Modifiable Psychological Factors Research Articles

Reliability and validity of the German version of the Iowa infant feeding attitude scale (IIFAS-G) and relations to breastfeeding duration and feeding method

BackgroundPublic health initiatives (e.g., the Baby Friendly Hospital Initiative) have led to an increase in breastfeeding rates worldwide. However, as (exclusive) breastfeeding duration is still below WHO recommendations, it is crucial to understand the factors that influence decisions on breastfeeding practice. Modifiable psychological factors such as intention to breastfeed have therefore become targets of recent interventions. As the intention to breastfeed is among the strongest predictors of breastfeeding duration, reliable tools for measuring the intention to breastfeed are needed. The Iowa Infant Feeding Attitude Scale (IIFAS) measures attitudes towards infant feeding and is used in various languages and across different cultural contexts. However, there has been no German version of the IIFAS (IIFAS-G) so far. The aim of this study was to investigate reliability, validity, and associations of the IIFAS-G with feeding method and breastfeeding duration.MethodsBetween August and November 2022, a total of 353 mothers (Mage = 35 years, SDage = 4.2 years) of singleton infants (47.3% female (1 undetermined), Mage = 10.8 months, SDage = 4.7 months, age range: 3-547 days; 90.4% living in Switzerland) participated in an online survey. The IIFAS-G was administered as a part of a larger study on early child development and infant feeding method.ResultsThe translated IIFAS-G showed unsatisfactory model fit for the two factor 17-item solution. Four items showed low factor loadings. After item reduction, a 13-item two factor solution showed satisfactory model fit (CFI = 0.92, TLI = 0.90, RMSEA = 0.07) and high internal consistency (Cronbach’s α = 0.85). The IIFAS-G score was higher for mothers who exclusively breastfed their infants compared to mothers who additionally or exclusively fed infant formula. Moreover, mothers with higher IIFAS-G scores were less likely to stop breastfeeding their child over the course of 1.5years (HR = 0.87).ConclusionA shorter two-factor IIFAS-G is proposed to investigate attitudes towards breastfeeding and formula feeding in German-speaking mothers.

Psychological predictors of performance-based physical functioning among pediatric pain program participants.

The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP). Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion. Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β=-.28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, β=-.28, p = .032. Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.

Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review.

Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n=891) were screened and coded by two raters. A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.

Protocol forthe Implementation ofPsychologically Informed Physical Therapy to Prevent Chronification inService Members With Musculoskeletal Disorders.

Musculoskeletal disorders (MSDs) are a primary cause of separation and long-term disability in active duty service members (ADSMs). Psychologically informed physical therapy (PiPT) is designed to identify and address modifiable psychological risk factors early in an MSD episode and has been proven effective in preventing chronicity in civilian populations. We developed a course to train military physical therapy (PT) personnel in PiPT for treating ADSM with MSD. This study tests the feasibility and effectiveness of our training. Establish the feasibility of implementing PiPT and its effectiveness in the U.S. military. An observational, prospective, comparative cohort study will test implementation and effectiveness. First, we will observe clinical outcomes in a cohort of ADSM with MSD receiving usual PT care at a military outpatient PT clinic. Next, we will train all PT staff in PiPT. Finally, PiPT will be implemented in a second cohort of ADSM. Data will be collected from each cohort at pre-treatment, fourth PT visit, 6 months post enrollment, and 12 months post enrollment. The primary outcomes are pain interference and psychological risk for chronicity. Data collection is ongoing. Findings will identify the factors associated with PiPT outcomes in ADSM, inform the implementation of PiPT across health care settings, and allow us to document the prevalence of risk factors for chronicity in ADSM. Findings can help to prevent chronification from MSD, thereby reducing lost man-hours and enhancing military readiness, contribute to the development of a highly skilled workforce for the provision of health services to ADSM, and enhance the efficiency of health care delivery through optimal allocation of PT resources, resulting in significant cost savings for the military.

Sexual Offending: Adverse Childhood Experiences, Shame, and Self-Compassion Explain the Variance in Self-Harm and Harm Towards Others?

Research investigating potential pathways from Adverse Childhood Experiences (ACEs) to later self-harming and offending behaviours has inconsistent findings. Past research, however, has not fully explored the interplay between ACEs and modifiable psychological factors, such as shame and self-compassion. The present study explored the relationship between ACE, shame, and self-compassion to identify their role in explaining the variance in later harm in a sample of individuals who have committed sexual offences. Two hundred and fifty adults incarcerated for sexual offences participated. Multiple Regression and Mediation Analyses were applied to establish if ACE, shame and self-compassion explained the variance in harm and explore potential psychological pathways between ACE and harm, with shame and self-compassion as potential modifiable mediators. ACE, shame and self-compassion explained 55% of self-harm and 52% of psychological and physical harm variance. A more complex relationship was indicated for sexual harm, with only 19% of the variance explained by the model. The study increases our understanding of the relationship between variables and potential modifiable pathways between ACEs and later harming behaviours in a sample of individuals with sexual convictions. These modifiable psychological factors could be targeted to increase resilience, post-traumatic growth and reduce the risk of harm in later life.

Targeting psychological and menopausal factors linked to non-adherence to anti-estrogen therapy in women with early-stage hormone-receptor positive breast cancer: Aweb-based feasibility study of Finding My Way.

Key Points Reduced adherence to anti‐estrogen therapy (AET; tamoxifen and aromatase inhibitors) in women with early‐stage hormone‐receptor‐positive (HR+) breast cancers leads to adverse clinical outcomes. Modifiable psychological factors (e.g., depressive symptoms and anxiety) and menopausal symptoms (e.g., sleep disturbance and hot flashes) are linked with diminished adherence. An intervention targeting psychological and menopausal symptoms has potential to improve AET adherence. We conducted a pilot study to evaluate the feasibility of a remotely administered behavioral intervention in women with early‐stage HR+ breast cancer taking AET at‐risk for non‐adherence with psychological and menopausal symptoms. Findings from this preliminary study show that a web‐based behavioral intervention is feasible and may be a potential method of reducing risk for AET non‐adherence in some patients.

Shame and Self-Compassion Connect Childhood Experience of Adversity With Harm Inflicted on the Self and Others.

Self-harm, suicide, and harm inflicted on others (e.g., victimization) remain key areas of public concern. Past research has explored the link between adverse childhood experiences (ACEs) and later self-harming and offending behaviors. However, research has not fully explored the interplay between ACEs and modifiable psychological factors, such as shame and self-compassion, that could be targeted to reduce the risk of harm and increase resilience and capacity for post-traumatic growth. The present study explored the relationship between ACEs, harm, shame, and self-compassion. A total of 1,111 adults participated. Approximately 49% were female, 45% male, and 2% nonbinary. Just under a third of the sample were incarcerated. We adopted a cross-sectional survey design and included current and retrospective data. The relationship between the variables was analyzed using Pearson product-moment correlation, and structural equation modeling was applied to explore the potential psychological pathways of causation. The model predicted just under 50% of the harm to self (i.e., self-harm) variance and just over a third (35%) of the harm to others (i.e., psychological and physical aggression) variance. ACEs, shame, and self-compassion had varying roles in mediating the relationship between ACEs and harm. The study increases our understanding of modifiable causal pathways between ACEs and later harming behaviors. Additionally, it indicates the importance of understanding the different dimensions of shame when considering ways to reduce the potential long-term negative consequences of ACEs.

Brief psychological screening for trapeziectomy: Identifying patients at high risk of a poor functional outcome.

This study investigates if the psychological subscale from the STarT Back Screening Tool (STarT Psych-sub) identifies patients at high risk of a poor functional outcome after a trapeziectomy based on modifiable psychological factors. A total of 83 patients completed the STarT Psych-sub, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and a numeric pain rating scale (NPRS) before trapeziectomy. QuickDASH, PEM and NPRS were completed at 6weeks, 16weeks and 1year after the trapeziectomy. The STarT Psych-sub stratified 24 patients (29%) as 'high-risk' and 59 (71%) as 'not high-risk' of a poor outcome. The 'high-risk' group reported worse function and pain (QuickDASH = 72.7, PEM = 81.1, NPRS = 8.3) at baseline than the 'not high-risk' group (QuickDASH = 56.1, PEM = 66.4, NPRS = 7.2). This difference remained constant at all time points after the trapeziectomy with 1-year scores on the QuickDASH = 39.6; PEM = 47.1 and NPRS = 3.7 for the 'high-risk' group and QuickDASH = 24.3; PEM = 33.3 and NPRS = 1.9 for the 'not high-risk' group. Brief psychological screening shows that patients with psychological risk factors experience improved pain and function outcomes following trapeziectomy, however their outcomes are significantly worse than patients who do not have psychological risk factors.

Sleep, Anxiety, and Vitamin D Status and Risk for Peripartum Depression.

Peripartum depression is common and carries significant morbidity and mortality. This study aimed to identify modifiable psychological and biological factors that increase the risk for peripartum depression. In a prospective cohort study, pregnant women (n = 105) completed self-report assessments of mood (Edinburgh Postnatal Depression Scale-EPDS), anxiety (Generalized Anxiety Disorder Scale-GAD), and sleep disturbances (Pittsburgh Sleep Quality Index-PSQI) and provided a blood sample at 8-to-12 and 24-to-28weeks of gestation and 6-to-8 and 10-to-12weeks postpartum. During the study, 33.3% (35/105) of participants met criteria for depression (EPDS ≥ 10). Women with elevated PSQI (OR: 1.17; 95% CI 1.04-1.33) or GAD (OR: 1.33; 95% CI 1.18-1.48) scores at 8-12weeks of gestation were significantly more likely to experience elevated depressive symptoms at subsequent assessments. Women with deficient vitamin D levels (≤ 20ng/L) were more likely to report elevated depressive symptoms at follow-up assessments, although these findings were not statistically significant (OR: 2.40; 95% CI 0.92-6.27). Participation rates for postpartum assessments were low. Depressive and anxiety symptoms, and sleep disturbances were assessed through self-report measures. Sleep, anxiety, and potentially vitamin D disturbances in early pregnancy are associated with an increase in peripartum depression. Interventions aimed at reducing sleep and anxiety disturbances and ensuring adequate levels of vitamin D in pregnancy are potential therapeutic targets to reduce risk of peripartum depression.

Psychological and Social Factors Associated with Coexisting Frailty and Cognitive Impairment: A Systematic Review.

Those living with coexistent frailty and cognitive impairment are at risk of poorer health outcomes. Research often focuses on identifying biological factors. This review sought to identify the association psychological and social factors have with coexisting physical and cognitive decline. Six databases were systematically searched in July 2020. Studies included individuals aged 60 years or older identified as being both frail and cognitively impaired. A narrative synthesis examined patterns within the data. Nine studies were included, most employed a cross-sectional design. Depression was investigated by all nine studies, those with coexistent frailty and cognitive impairment had higher levels of depressive symptoms than peers. Findings were mixed on social factors, although broadly indicate lower education, living alone and lower material wealth were more frequent in those living with coexistent decline. Further research is needed to explore potentially modifiable psychological and social factors which could lead to the development of supportive interventions.

Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review

BackgroundPsychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention.MethodsThis is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against.ResultsOf 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome.ConclusionsFive constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.

Chronic pain severity, impact, and opioid use among patients with cancer: An analysis of biopsychosocial factors using the CHOIR learning health care system.

Despite the biopsychosocial underpinnings of chronic noncancer pain, relatively little is known about the contribution of psychosocial factors to chronic cancer pain. The authors aimed to characterize associations between biopsychosocial factors and pain and opioid use among individuals with chronic pain and cancer. The authors conducted a retrospective, cross-sectional study of 700 patients with chronic pain and cancer seeking treatment at an academic tertiary pain clinic. Patients completed demographic questionnaires and validated psychosocial and pain measures. Multivariable, hierarchical linear and logistic regressions assessed the relative contributions of biopsychosocial factors to the primary dependent variables of pain severity, pain interference, and opioid use. Participants were 62% female and 66% White with a mean age of 59 ± 15 years, and 55% held a college degree or higher. Older age, African American or "other" race, sleep disturbance, and pain catastrophizing were significantly associated with higher pain severity (F(5,657) = 22.45; P ≤ .001; R2 = 0.22). Depression, sleep disturbance, pain catastrophizing, lower emotional support, and higher pain severity were significantly associated with pain interference (F(5,653) = 9.47; P ≤ .001; R2 = 0.44). Lastly, a poor cancer prognosis (Exp(B) = 1.62) and sleep disturbance (Exp(B) = 1.02) were associated with taking opioids, whereas identifying as Asian (Exp(B) = 0.48) or Hispanic (Exp(B) = 0.47) was associated with lower odds of using opioids. Modifiable psychological factors-specifically sleep disturbance, depression, and pain catastrophizing-were uniquely associated with pain and opioid use in patients with chronic pain and diverse cancer diagnoses. Future behavioral pain interventions that concurrently target sleep may improve pain among patients with cancer. Feeling depressed, worrying about pain, and bad sleep are related to higher pain symptoms in individuals with chronic pain and cancer. Specifically, those who struggle to sleep have worse pain and use more opioids. Also, individuals who have a bad prognosis for their cancer are more likely to be using opioid pain medications. Although race and cancer are related to chronic pain in patients, psychological well-being is also strongly related to this same pain.

Factors related to suicide among students: a narrative review of psychological literature

PurposeThe purpose of this paper is to provide an educational overview of suicidal behavior and the factors related to suicidality among students between the ages of 18 and 30 years.Design/methodology/approachThe literature related to suicide among students were identified through various electronic database searches. The databases searched included: PsycINFO, PubMed, MEDLINE, ERIC/ProQuest, Embase, Scopus, Google Scholar and PMC using the following search terms and their derivatives: suicide/self-harm, suicide risk and students, mental health issues and suicide, substance use and suicide, childhood adversities and suicide, recent life stressors, help-seeking attitude and elevated suicidal risk, help-seeking behavior and suicide and subjective factors and suicide.FindingsSuicide is an important public health problem. Several factors influence suicide (including suicidal ideation and taking life or dying by suicide) such as genetics, family functions, socioeconomic status, personality and psychiatric comorbidity. The main themes that were investigated included: mental health issues, childhood adversity and recent life stressors, barriers toward seeking professional help and subjective factors (psychache risk of suicidal behavior, impulsivity, aggression).Originality/valueThis review focuses on several modifiable psychological factors that have been shown to contribute toward suicidal ideation in youth, especially among university students.

Psychosocial factors associated with frailty in the community-dwelling aged population with depression. A cross-sectional study

ObjectiveThere is a two-way relationship between frailty and depression, but the mechanisms by which one may influence the other are not well understood. The objective of this study was to evaluate the relationship between psychosocial factors and frailty in community-dwelling aged populations with depression. DesignObservational cross-sectional study. Site5 primary care centres. ParticipantsCommunity-dwelling subjects with depression aged ≥70 years. Main measurementsFrailty status was established according to Fried criteria, depression and depression severity were evaluated by DSM-IV criteria and the Hamilton Depression Rating Scale, respectively, and psychosocial factors were assessed using the Gijón Social-Familial Evaluation Scale and ad hoc questionnaires. ResultsRecruited were 338 subjects (mean age 77.2 years), 82% women and 36.1% rated as frail. A dose–response relationship was observed between depression severity and frailty risk. Widowhood was a risk factor for frailty, while a higher educational level, home internet, stairs in the home, and an active social life had a protective effect. A multivariate analysis showed that age, number of drugs, and depression severity were independent risk factors for frailty, while an active social life was a protective factor. The severity of depressive symptoms showed higher association with frailty than other clinical and socio-demographic characteristics. ConclusionsIn depressed elderly subjects, frailty is associated with psychologiocal factors such as the intensity of depressive symptoms and with social factors such as education level, widowhood, loneliness, and limited social life. More research is required to better understand the modifiable psychological risk factors for frailty.

Modifiable Psychological Factors Affecting Functioning in Fibromyalgia.

Objective: To examine the role of several interrelated, potentially modifiable psychological factors (i.e., mindfulness and catastrophizing) in influencing patient-reported functioning. Methods: In this cross-sectional study, 107 patients with fibromyalgia completed self-report assessments of pain severity, functioning and impact of symptoms, mindfulness, and pain catastrophizing. Linear regression and bootstrapping mediation analyses were performed to assess the relationships between these factors. Results: Pain intensity was significantly and positively associated with pain catastrophizing and impact of fibromyalgia on functioning. Linear regression analyses indicated that pain intensity, catastrophizing, and mindfulness affect functioning in fibromyalgia. Follow-up mediation analysis revealed a significant indirect effect of pain catastrophizing on the relationship between pain intensity and fibromyalgia functioning. Conclusion: Individuals with fibromyalgia who have higher levels of pain and catastrophizing, and lower levels of mindfulness, are more likely to experience impaired functioning. Our findings suggest that pain catastrophizing appears to be an especially important variable contributing to reduced functioning in women with fibromyalgia. Therefore, catastrophizing-reducing treatments (e.g., cognitive behavioral therapy) are likely to have direct, beneficial impacts on functioning.

Effect of Preoperative Modifiable Psychological and Behavioural Factors on Early Outcome Following Total Knee Arthroplasty in an Indian Population.

Non-surgical factors have been found to have significant impact on outcome following Total Knee Arthroplasty (TKA). The study was conducted to know the independent effect of each of the four interacting psychological factors: anxiety, depression, pain catastrophizing and kinesiophobia on early outcome following TKA in an Indian population. 104 consecutive patients undergoing TKA were included in the study and followed up at 6weeks, 6months and one year. Preoperatively, Hospital Anxiety and Depression Scale was used to diagnose and quantify anxiety and depression, pain catastrophizing and kinesiophobia were assessed using Pain Catastrophizing Scale and Tampa Scale for Kinesiophobia, respectively. Outcome was assessed on the basis of Knee Society Score and Knee Injury and Osteoarthritis Outcome Score. Regression analysis was done to know independent effect of each factor on outcome scores. Nine (8.7%) patients were found to have undiagnosed psychopathology. The patients with psychopathologies were found to have significantly worse knee outcome scores on follow-up, although the rate of improvement in knee symptoms and function was not significantly different from those without psychopathology. The degree of Anxiety correlated with worse knee pain and stiffness up to 6months while it correlated with poor knee function for a longer duration. The degree of depression and pain catastrophizing correlated with worse knee pain, stiffness and function at all visits while kinesiophobia didn't show correlation independent other factors. Psychopathology was found to be associated poor knee outcome scores with degree of preoperative depression and pain catastrophizing as significant independent predictors as poor outcome, whereas the effect of degree of anxiety on knee pain and stiffness was found to wane over time. Kinesiophobia didn't show any independent correlation. The online version of this article (10.1007/s43465-020-00325-x) contains supplementary material, which is available to authorized users.

Emerging Ideas. Familial Influences, Shame, Guilt, and Depression Among Sexual Minority Adolescents

ObjectiveThis study examined the mediating effects of self‐conscious emotions (i.e., shame and guilt) on the relationships between familial influences and depressive symptoms among sexual minority adolescents (SMAs).BackgroundFamilial influences, such as family rejection or parental affirmation, are associated with depression. However, little research has been conducted to identify specific mechanisms that can explain the associations between familial influences and depressive symptoms among SMAs.MethodParticipants were 94 adolescents, aged 12 to 18 years, who were recruited through the community and completed self‐report measures.ResultsFamily rejection was associated with more feelings of shame and guilt, whereas parent affirmation was associated with less shame and guilt. Shame and guilt were associated with more depressive symptoms. Indirect effects of family rejection on depression were significant through shame but not guilt. Indirect effects of parental affirmation on depression were significant through shame and guilt.ConclusionThe results help identify mechanisms through which familial influences may be associated with depressive symptoms. Shame and guilt are important modifiable psychological factors that can be targets of intervention for SMAs.ImplicationsFuture research and interventions must incorporate familial influences as well as self‐conscious emotions to improve the mental health of SMAs.

An Iterative Formative Evaluation of Medical Education for Multiple Myeloma Patients Receiving Autologous Stem Cell Transplant.

Multiple myeloma (MM) is an incurable cancer characterized by abnormal plasma cells in the bone marrow, resulting in increased risk of infection. Autologous stem cell transplant (ASCT) is the most effective treatment for MM, but successful transplant requires the patient and caregiver to learn and independently implement medical tasks. The Ready for Transplant (R4T) ethnographic-based formative evaluation includes evaluation of ongoing patient education and the addition of novel supplemental educational videos that patients can review before in-person transplant education. To evaluate R4T, a formative evaluation informed by utilization-orientated evaluation theories, including over 150hours of ethnographic observation of nurse/patient education (N= 70), plus retrospective and prospective patient (N= 35) and clinician interviews (N= 7) was conducted over 18months. Through thematic analysis, barriers and facilitators of the patient's ability to process education surrounding ASCT were identified. Barriers included anxiety surrounding what to expect in ASCT, anxiety surrounding what to expect at the education visit, overwhelming volume of information, lack of medical expertise, and disengaged patients, while facilitators included large social networks willing to help and clinician adjusting script to meet unique needs of the patient. This manuscript represents an iterative method for improving on education that people with MM receive surrounding ASCT. Ultimately, the supplemental video-based education was created to address modifiable social and psychological factors by providing generalized information that could then be tailored during in-person meetings to meet each patients' individual needs.

Loneliness, Sense of Control, and Risk of Dementia in Healthy Older Adults: A Moderated Mediation Analysis

ABSTRACT Objectives: Despite the rising prevalence of dementia, little research has been conducted to identify modifiable psychological factors that alleviate the risk of dementia in older adults and the underlying mechanisms. Given that loneliness is, in part, concomitant with a weakened sense of control, we examined whether sense of control would mediate the relation between loneliness and dementia risk. Further, considering that working -memory capacity is a critical cognitive resource that serves as a buffer against age-related cognitive decline, we examined a second-order moderated mediational model whereby working-memory capacity moderates the relation between control beliefs and dementia risk in older adults. Methods We administered a series of measures to older community-dwelling adults (ages 60–93; N = 69), including the participant-rated AD8 to assess the risk of dementia. Using the PROCESS macro, we examined the moderated mediation model for the relation between loneliness, sense of control, and dementia risk. Results We found that sense of control significantly mediated the relation between loneliness and risk of dementia. Moreover, the indirect effect of loneliness on dementia risk via lowered sense of control was significant only in individuals with poorer working-memory capacity. Notably, these findings held true when important covariates were controlled for. Conclusions Our findings underscore the critical role of control beliefs and working memory in protecting against dementia risk. Clinical implications Our findings have implications for intervention programs that target alleviating dementia risk and promoting healthy aging in older adults by improving socioemotional health and cognitive functioning.

Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors.

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.