mental Health Composite Scores Research Articles

Physical and Psychological Recovery Following Toxic Epidermal Necrolysis: A Patient Survey.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening diseases that cause sloughing of the skin and mucous membranes. Despite improved survival rates, few studies focus on long-term outcomes. We conducted a single-center review of all patients with SJS/TEN admitted from January 2008 to 2014. SJS/TEN survivors were invited to participate in the validated Veterans RAND 12-Item Health Survey (VR-12) to assess health-related quality of life using a mental health composite score and physical health component score (PCS). The sample was compared to U.S. norms using one-sample two-tailed t tests. A second questionnaire addressed potential long-term medical complications related to SJS/TEN. Of 81 treated subjects, 24 (30%) long-term survivors responded. Participants identified cutaneous sequelae most frequently (79%), followed by nail problems (70%), oral (62%), and ocular (58%) sequalae. Thirty-eight percent rated their quality of life to be "unchanged" to "much better" since their episode of SJS/TEN. The average PCS was lower than U.S. population norms (mean: 36 vs 50, P = .006), indicating persistent physical sequelae from SJS/TEN. These results suggest that SJS/TEN survivors continue to suffer from long-term complications that impair their quality of life and warrant ongoing follow-up by a multidisciplinary care team.

Salvage Revision Hip Arthroscopy Including Remplissage Improves Patient-Reported Outcomes After Cam Over-Resection

To evaluate outcomes of arthroscopic hip remplissage with folded iliotibial band allograft to treat cam over-resection. Patients who underwent arthroscopic iliotibial band hip remplissage from May 2013 to April 2018 were prospectively evaluated. Pre- and postoperative patient-reported outcome scores were compared and included the 12-Item Short Form Survey (SF12) Physical Health Composite Score (PCS), SF12 Mental Health Composite Score (MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport). Postoperative Tegner Activity Scale and patient satisfaction (1-10) were also evaluated. Thirteen patients (2 men, 11 women) with an average age of 39.8 ± 9 years underwent arthroscopic hip remplissage with minimum 2-year and mean 3.1-year follow-up (range, 2.1-4.1 years). One hundred percent follow-up was achieved. The average number of previous surgeries was 1.38 (range, 1-3). One patient underwent total hip arthroplasty 2 years after remplissage. All 12 patients who did not undergo total hip arthroplasty had improved patient-reported outcomes after remplissage (mean scores: SF12 PCS 36 vs 42, P= .02; SF12 MCS 45 vs 51, P= .14; mHHS 45 vs 66, P < .001; minimal clinically important difference [MCID] 83%; WOMAC 42 vs 28, P < .001; HOS ADL 52 vs 69, P= .003; MCID, 67%; HOS Sport 27 vs 46, P= .015; MCID, 67%). All improvements met statistical significance, besides the SF12 MCS. Median postoperative Tegner score was 2.9. Median postoperative patient satisfaction was 7 out of 10 (range, 5-10). Arthroscopic hip remplissage is a successful salvage treatment option for hip instability caused by previous cam over-resection. Care must be taken during primary surgery not to over-resect the cam as patient-reported outcomes after remplissage are inferior to those undergoing primary hip arthroscopy. Level IV, case series.

Outcomes of First Metatarsophalangeal Joint Fusion Using a Precontoured Plate.

The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° (P < .05) and the mean reduction of the HVA was 33° (P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points (P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. Level III.

Adherence to dietary guidelines is associated with better physical and mental quality of life: results from a cross-sectional survey among 728 Dutch MS patients

ABSTRACT Background A healthy diet has been associated with less symptoms or progression of disease in multiple sclerosis (MS). However, whether specific diets are needed, or general healthy diet recommendations are sufficient is unknown. Objective To investigate the association between diet quality, use of diets, and quality of life (QoL) in men and women with MS. Methods Diet quality was measured with the Dutch Healthy Diet-index, which measures adherence to the Dutch Guidelines for a Healthy Diet. QoL was assessed with the MSQoL-54 questionnaire. A total of 728 people were included (623 women, 105 men). Multiple linear regression, stratified for gender, was used to analyse the data. Results In women with MS, an association was found between diet quality and both physical and mental QoL after adjusting for several confounders (Physical Health Composite Score (β=0.410; P=0.001); Mental Health Composite Score (β=0.462; P=0.002)). Similar results were less pronounced in men. Subjects following a specific diet had higher diet quality and QoL than subjects not following a diet. Conclusion Adherence to the Dutch dietary guidelines is associated with better physical and mental QoL, especially in women. Following an MS-specific diet may help to adhere to these guidelines.

A comparison of health-related quality of life in autonomic disorders: postural tachycardia syndrome versus vasovagal syncope.

Postural tachycardia syndrome (POTS) and vasovagal syncope (VVS) are two disorders of orthostatic intolerance which are often misdiagnosed as the other. In each case, patients experience a reduced health-related quality of life (HRQoL) compared to healthy populations. This study was conducted to test the hypothesis that HRQoL is worse in POTS. POTS patients were recruited from the Dysautonomia International Annual Patient and Caregiver Conference. VVS patient data came from those enrolled in the Second Prevention of Syncope Trial. Participants aged ≥ 18years (177 POTS and 72 VVS) completed the RAND 36-Item Health Survey, a generic and coherent health-related quality of life survey. POTS patients reported reduced HRQoL compared to VVS patients in physical functioning (42.5 ± 1.7 vs. 76.5 ± 2.9, p < 0.001), role limitations due to physical health (11.4 ± 1.9 vs. 33.0 ± 5.0, p < 0.001), energy and fatigue (27.2 ± 1.3 vs. 50.7 ± 2.6, p < 0.001), social functioning (45.2 ± 1.8 vs. 71.2 ± 2.9, p < 0.001), pain (48.8 ± 1.9 vs. 67.7 ± 2.9, p < 0.001), and general health (31.2 ± 1.5 vs. 60.5 ± 2.6, p < 0.001) domains. Scores did not differ significantly in the role limitations due to emotional health (p = 0.052) and emotional well-being (p = 0.271) domains. Physical and general health composite scores were lower in the POTS population, while mental health composite scores were not different. Differences in HRQoL exist between these patient populations. POTS patients report lower scores in physical and general health domains than VVS patients, but emotional health domains do not differ significantly. Targeting physical functioning in these patients may help improve quality of life.

Correlation between Base Transceiver Station and the Quality of Sleep and Life of Nearby Residents

Introduction: Electromagnetic waves that are of higher energy than visible light transmit information between mobile phones and antennas BTS (Base Transceivers Station). The increasing use of mobile phones due to the proliferation of antennas is a matter of concern. The present study aimed to investigate the correlation between distance from the BTS antennas and the quality of sleep and life of nearby residents. Material and Methods: For the assessment of the quality of sleep, the Pittsburgh Sleep Quality standard questionnaire (PSQI) was used. On the other hand, the 12-item Short -Form Health Survey (SF-12) was used to assess the quality of life. This questionnaire contains two parameters: Mental Health Composite Scores (MCS) and Physical Health Composite Scores (PCS). Results: The analysis of the data obtained from 810 people indicated that the most sleep disturbance and the minimum average MCS score (p <0.05) were detected in the residents who were living within 50-100 meters from the antenna. Moreover, it was found that the average PCS score was lower among those residing within 100-200 meters from the antenna, as compared to other residents. Conclusion: The present study demonstrates that exposure to electromagnetic waves can affect sleep quality, as well as the mental and physical life qualities of the residents depending on the distance from BTS. Antennas implant must be set in patterns that have the lowest intensity in terms of beam convergences for all residents.

Loneliness and Mental Health: Recommendations for Primary Care Intakes.

Introduction/ObjectivesThe healthcare intake process plays a significant role in informing medical personnel about patients’ demographic information, subjective health status, and health complaints. Intake forms can help providers personalize care to assist patients in getting proper referrals and treatment. Previous studies examined factors that could be included in intake forms independently, but this study analyzed loneliness, religiousness, household income, and social integration together to see how the combined effect influences mental and physical health status. This study aims to determine which of those 4 variables better inform patients’ mental versus physical health status.MethodsOne hundred and seventy-nine participants completed surveys, including the SF-12® Health Survey, measuring perceived physical and mental health, UCLA 3-item Loneliness Scale, and a demographics questionnaire with questions about household income and time spent dedicated to religious practice, if applicable. Additionally, individuals answered social integration questions about how often they contact close family and friends or volunteer in the community. Using loneliness, household income, religiousness, social integration as independent variables, and controlling for demographic variables such as age, gender, and race, 2 regression models were built with Mental and Physical Health Composite Scores from the the SF-12® Health Survey as dependent variables.ResultsLoneliness was associated with mental health measures (b = −2.190, P < .001), while household income was associated with physical health measures (b = 0.604, P = .019) above and beyond other variables in the regression models.ConclusionsIntegrating the 3 loneliness questions into intake forms can help approximate an individual’s mental health status. This would allow the provider to be able to assess mental health problems more effectively and provide needed resources.

Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.

Can lifestyle interventions improve Canadian men's mental health? Outcomes from the HAT TRICK programme.

Engaging men in mental health promotion can be difficult because of reticence about help-seeking, especially for gender neutral programmes. Developments in men's health research has pointed to the success of gender-sensitized programmes to increase men's engagement in healthy lifestyle interventions targeting physical activity and healthy eating; however, less is known about the impact of these interventions on men's mental health. This study explored changes to men's depression risk and health-related quality of life at post-intervention (12 weeks) and 9-month follow-up, after participating in HAT TRICK, a gender-sensitized lifestyle intervention for overweight men. Participants completed validated self-report measures of mental health at baseline, post-intervention (12 weeks) and 9-month follow-up. Men's scores on the Male Depression Risk Scale (MDRS) and the SF-12 questionnaire, including physical health (PH12) and mental health (MH12) composite scores, were analyzed using mixed linear models to assess linear trends. At baseline, men (N = 62) had a mean age of 50.98 (SD = 10.09) years and BMI of 35.87 (SD = 5.51) kg/m2. Results show that both the MDRS and the MH12 showed improvements in participants' mental health, with significant linear trends (p = 0.003; p = 0.003) qualified with significant quadratic trends over time (p = 0.02; p = 0.03). There were no significant changes in the PH12 over time. Gender-sensitized programmes for overweight men, such as HAT TRICK, are a promising approach to positively influence components of men's mental health, with the potential for sustained improvements over the long term.

Studying physical and mental health status among hijra, kothi and transgender community in Kolkata, India.

Individuals with diverse sexual orientation and gender identities have historically experienced the major share of stigma, discrimination, and marginalization among all the LGTBIQ+communities in India. Transgender, intersex, or queer individuals are deprived of their basic rights, self-dignity, bodily autonomy, and healthcare leading to significant negative health status. Recent legal reforms such as the decriminalization of Section 377 of the Indian Penal Code (prohibited same-sex activity) and amendments to the Transgender Persons (Protection of Rights) Bill may improve their health. In this context, the study has the following objectives: 1) to measure the physical and the mental health status of hijra, kothi, and transgender (HKT) individuals using the Short Form 12 (SF-12) questionnaire; 2) understand the variation in their health status by social determinants; and 3) identify spatial patterns of HKTs general, physical, and mental health. Data was collected using a Bengali version of SF-12 (N=98). We calculated physical (PCS) and mental (MCS) health composite scores and conducted relevant statistical and spatial analysis. Findings revealed that HKT individuals had poor mental health (mean MCS=42.3) compared to their physical health (mean PCS=49.0). ANOVA tests showed statistically significant variation of PCS and MCS among HKTs by their age and income. Participants with both poor and good health conditions were evenly distributed in the study area, with no significant spatial clustering. This study was the first attempt to assess the health-related quality of life among the HKT individuals using SF-12, not previously adapted to gender-diverse communities in India. Results clearly indicate that there is a pressing need to address both physical and mental health among gender-diverse communities by not only improving awareness of their healthcare rights but by also removing social and structural barriers to health programs, increasing targeted health interventions, grassroot level activism, and government advocacy.

Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study.

BackgroundWeb-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients’ perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information.ObjectiveThe aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention.MethodsThe original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores.ResultsA total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=–0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI –21.40 to –17.21, P<.001), and there was a moderate correlation with the patients’ perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified.ConclusionsThis study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies.Trial RegistrationClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612

Relationship Between Muscular Fitness And Health Related Quality Of Life In Professional Firefighters

High muscular fitness levels are needed to perform occupational tasks for a professional firefighter. Common occupational tasks include heavy equipment carrying, forced entry and securing. However, current evidence suggests fitness levels often decline over the course of a firefighter’s career, which in turn impacts occupational task performance capabilities. Additionally, work-related stress occurring during the careers of firefighters contributes to higher rates of posttraumatic stress disorder compared to civilian counterparts. Health related quality of life (HRQoL) considers the elements that impact individual feelings of well-being and its perception may be influenced by components of physical and mental health. Currently, limited research exists describing the relationship between muscular fitness and HRQoL in professional firefighters. PURPOSE: To explore the relationship between muscular fitness and HRQoL in professional firefighters. METHODS: 35 firefighters (31 males, 4 females, 36 ± 7 years, 178 ± 8 cm, 88.5 ± 18 kg) participated in the study. Five muscular fitness assessments were performed: maximum vertical jump, 1-repetition maximum bench press, maximum repetitions of pull-ups, maximum repetitions of push-ups, and the wall sit and reach. HRQoL was measured using the Short-Form (SF) 36 Questionnaire. Physical and mental composite scores were computed for the SF 36. Descriptive statistics (mean ± SD) were calculated for each variable. Pearson correlation tests were used to assess association between variables (p <0.05). RESULTS: There was a significant correlation between pull-ups and the mental component of HRQoL (r = -0.37; p < 0.05). No other statistically significant relationships were found. Mean pull-up and mental health composite scores were 7.1 ± 6.5 repetitions and 80.3 ± 10.8, respectively. CONCLUSIONS: It was unexpected that none of the fitness assessments were found to have a significant relationship with the physical composite score. Furthermore, the finding that only a single component of muscular fitness had a significant relationship with mental health is a novel finding. Based on results, HRQoL of professional firefighters might be the product of numerous factors and deserves further study.

Relationship Between Health-Related Quality Of Life, Aerobic Fitness, And Body Composition In Professional Firefighters

The firefighting profession requires high levels of physical fitness. Specifically, cardiovascular fitness has shown a strong relationship with the ability to perform occupational tasks. Despite this, not all firefighters maintain ideal fitness levels. Sudden cardiac arrest is the leading cause of on-duty fatalities for firefighters. Recent data suggests the prevalence of obese and overweight firefighters exceeds that of the general US population. Obesity is often correlated with low fitness levels in the general population, however when aerobic fitness improves, favorable outcomes in health related quality of life (HRQoL) have been reported. The relationship between HRQoL, aerobic fitness levels and body composition has not been studied in the professional firefighter population. PURPOSE: To determine the relationship of HRQoL, aerobic fitness, and body composition measures in professional firefighters. METHODS: 16 professional firefighters (14 male; 36±8 yrs; 178±10 cm; 87.0±20.0 kg; 27.1±3.7 kg/m2) completed baseline HRQoL survey, BodPod, and maximal oxygen uptake (VO2max) test. HRQoL was assessed using the SF-36, with the physical and mental composite scores used for analysis. Body fat percentage was estimated using BodPod. VO2max was assessed using a graded treadmill exercise test. Descriptive statistics (mean ± SD) were reported. Pearson correlation tests were used to assess association between variables. RESULTS: Overall participant anthropometrics are as follows: body fat (23.5 ± 6.8 %), VO2max (44.9 ± 6.0 mL/kg/min), physical health composite score (56.5 ± 2.6), and mental health composite score (48.9 ± 6.1). According to BMI classifications 6 firefighters were obese (>30 kg/m2) and 4 were overweight (25-29.9 kg/m2). There were statistically significant negative correlations between VO2max and body fat % (r = -0.88; p < 0.000), and fat mass (r = -0.86; p < 0.001). There was a positive correlation between physical health composite score and age (r = 0.57; p < 0.001). No other relationships were found to be statistically significant. CONCLUSIONS: The observed inverse relationship between aerobic fitness and body fat percentage supports prior findings. The novel finding that HRQoL was not correlated with aerobic fitness or body composition measures in this sample may warrant further study.

Effects of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy in People With Diabetes: A Systematic Review and Meta-Analysis.

The purpose of this study was to determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on depression, quality of life (QoL), and glycosylated hemoglobin (HbA1c) in people with diabetes. A systematic literature review and meta-analysis was conducted. Eight databases (PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], Cochrane, PsycINFO, and three Chinese databases) were searched for relevant studies from inception to December 2019. Only randomized controlled trials (RCTs) of MBSR and MBCT interventions for people with type 1 and type 2 diabetes were included. Nine studies described in 11 articles were included in the review. Meta-analysis showed a significant effect favoring MBSR and MBCT on depression (standardized mean difference -0.84; 95% confidence interval [CI] -1.16 to -0.51; p < .0001), the mental health composite score of QoL (mean difference [MD] 7.06; 95% CI 5.09 to 9.03; p < .00001), and HbA1c (MD -0.28; 95% CI -0.47 to -0.09; p = .004). However, effects on the physical health composite score of QoL have not been found. MBSR and MBCT are beneficial in improving depression, the mental health composite score of QoL, and HbA1c in people with diabetes. More well-designed trials using longer follow-up measurements are needed. MBSR and MBCT could be considered as effective complementary treatment alternatives for people with diabetes.

The influence of multiple sclerosis-related symptoms on health-related quality of life

Multiple sclerosis (MS) is a chronic disease that is associated with a variety of MS-specific symptoms. Many of these symptoms have a negative impact on health-related quality of life (HRQoL). Until now it is unclear which MS-specific symptoms have the highest impact on the HRQoL. The study is based on the data of a member survey of the German MS Society (DMSG) in 2015 (n = 424). Considering socio-demographic variables and general medical variables, the influence of MS-specific symptoms on HRQoL was examined. The HRQoL was collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument. In a pretest, all influencing variables were tested for a significant mean difference (p = 0.05), or a mean correlation (Pearson's r ≥ 0.3). Subsequently, the influence of the variables identified in the pretest on the HRQoL was investigated by multiple linear regression analysis. We calculated a mean physical health composite score (PHCS) of 48.3 (sd = 17.7) and a mean mental health composite score (MHCS) of 56.0 (sd = 20.1). The most fundamental factors influencing HRQoL were the MS-specific symptoms of depression, pain and cognitive impairment. MS-related symptoms with a mobility context showed declining PHCS. Speech disorder and dizziness were associated with a decreasing MHCS. Employment status was the only socio-economic factor that significantly affected HRQoL in multiple regression. The general medical factors showed no significant influence on HRQoL. MS-specific symptoms have a major impact on the HRQoL of people with MS. Our study show that especially the so-called 'hidden symptoms' such as the symptoms of depression, pain and cognitive impairment have a significant influence on the HRQoL. Greater attention should be paid to these in the care of people with MS.

Proactive health support (PaHS) – telephone-based self-management support for persons at risk of hospital admission: Study protocol for a randomized controlled trial

BackgroundA small proportion of patients account for most of the healthcare costs. Previous studies of supportive interventions have several methodological limitations and results are mixed. This article describes the protocol for Proactive Health Support: a national randomized controlled trial of telephone-based self-management support (ClinicalTrials.gov, NCT03628469). The main aim of the intervention is to reduce hospital admissions and improve quality of life at six months. MethodsA sample size of 4400 is needed and individuals with the highest risk of hospital admission in Denmark are invited by electronic communication and telephone to participate in a 1:1 randomized controlled trial. The intervention group receives one face-to-face start-up session followed by telephone sessions about individual goals regarding participants' knowledge, coping and need of healthcare. Quality of life was assessed with the mental health composite score of the SF-36v2 questionnaire. Primary analyses are done using the intention-to-treat principle. DiscussionThe trial has been approved by The Regional Committee on Health Research Ethics (SJ-677). Intervention nurses do not assume clinical responsibility for the participants and the intervention is an addition to the general healthcare services. The intervention is complex due to challenging skills and behaviors required by nurses, individual tailoring of the intervention, and interacting intervention components. The study therefore includes process evaluation. The research program comprises: 1. Development initiation, 2. Intervention effect, 3. Cost-effectiveness, 4. Organizational implementation, and 5. Participants' experiences. Inclusion to the trial began April 9th, 2018, was completed July 1st, 2019 and follow-up will be completed February 1st, 2020.

PD41-12 RESECTION OF PUBIC SYMPHYSIS WITH CYSTECTOMY AND URINARY DIVERSION IMPROVES LONG TERM PATIENT REPORTED PHYSICAL HEALTH MEASURES AMONG PATIENTS WITH UROSYMPHYSEAL FISTULA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-12 RESECTION OF PUBIC SYMPHYSIS WITH CYSTECTOMY AND URINARY DIVERSION IMPROVES LONG TERM PATIENT REPORTED PHYSICAL HEALTH MEASURES AMONG PATIENTS WITH UROSYMPHYSEAL FISTULA William R Boysen*, Brian Inouye, and Andrew C Peterson William R Boysen*William R Boysen* More articles by this author , Brian InouyeBrian Inouye More articles by this author , and Andrew C PetersonAndrew C Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fistulization from the urinary tract to the pubic symphysis with resultant osteomyelitis is a devastating complication of prostate cancer treatment. Surgical management with removal of the pubic symphysis and infected bone at time of cystectomy and urinary diversion can cure the associated pain and chronic infection. However, the impact of this radical surgery on physical and mental function is unknown. We hypothesized that patient reported physical and mental function would improve following surgery. METHODS: We identified patients who underwent cystectomy with urinary diversion and pubic symphysectomy for urosymphyseal fistula at our facility. The validated Short Form 12 (SF-12) questionnaire generates a physical composite score (PCS) and mental health composite score (MCS) ranging from 0 to 100, which can be compared to population means for a given age group. The SF-12 was administered at most recent clinic follow up, as well as preoperatively to a subset of patients. Statistical analyses included descriptive statistics and Mann-Whitney U-test. RESULTS: Twelve men completed post-operative SF-12, with a mean age of 70.3 years at time of surgery and mean follow up of 16.2 months. All patients had resection of pubic symphysis at time of cystectomy with urinary diversion. Four patients completed the SF-12 preoperatively. The mean PCS preoperatively was 25.4, and improved to 43.3 postoperatively (p=0.02, figure 1). The preoperative PCS was significantly less than the national average of 44.9 for men in this age group (p=0.01), while the postoperative PCS did not differ from the national average (p=1.0). The mean MCS preoperatively was 42.3, and improved to 51.8 postoperatively (p=0.07, figure 1). The preoperative MCS was significantly less than the national average of 54.8 for men in this age group (p=0.013), while the postoperative PCS did not differ from the national average (p=0.12). CONCLUSIONS: Despite resection of the pubic symphysis, radical surgery for urosymphyseal fistula results in improved physical function scores. Preoperative physical and mental function scores are well below the national average, but following surgery both return to the population average for men of the same age. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e826-e826 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information William R Boysen* More articles by this author Brian Inouye More articles by this author Andrew C Peterson More articles by this author Expand All Advertisement PDF downloadLoading ...

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

BackgroundEmerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa.MethodsWe enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization’s Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar’s test was used for comparisons between paired results of categorical variables relating to injecting frequency.ResultsThe majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254).ConclusionsInterim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

Using the 12-item short form health survey (SF-12) to assess self rated health of an engaged population impacted by hurricane Harvey, Houston, TX

BackgroundIn the last decade there has been an increase in community-based organizations providing support and educational outreach to populations effected by hazards. Prior research has demonstrated various roles that community social capital can play in both the enhancement of disaster preparedness and the mitigation of physical and mental health impacts following a natural disaster.MethodsTo assess self-reported health of residents of South Houston, Texas impacted by Hurricane Harvey, attendees of a community event completed a survey that included the 12 item short form health survey version 2 (SF-12v2).ResultsAlthough survey participants were older and more likely to be African-American than the overall population of Houston, they had higher mental health composite scores that the national average, with increases in mental wellbeing associated with a longer length of residence in their neighborhood.ConclusionsThe City of Houston, with highly segregated, socially vulnerable populations at high risk from natural hazards, should consider ways to support community engagement around disaster preparedness, response, and recovery that may build community cohesion and improve post-disaster mental health.

The Influence of Preoperative Mental Health on PROMIS Physical Function Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Retrospective. To demonstrate whether preoperative mental health status can be predictive of postoperative functional outcomes as measured by Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). There is a paucity of scientific investigations into the association between preoperative mental health as evaluated by a validated questionnaire such as the Short Form-12 Mental Health Composite Score (SF-12 MCS) and postoperative outcomes following MIS TLIF. Patients undergoing a primary MIS TLIF were retrospectively reviewed and stratified into cohorts based on preoperative SF-12 MCS scores. The Physical Function scores of PROMIS, of which there are other domains including Pain Interference, Sexual Function, and Cognitive Function, were compared between the cohorts. In addition, the improvement in PROMIS scores based on preoperative SF-12 MCS scores following MIS TLIF was analyzed using multivariate linear regression. One hundred seventy-two patients were included: 85 patients (49.4%) had a preoperative SF-12 MCS score <50 and 87 (50.6%) had a preoperative SF-12 MCS score ≥50. Patients with poorer mental health demonstrated significantly worse PROMIS PF scores preoperatively (33.8 vs. 36.5, P < 0.001), as well as at all postoperative timepoints: 6-weeks (35.1 vs. 38.4, P < 0.001), 3-months (38.9 vs. 42.9, P < 0.001), 6-months (41.4 vs. 45.5, P < 0.001), and 1-year (42.4 vs. 47.6, P < 0.001). However, at the 1-year timepoint, patients with worse mental health reported experiencing significantly less improvement from baseline (postoperative change of 8.6 vs. 11.1, P = 0.002). Patients with worse preoperative mental health not only demonstrated worse preoperative PROMIS PF scores, but also continued to have significantly worse postoperative outcomes. However, the postoperative improvement experienced by patients was similar in the short-term following surgery regardless of preoperative mental health status. Patients with poor mental health experienced significantly less postoperative improvement only at the 1-year timepoint. 3.