Multidimensional Health Research Articles

Having More Tender Than Swollen Joints is Associated With Worse Function and Work Impairment in Patients With Early Rheumatoid Arthritis.

Patients with early rheumatoid arthritis (RA) may present with more tender than swollen joints, which can persist. Elevated tender-swollen joint difference (TSJD) is often challenging, because there may be multiple causes and it may contribute to overestimating disease activity. Little is known about the phenotype and impact of TSJDs on patient function. Our objective was to evaluate the impact of TSJD on functional outcomes in early RA and to see whether associations vary by joint size. Data were from patients with active, early RA (≤12 months) enrolled in the Canadian Early Arthritis Cohort, who completed assessments of general function (Multidimensional Health Assessment Questionnaire [MDHAQ]), upper extremity (UE) function (Quality of Life in Neurological Disorders [Neuro-QoL] UE scale), and work/activity impairment (Work Productivity and Activity Impairment RA) over their first year of follow-up. A total of 28 joint counts were performed. TSJDs were calculated. Adjusted associations between TSJDs and functional outcomes were estimated in separate multivariable linear mixed effects models. Separate analyses were performed for large- versus small-joint TSJD. Patients (N=547) were 70% female, mean age 56 (SD 15) years, mean disease duration 5.3 (SD 2.9) months. At baseline, 287 (52%) had TSJD >0 (43% involved large joints and 34% small joints), decreasing to 32% at 12 months. A one-point increase in TSJD was significantly associated with worse function (MDHAQ: adjusted mean change 0.10, 95% confidence interval [CI] 0.08-0.13; Neuro-QoL UE function T score: adjusted mean change -0.59, 95% CI -0.76 to -0.43; and greater work impairment: adjusted mean change 1.95%, 95% CI 0.85%-3.05%). Higher large-joint TSJDs were associated with the worst functional outcomes. Having more tender than swollen joints is common in early RA and is associated with worse function, most notably when involving large joints. Early identification and targeted intervention strategies may be needed.

Validation and Cultural Adaptation of Persian Version of Multidimensional Health Assessment Questionnaire in Rheumatoid Arthritis Patients.

Rheumatoid arthritis (RA) is a multidimensional disease. In addition to quantitative factors, qualitative factors play an important role in the progress and outcome of the diseases. One of the most effective methods of collecting qualitative information is questionnaires reported by patients. The data obtained from the questionnaires are as important as the clinical criteria. Multidimensional health assessment questionnaire (MDHAQ) is one of the latest questionnaires that provide useful information in a short time. To investigate the reliability and validity of the Persian form of MDAHAQ for the use of Iranian patients. Two groups of participants were selected for this study. The validity test group included 110 patients, and the reliability test group included 140 patients. Translation and adaption of MDHAQ were performed by using Guillemin guidelines. The reliability was tested by using test-retest and Cronbach's alpha for internal consistency. Persian version of the health assessment questionnaire (HAQ) was used for assessing the criterion validity. The correlation between the MDHAQ score and Disease Activity Score-28 (DAS28), Clinical Disease Activity Index (CDAI), and the Persian version of the health assessment questionnaire (HAQ) was evaluated using the Spearman coefficient. Discriminant validity was tested in groups of patients based on two varied disease activities based on CDAI and DAS28. Test-retest with intra-class correlation coefficient (ICC) gave a coefficient of 0.865(95% CI: 0.809, 0.904) for physical function and 0.786(95% CI: 0.698, 0.848) for psychological items. Cronbach's alpha was 0.885 and 0.705 for physical function and psychological dimensions respectively. The Persian version of the MDHAQ had a good to strong correlation with the Persian version of the HAQ (ranging from 0.604 to 0.962) and also with CDAI (ranging from 0.616 to 0.838) and a moderate correlation with DAS28 (ranging from 0.415 to 0.439). The Persian form of MDHAQ is a reliable and valid instrument for the routine evaluation of RA patients in rheumatology clinics in Iranian RA patients.

Effectiveness of a health communication intervention on health literacy in the first year following kidney transplantation – A randomized controlled study

ObjectiveThis study aimed to evaluate the effect of a new health communication intervention focusing on knowledge management skills on health literacy and medication adherence during the first year following kidney transplantation. MethodsWe randomized 195 patients during 2020–2021, to either intervention- or control group. Questionnaires were completed at baseline and at 12 months post-transplantation with a 12-month response rate of 84%. Health literacy was measured by the multidimensional Health Literacy Questionnaire (HLQ) instrument. Medication adherence was measured by the self-reported questionnaire (BAASIS©). ResultsResults showed that the intervention group had a significant increase in 2 HLQ domains compared to the control group capturing the “ability to appraise health information” Domain 5, (p-value = 0.002) and the “ability to navigate the healthcare system” Domain 7, (p-value <0.04). The effect sizes of SRM were 0.49 (Domain 5) and 0.33 (Domain 7). Medication adherence was comparable in the groups at any measure points. ConclusionsThis study contributes to important knowledge about how a health communication intervention focusing on knowledge translation using motivational interviewing techniques positively strengthens health literacy in kidney transplant recipients. Practical implicationsCurrent patient education practice may benefit from focusing on knowledge translation in combination with motivational interview technique.

Development of the American College of Rheumatology Patient-Reported Outcome Quality Measures for Systemic Lupus Erythematosus.

As part of a Centers for Disease Control and Prevention-funded American College of Rheumatology (ACR) initiative, we sought to develop quality measures related to Patient Reported Outcome Measure (PROM) use for systemic lupus erythematosus (SLE) clinical care. An expert workgroup composed of physician, patient, and researcher representatives convened to identify patient-reported outcome (PRO) domains of greatest importance to people with SLE. A patient advisory panel separately ranked domains. PROMs assessing priority domains were identified through structured literature review, and detailed psychometric reviews were conducted for each PROM. In a Delphi process, the expert workgroup rated PROMs on content validity, psychometric quality, feasibility of implementation, and importance for guiding patient self-management. The patient advisory panel reviewed PROMs in parallel and contributed to the final recommendations. Among relevant PRO domains, the workgroup and patient partners ranked depression, physical function, pain, cognition, and fatigue as high-priority domains. The workgroup recommended at least once yearly measurement for (1) assessment of depression using the Patient Health Questionnaire or Patient Reported Outcomes Measurement Information System (PROMIS) depression scales; (2) assessment of physical function using PROMIS physical function scales or the Multi-Dimensional Health Assessment Questionnaire; and (3) optional assessments of fatigue and cognition. Pain scales evaluated were not found to be sufficiently superior to what is already assessed in most SLE clinic visits. Expert workgroup members and patient partners recommend that clinicians assess depression and physical function at least once yearly in all people with SLE. Additional PROMs addressing cognition and fatigue can also be assessed. Next steps are to incorporate PROM-based quality measures into the ACR The Rheumatology Informatics System for Effectiveness registry.

Development and preliminary evaluation of the Comprehensive Health Self-Assessment Questionnaire (CHSAQ) for individuals in the Chinese People Liberation Army

ObjectiveThere is currently no widely accepted multidimensional health assessment questionnaire for individuals in the Chinese People Liberation Army (PLA). This study developed a multidimensional health survey questionnaire (Comprehensive Health Self-Assessment Questionnaire, CHSAQ) suitable for personnel in the PLA and conducted a preliminary examination of its reliability, validity, and discriminative ability.MethodsAfter 183 items from 32 dimensions were selected to form the initial version of the CHSAQ, three groups of soldiers were selected from May 2022 to April 2023 and completed three survey rounds (with 183, 131, and 55 valid items). The items were screened based on classic test theory. After screening, the final questionnaire entries were formed, the structure of the questionnaire was explored through exploratory factor analysis and confirmatory factor analysis, and its reliability, structural validity, and discriminative ability were evaluated.ResultsThe final questionnaire consisted of 8 dimensions and 55 items on job satisfaction, anxiety and depression, daily activities, physical function, the otolaryngology system, the integumentary system, sleep disorders, and the visual system. The total cumulative variance contribution rate was 64.648% according to exploratory factor analysis. According to the confirmatory factor analysis, the normed fit index (NFI) was 0.880, and the comparison fit index (CFI) was 0.893 (close to 0.90). The Cronbach’s α coefficient of the total questionnaire was 0.970, the split half reliability coefficient was 0.937, and the retest reliability coefficient was 0.902. The results are presented as different pairwise comparisons.ConclusionOur study developed a self-report questionnaire for evaluating the comprehensive health status of personnel in the PLA in accordance with the standard procedure for questionnaire development. Our findings also showed that the CHSAQ for individuals in the PLA has good reliability and structural validity.

What Are the Underlying Mental Health Constructs Associated With Level of Capability in People With Knee and Hip Osteoarthritis?

Mental health characteristics such as negative mood, fear avoidance, unhelpful thoughts regarding pain, and low self-efficacy are associated with symptom intensity and capability among patients with hip and knee osteoarthritis (OA). Knowledge gaps remain regarding the conceptual and statistical overlap of these constructs and which of these are most strongly associated with capability in people with OA. Further study of these underlying factors can inform us which mental health assessments to prioritize and how to incorporate them into whole-person, psychologically informed care. (1) What are the distinct underlying factors that can be identified using statistical grouping of responses to a multidimensional mental health survey administered to patients with OA? (2) What are the associations between these distinct underlying factors and capability in knee OA (measured using the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement [KOOS JR]) and hip OA (measured using Hip Disability and Osteoarthritis Outcome Score, Joint Replacement [HOOS JR]), accounting for sociodemographic and clinical factors? We performed a retrospective cross-sectional analysis of adult patients who were referred to our program with a primary complaint of hip or knee pain secondary to OA between October 2017 and December 2020. Of the 2006 patients in the database, 38% (760) were excluded because they did not have a diagnosis of primary osteoarthritis, and 23% (292 of 1246) were excluded owing to missing data, leaving 954 patients available for analysis. Seventy-three percent (697) were women, with a mean age of 61 ± 10 years; 65% (623) of patients were White, and 52% (498) were insured under a commercial plan or via their employer. We analyzed demographic data, patient-reported outcome measures, and a multidimensional mental health survey (the 10-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag [OSPRO-YF] assessment tool), which are routinely collected for all patients at their baseline new-patient visit. To answer our first question about identifying underlying mental health factors, we performed an exploratory factor analysis of the OSPRO-YF score estimates. This technique helped identify statistically distinct underlying factors for the entire cohort based on extracting the maximum common variance among the variables of the OSPRO-YF. The exploratory factor analysis established how strongly different mental health characteristics were intercorrelated. A scree plot technique was then applied to reduce these factor groupings (based on Eigenvalues above 1.0) into a set of distinct factors. Predicted factor scores of these latent variables were generated and were subsequently used as explanatory variables in the multivariable analysis that identified variables associated with HOOS JR and KOOS JR scores. Two underlying mental health factors were identified using exploratory factor analysis and the scree plot; we labeled them "pain coping" and "mood." For patients with knee OA, after accounting for confounders, worse mood and worse pain coping were associated with greater levels of incapability (KOOS JR) in separate models but when analyzed in a combined model, pain coping (regression coefficient -4.3 [95% confidence interval -5.4 to -3.2], partial R 2 0.076; p < 0.001) had the strongest relationship, and mood was no longer associated. Similarly, for hip OA, pain coping (regression coefficient -5.4 [95% CI -7.8 to -3.1], partial R 2 0.10; p < 0.001) had the strongest relationship, and mood was no longer associated. This study simplifies the multitude of mental health assessments into two underlying factors: cognition (pain coping) and feelings (mood). When considered together, the association between capability and pain coping was dominant, signaling the importance of a mental health assessment in orthopaedic care to go beyond focusing on unhelpful feelings and mood (assessment of depression and anxiety) alone to include measures of pain coping, such as the Pain Catastrophizing Scale or Tampa Scale for Kinesiophobia, both of which have been used extensively in patients with musculoskeletal conditions. Level III, prognostic study.

Profile of Caregiving Activities and Association With Physical Health Among Dementia Spousal Caregivers.

This study aims to identify patterns of caregiving intensity and assess associations between caregiving intensity and multidimensional physical health indicators and health behaviors among spousal caregivers of persons with Alzheimer's disease and related dementia. Using data from 152 spousal caregivers aged 65 and older, the intensity of their caregiving experience was measured as the number and frequency of health- and medical-related helping activities for their care recipient. Multidimensional health indicators included self-reported fatigue, sleep disturbance, physical functioning, pain interference, general health, and the number of chronic conditions from the electronic health records. Self-reported health promotion behaviors were assessed as health responsibility, physical activity, nutrition, interpersonal relations, and stress management. Two distinct caregiving intensity patterns, high-intensity (37.5%) and low-intensity (62.5%) caregiving, were identified with cluster analysis. Caregivers in the high-intensity caregiving cluster reported feeling more tired (t = 2.25, p < .05), experiencing more sleep disturbance (t = 3.06, p < .01), and performing less physical activity (t = 2.05, p < .05) compared with caregivers in the low-intensity group. Future studies are needed to develop effective interventions to address caregiving intensity and its consequences on the health of spousal caregivers of persons with dementia.

Psychological well-being and factors affecting it after the COVID-19 pandemic.

The COVID-19 pandemic has enormously impacted human activity worldwide, partly due to many governments issuing stay-at-home orders and limiting the types of social interactions citizens can engage in. Hence, this study investigated psychological well-being and factors affecting it after the COVID-19 pandemic. A total of 345 participants were recruited in the study. This research was conducted between February and May 2023 in Sarab, East Azerbaijan, Iran. To measure the data, valid and reliable instruments of Goldberg's General Health Questionnaire (GHQ-28), Multidimensional Health Locus of Control (MHLC), interpersonal support evaluation list (ISEL-SF), and health-protective behaviors checklist instrument were used. According to the results, health locus of control (r = 0.227; p < 0.001), social support (r = 0.339; p < 0.001), and COVID-19 preventive behaviors (r = 0.376; p < 0.001) were positively correlated with psychological well-being. The strongest correlation was observed between psychological well-being and protective behaviors (r = 0.376; p < 0.001). In the hierarchical regression model, total, demographic characteristics along with health locus of control, social support, covid-19 preventive behaviors, and history of COVID-19 infection were able to explain 57.4% of the variation in psychological well-being. Public healthcare providers' and policymakers' preventive and supportive actions are highly advised for promoting health locus of control and social support in adults after the COVID-19 pandemic. In addition, it is better to include a community's social and environmental changes.

Association of Psychosocial Factors with Activation Among Patients with Glaucoma

To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with POAG. Prospective cross-sectional cohort study. Patients (n=202) with mild, moderate, or advanced bilateral POAG. Patients (n=1,164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a determinants of health questionnaire were administered by phone to 202 study participants. The NEI VFQ-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4 (PMCSMS), the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), health literacy and a determinants of health questionnaire. For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (p<0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (R2=5.3%, p=0.001; 95% CI= [0.077, 0.276]). For each unit increase in 'Internal 'on the MHLC, mean PAM score increased (R2=19.3%, 95% CI= [.649, 1.166], p<0.001). For each unit increase in 'Doctors' on the MHLC, mean PAM score increased (R2=11.0%, 95% CI= [1.555, 3.606], p<0.001). For each unit increase in 'Chance' on the MHLC, mean PAM score decreased (R2=2.6%, 95% CI= [-0.664,-0.051], p=0.023). On multivariate analysis adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI = [0.061,1.35], p=0.032); for each unit increase in MHLC 'Doctors', mean PAM score increased (95% CI=[-1.448,3.453], p<0.001); for each unit increase in MHLC 'Internal', mean PAM score increased (95% CI=[0.639,1.137 ], p<0.001); for each unit increase in MHLC 'Chance' , mean PAM score decreased (95% CI=[-0.685,-0.098], p=0.009). We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes.

The multidimensional sleep health of individuals with multiple sclerosis and Huntington's disease and healthy controls.

Sleep issues are common for people with neurodegenerative conditions, yet research has focused on specific aspects of sleep. While important, a more holistic approach to investigating sleep, termed "sleep health," considers sleep's positive and negative aspects. Current studies exploring sleep health have lacked a control group for reference. For the first time, this study investigated the sleep health of people living with multiple sclerosis and Huntington's disease (HD) and compared it with a community sample. 111 people, including 43 with multiple sclerosis, 19 with HD, and 49 from a community sample, participated in this study. The data, including actigraphy, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale, were collected as part of ongoing research studies. Seven sleep health domains were determined from the collected data, and a composite sleep health score was developed. Analysis of variance and independent t tests were performed to identify population and sex differences. The HD group had higher sleep regularity and lower sleep rhythmicity than the multiple sclerosis and community sample groups. The HD group had significantly less sleep duration than the multiple sclerosis group. No significant differences between the groups were observed in the sleep health composite score. Males had significantly higher sleep regularity within the HD group but significantly lower sleepiness scores in the community sample. These findings indicate that people with HD may experience greater variance in their wake times, therefore decreasing the consistency of being awake or asleep 24 hours apart. Understanding the mechanisms for this should be explored in people with HD. Turner M, Griffiths M, Laws M, Vial S, Bartlett D, Cruickshank T. The multidimensional sleep health of individuals with multiple sclerosis and Huntington's disease and healthy controls. J Clin Sleep Med. 2024;20(6):967-972.

Multidimensional sleep health is associated with worse cardiometabolic health in adolescent females with Polycystic Ovary Syndrome (PCOS) and obesity

Multidimensional sleep health is associated with worse cardiometabolic health in adolescent females with Polycystic Ovary Syndrome (PCOS) and obesity

Multidimensional sleep health and long-term cognitive decline in community-dwelling older men

Multidimensional sleep health and long-term cognitive decline in community-dwelling older men

PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria

BackgroundPROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens, and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL. MethodsA cross-sectional study was performed at one routine visit of 213 RA patients, who completed MDHAQ, PROMIS-29, and reference 2011 FM Criteria. PROMIS-29 T-scores were compared in RA vs population norms and in FM+ vs FM- RA patients, based on MDHAQ/FAST4 and reference criteria. Possible associations between PROMIS-29 T-scores and corresponding MDHAQ scores were analyzed using Spearman correlations and multiple regressions. ResultsMedian PROMIS-29 T-scores indicated clinically and statistically significantly poorer status in 25-27% FM+ vs FM- RA patients, with larger differences than in RA patients vs population norms for 6/7 domains. MDHAQ scores were correlated significantly with each of 7 corresponding PROMIS-29 domains (|rho|≥0.62, p<0.001). Linear regressions explained 55-73% of PROMIS-29 T-score variation by MDHAQ scores and 56%-71% of MDHAQ score variation by PROMIS-29 T-scores. ConclusionsScores for 7 PROMIS-29 domains and MDHAQ were highly correlated. The MDHAQ is effective to assess HRQL and offers incremental medical information, including FAST4 screening. The results indicate the importance of assessing comorbidities such as fibromyalgia screening in interpreting PROMIS-29 T-scores.

Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over.

Healthy aging is a process of not only achieving good health but also increasing the life satisfaction of older adults aged 60 years and over, in which health behaviors play an important role. There is a lack of research on the time-varying dependencies between health, life satisfaction, and health behaviors, impeding a deeper understanding of healthy aging. To develop an integrated framework for modeling the interrelationships among the components of healthy aging between multiple time slices. Based on the Chinese Longitudinal Healthy Living Survey (CLHLS) data in the three waves of 2011/2012, 2014, and 2017/2018, Bayesian network and dynamic Bayesian network are jointly employed to study the relationships among the components of healthy aging within one time slice, as well as to explore the time-varying dependencies among the components between time slices. The results of structure learning reveal the direction of effects between different dimensions of health, with mental health and social health affecting physical health and self-rated health affecting both physical and mental health. In addition, health behaviors are found to affect mental health and social health, while self-rated health can influence life satisfaction. The parameters learned from the data show the magnitude and direction of concurrent effects, one-period lagged effects and two-period lagged effects between the factors, which find that the time-varying dependencies vary but are generally positive, long-term, and accumulative over time. In addition, the results of autoregressive effects show the positive predictive effects of health and life satisfaction. It confirms the influence pathway from health behaviors to multidimensional health to life satisfaction, and the time-varying dependencies among the components of healthy aging, which facilitates a deeper understanding of healthy aging. Combining the results of autoregressive effects and descriptive statistics, it further indicates that healthy aging is a comprehensive result arising from interactions of multiple factors. Policymakers should guide older adults aged 60 years and over to adopt healthier behaviors and ensure the long-term sustainability and continuity of policies.

The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis.

The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied. To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort. We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research. PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort. Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.

The Effect of Diet Composition on the Post-operative Outcomes of Roux-en-Y Gastric Bypass in Mice.

Roux-en-Y gastric bypass (RYGB) leads to the improvement of many obesity-associated conditions. The degree to which post-operative macronutrient composition contributes to metabolic improvement after RYGB is understudied. A mouse model of RYGB was used to examine the effects of diet on the post-operative outcomes of RYGB. Obese mice underwent either Sham or RYGB surgery and were administered either chow or HFD and then monitored for an additional 8weeks. After RYGB, reductions to body weight, fat mass, and lean mass were similar regardless of diet. RYGB and HFD were independently detrimental to bone mineral density and plasma vitamin D levels. Independent of surgery, HFD accelerated hematopoietic stem and progenitor cell proliferation and differentiation and exhibited greater myeloid lineage commitment. Independent of diet, systemic iron deficiency was present after RYGB. In both Sham and RYGB groups, HFD increased energy expenditure. RYGB increased fecal energy loss, and HFD after RYGB increased fecal lipid content. RYGB lowered fasting glucose and liver glycogen levels but HFD had an opposing effect. Indices of insulin sensitivity improved independent of diet. HFD impaired improvements to dyslipidemia, NAFLD, and fibrosis. Post-operative diet plays a significant role in determining the degree to which RYGB reverses obesity-induced metabolic abnormalities such as hyperglycemia, dyslipidemia, and NAFLD. Diet composition may be targeted in order to assist in the treatment of post-RYGB bone mineral density loss and vitamin D deficiency as well as to reverse myeloid lineage commitment. HFD after RYGB continues to pose a significant multidimensional health risk.

Trends and regional distribution in health-related quality of life across sex and employment status: a repeated population-based cross-sectional study.

This study investigated the association between sex and health-related quality of life (HRQoL) based on employment status. This was a population-based cross-sectional study. Data were collected from 1 996 153 adults aged ≥19years who participated in the Korea Community Health Survey from 2011 to 2019. Low HRQoL was classified based on separate cutoff points (males: 0.92, females: 0.90) on the European Quality of Life-5 Dimensions index. Multivariable logistic regression analyses were used to estimate odds ratios (ORs) and 95% CIs. From 2011 to 2019, the trend of the prevalence of low HRQoL levels was consistently high in the order of unemployed males, unemployed females, employed males, and employed females. Regarding the regional distribution of unemployed males, the prevalence of low HRQoL was 29.5% to 43.5%. Unemployed males had a higher prevalence of low HRQoL (OR: 1.15; 95% CI: 1.12-1.24) than employed males. This study suggests that the prevalence of low HRQoL levels among unemployed males was consistently high at the annual trend and regional levels. Further research considering comprehensive health determinants and multidimensional public health interventions is required to prevent deterioration of HRQoL during unemployment.

Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures

BackgroundOne-third of veterans returning from the 1990–1991 Gulf War reported a myriad of symptoms including cognitive dysfunction, skin rashes, musculoskeletal discomfort, and fatigue. This symptom cluster is now referred to as Gulf War Illness (GWI). As the underlying mechanisms of GWI have yet to be fully elucidated, diagnosis and treatment are based on symptomatic presentation. One confounding factor tied to the illness is the high presence of post-traumatic stress disorder (PTSD). Previous research efforts have demonstrated that both GWI and PTSD are associated with immunological dysfunction. As such, this research endeavor aimed to provide insight into the complex relationship between GWI symptoms, cytokine presence, and immune cell populations to pinpoint the impact of PTSD on these measures in GWI.MethodsSymptom measures were gathered through the Multidimensional fatigue inventory (MFI) and 36-item short form health survey (SF-36) scales and biological measures were obtained through cytokine & cytometry analysis. Subgrouping was conducted using Davidson Trauma Scale scores and the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM)-5, into GWI with high probability of PTSD symptoms (GWIH) and GWI with low probability of PTSD symptoms (GWIL). Data was analyzed using Analysis of variance (ANOVA) statistical analysis along with correlation graph analysis. We mapped correlations between immune cells and cytokine signaling measures, hormones and GWI symptom measures to identify patterns in regulation between the GWIH, GWIL, and healthy control groups.ResultsGWI with comorbid PTSD symptoms resulted in poorer health outcomes compared with both Healthy control (HC) and the GWIL subgroup. Significant differences were found in basophil levels of GWI compared with HC at peak exercise regardless of PTSD symptom comorbidity (ANOVA F = 4.7, P = 0.01,) indicating its potential usage as a biomarker for general GWI from control. While the unique identification of GWI with PTSD symptoms was less clear, the GWIL subgroup was found to be delineated from both GWIH and HC on measures of IL-15 across an exercise challenge (ANOVA F > 3.75, P < 0.03). Additional differences in natural killer (NK) cell numbers and function highlight IL-15 as a potential biomarker of GWI in the absence of PTSD symptoms.ConclusionWe conclude that disentangling GWI and PTSD by defining trauma-based subgroups may aid in the identification of unique GWI biosignatures that can help to improve diagnosis and target treatment of GWI more effectively.

Associations between health promotion behaviors and multidimensional health among Chinese middle-school students—a study focusing on gender differences

Adolescence is a crucial period for establishing lifelong healthy behaviors, and unhealthy habits developed during adolescence can increase the risk of chronic diseases in adulthood. However, few is on the relationships between health promotion behaviors and multidimensional health in Chinese middle-school students, focusing on identifying gender-specific differences. This study employed a non-experimental, correlational design using online surveys to collect data from 179 middle-school students and 103 teachers. Data analysis was conducted using SPSS v20, including ordinal logistic regression analysis, Chi-square tests and t-tests. The results indicate that approximately 43.7% of middle-school teachers perceive that rural students as having effective health promotion behaviors. Female students demonstrated higher levels of health promotion behaviors than males, with significant gender differences observed in health responsibility behavior (p = 0.011) and interpersonal relationships (p = 0.025). However, no gender differences were found in the multidimensional health of rural middle-school students. Both male and female students showed concerning levels of physical health, with only 38.2% of males and 37.78% of females rated as good or excellent. Notably, life appreciation behavior was identified as the only significant predictor of multidimensional health among these students, indicating that higher scores in this domain correlate with better health. Health educators and policymakers are advised to account for gender differences in the development and delivery of health promotion initiatives aimed at adolescents, with a particular emphasis on fostering life appreciation. Interventions focused on these aspects may offer substantial potential in diminishing health risks in adulthood and enhancing overall lifelong well-being.

Multi-dimensional poverty and health outcomes in Ghana

There is evidence on the social gradient in health in multiple settings. Recent research is increasingly focused on linkages between multidimensional poverty and health to capture and ascertain the role of non-monetary factors on individuals' health. In this paper, using the 2018/19 wave of the Ghana Socioeconomic Panel Survey (GSEPS) and the country's newly introduced multidimensional poverty index, bivariate correlations and regression analyses are carried out to explore associations between household multidimensional poverty and a series of health outcomes, including physical and mental health. There is evidence of significant subgroup differences across the country by gender, rural/urban residence, education, and region. Regression analyses consistently indicate that poorer mental and physical health outcomes are positively and significantly correlated with greater multidimensional poverty. Robustness tests indicate that deprivations in electricity access, safe sanitation and education are particularly relevant. Findings suggest the importance of a more equal geographical distribution of social amenities and infrastructure, as well as adequate targeting of policies to reduce health inequalities across the country and achieve a more equitable and inclusive distribution of resources within the country.