Negative Health Outcomes Research Articles

School Nurse-Led Health Assessment for Students Experiencing Homelessness: A Quality Improvement Project.

Childhood homelessness is increasing and is associated with negative health and academic outcomes. The goal of this quality improvement project was to improve access to healthcare and health outcomes for students experiencing homelessness through a school nurse-led comprehensive health assessment. The multilevel intervention included identifying students experiencing homelessness, conducting a standardized health assessment, and making referrals to care. This 8-month project was conducted in an urban school district. Feasibility and acceptability data were collected to guide sustainability. Student health and referral data were analyzed using descriptive statistics. At the project start, 688 students were identified as experiencing homelessness. More than half (67%) had a partial or fully completed health assessment during the project. Of the students assessed, most had a primary care provider, some had a health condition, and half had a dental home. Students experiencing homelessness would benefit from systematic school-based health assessments to identify unmet health needs.

Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review.

Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual's life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood. This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth. Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability. Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder. The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need.

Geographical disparities in temporal trends of low birth weight in Saskatchewan from 2002/2003 to 2021/2022: insights from a joinpoint regression analysis.

Low birth weight (LBW) is an important public health indicator that is associated with various negative health outcomes in infants. To effectively implement interventions that would improve health outcomes in children, it is important to understand both the historical trends and current levels of LBW rates. In this study, trends and regional differences in LBW rates in Saskatchewan from 2002/2003 to 2021/2022 were assessed. A joinpoint regression analysis was conducted using historical LBW rates, obtained from the Canadian Institute for Health Information database. Data were analysed using average percent change and average annual percent change. Spatial patterns and trends were identified using a choropleth map. From a provincial and national rate of 5.2% in 2002/2003, the LBW rate in Saskatchewan increased to 6.5% in 2021/2022, approaching the national rate of 6.8%. Over the 20-year period, average annual changes for Canada were 1.4% and 1.0% for Saskatchewan. There was a turning point in the study: 2004/2005 for Canada and 2011/2012 for Saskatchewan. Initially, Saskatchewan had stable LBW rates, increasing yearly by 0.1%, while the national rate was 5.7%. However, in recent years, Saskatchewan's rate increased to 1.8% annually, surpassing the national rate of 0.9%. Geographical differences were also observed within Saskatchewan, with the Far North region having the highest LBW rate (9.2%), and the Central West region having the lowest rate (4.3%) in 2021/2022. The Central East, Regina Qu'Appelle, and southern Saskatchewan saw significant upwards trends in LBW rates between 2015/2016 and 2021/2022. There is an increasing trend in LBW rates in Canada and Saskatchewan, as well as geographical disparities within the province. The geographical disparities in LBW rates underscore the need for tailored interventions in high-risk regions in the province.

Adverse childhood experiences and myocardial infarction: Analysis of United States Behavioral Risk Factor Surveillance System (BRFSS) data

Adverse childhood experiences (ACEs) have been linked to an increased risk of disease in adulthood and a range of other negative health outcomes, including cardiovascular disease (CVD). This study aims to build on previous research on ACEs and CVD by investigating the association between ACEs and heart attack or myocardial infarction diagnosis. Our analysis used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and ACE Module questionnaires. Responses included data from a national sample of 52,492 adults aged 18 years or older in the United States. ACEs value is a composite score of physical, emotional and sexual abuse, household dysfunction, neglect, and other childhood traumas. The study population had a mean number of 1.75 ACEs (SD 2.25), with 61% experiencing at least one ACE and 17% experiencing four or more ACEs. Almost 6% of adults in the sample reported a previous myocardial infarction (5.7%). Multiple logistic regression analysis demonstrated that, after adjusting for a variety of sociodemographic and health covariates, every one-event increase in the number of ACEs was significantly associated with 6% increased odds of myocardial infarction in adulthood (adjusted odds ratio [aOR] = 1.06, 95% confidence interval [CI] = 1.04 – 1.09, p <0.001). Efforts to decrease the incidence of myocardial infarction and reduce cardiac-related mortality in the U.S. should include policies that reduce the occurrence of ACEs and provide resources for adults to address their childhood traumas.

Prevalence and Predictors of Potentially Inappropriate Prescribing in Older People Receiving Home Health Care in Saudi Arabia According to the American Geriatrics Society Beers Criteria 2019.

Potentially inappropriate prescribing (PIP) is a common health problem in older adults and is associated with negative health outcomes such as the occurrence of adverse drug events. Several studies have been conducted in different countries and settings to assess the prevalence of PIP, including in Home Care Services. However, data on the prevalence of PIP in home-care services in Saudi Arabia are limited. This study aimed to evaluate PIP use among older patients receiving home healthcare services in Saudi Arabia and to identify the predictors and commonly implicated medications.; Methods: A cross-sectional study was conducted over an 8-month period between January and August 2023. Data were collected from the medical records of patients older than 65 years who were currently receiving home health care services at King Faisal Hospital in Taif City, Saudi Arabia. PIPs were identified using the 2019 updated Beers Criteria.; Results: A total of 375 patients were included. Out of these, 285 PIPs were identified, of which 219 patients (58.4%) received at least one PIP. The most common therapeutic class associated with the PIPs was gastrointestinal medications (66.3%). Patient age and number of medications were significant predictors of PIP.; Conclusions: Our study found a high prevalence of PIP among elderly patients receiving home health care in Taif, Saudi Arabia. This study highlights the need for improved patient data automation and implementation of the Beers criteria to prevent PIPs in the future.

A decision analysis of cancer patients and the consumption of ready-to-eat salad.

Listeria monocytogenes is a foodborne pathogen of concern for cancer patients, who face higher morbidity and mortality rates than the general population. The neutropenic diet (ND), which excludes fresh produce, is often utilized to mitigate this risk; however, an analysis weighing the theoretical listeriosis risk reduction of produce exclusion aspects of the ND and possible negative tradeoffs has never been conducted. Consequently, this work constructed decision analytic models using disability-adjusted life years (DALYs) to compare the impacts of the ND, such as increased neutropenic enterocolitis (NEC) likelihood, with three alternative dietary practices (safe food handling [SFH], surface blanching, and refrigeration only) across five age groups, for cancer patients who consume ready-to-eat salad. Less disruptive diets had fewer negative health impacts in all scenarios, with median alternative diet DALYs per person per chemotherapy cycle having lower values in terms of negative health outcomes (0.088-0.443) than the ND (0.619-3.102). DALYs were dominated by outcomes associated with NEC, which is more common in patients following the ND than in other diets. Switchover point analysis confirmed that, because of this discrepancy, there were no feasible values of other parameters that could justify the ND. Correspondingly, the sensitivity analysis indicated that NEC mortality rate and remaining life expectancy strongly affected DALYs, further illustrating the model's strong dependence on NEC outcomes. Given these findings, and the SFH's ease of implementation and high compliance rates, the SFH diet is recommended in place of the ND.

Validation and reliability of the Chinese version of the Friendship Scale (FS-C) in family caregivers of people with severe mental illness

Social isolation has been shown to contribute to negative health outcomes. Within a Chinese cultural context where people highly value social relationships, family caregivers of people with severe mental illness are prone to experience social isolation due to demanding caregiving tasks and prevalent social stigma. However, an instrument that could comprehensively measure social isolation in Chinese family caregivers is lacking. The six-item Friendship Scale was designed to measure social isolation but it has not previously been validated for use in the Chinese context. This study aimed to assess the reliability and validity of the Friendship Scale – Chinese version (FS-C) in family caregivers of people with severe mental illness (SMI) (N = 200). Confirmatory factor analysis affirmed FS-C's single-factor structure. FS-C demonstrated good internal consistency (Cronbach's alpha = 0.74) and test-retest reliability (ICC = 0.72). Convergent validity was supported by moderate to strong correlations with social networks (r = 0.342, p < 0.01) and loneliness (r = −0.608, p < 0.01). Divergent validity was confirmed by a weak correlation with perceived social stigma (r = −0.190, p < 0.01). FS-C is a reliable and valid tool for assessing social isolation among Chinese family caregivers of people with SMI.

Consequences of acute and long-term excessive iodine intake: A literature review focusing on seaweed as a potential dietary iodine source.

Macroalgae, also called seaweed, are becoming more widespread as food in Western diets. Seaweed can accumulate iodine, an essential nutrient for humans. However, some species of seaweed may contain very high amounts of iodine, and therefore, iodine has been identified as one of the major hazards in the seaweed food chain. Macroalgae may be consumed regularly, though many consumers report eating macroalgae only occasionally. The aim of this paper is to explore possible health consequences of excessive iodine intake according to long-term (chronic) or occasional (acute) excessive exposure to iodine, relating to a regular (chronic) or occasional (acute) seaweed intake, respectively. Furthermore, through a modeling exercise, we add different amounts of seaweed to the diet in a population group to explore the possible safe amounts that can be added without exceeding excessive iodine intakes and risking detrimental health effects. Chronic excessive iodine intakes were associated with several negative health outcomes at variable doses in various studies. For acute excessive iodine exposure, negative health effects seemed to be associated with higher iodine exposures. However, the research on this topic was limited. The chronic and acute iodine exposures needed to result in negative health outcomes may easily be ingested by macroalgae consumption. Adding seaweed to the diet must be done thoughtfully to avoid the risk of exceeding thresholds for excessive iodine intake.

Impact of Polypharmacy on Symptoms and Health Outcomes in Older Adults With and Without Alzheimer's Disease and Related Dementias.

There is a critical gap in understanding the symptom experience and health outcomes of older adults with and without Alzheimer's Disease and related dementias (ADRD) and polypharmacy (PPY). The primary aim of the study was to compare the number of symptoms experienced over time in older adults with and without ADRD by polypharmacy status. The secondary aim was to examine the trajectory of physical function and health outcomes over time in each group. This study utilized longitudinal data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries from 2016-2019. The sample was separated into four groups (N = 2,052): neither ADRD or PPY (n = 1,048), PPY only (n = 761), ADRD only (n = 116), and both ADRD and PPY(n = 127). The overall sample was predominately female (57.9%), White (70.9%), aged 84 or younger (75%), married (46%), and had some college or a college degree (50%). Participants with both ADRD and PPY experienced more symptoms on average, had higher odds of falls, hospitalizations, and mortality than all other groups. Older adults with both ADRD and PPY had lower physical function, needed more assistance with activities of daily living and higher assistive device utilization compared to the other three groups. Findings indicate that older adults with both ADRD and PPY experience more symptoms, negative health outcomes and physical function decline that can negatively impact their quality of life. Further research is needed to identify strategies for reducing PPY in people with ADRD.

A protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries

BackgroundCompared to the general population, people living in prison are at an increased risk to experience negative (mental) health outcomes. Moreover, delinquency and drug use have many risk factors in common. A need exists for increasing the knowledge about health needs, drug use patterns and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study about wellbeing, drug use and related care in prison.Methods/designA multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, the European Questionnaire on Drug use among people living in Prison, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data regarding health and social reintegration measures in prison is collected through a quantitative survey addressed to the prison authorities.DiscussionThis study protocol presentes a European study which aims to assess drug use among people living in prison and recently released people who use drugs as well as the existing care services in prisons. Hereby, factors related to the prison environment and their needs, both inside and outside prison are taken into account. Importantly, this study protocol describes a methodology which is developed to be executed in different prison settings within different countries simultaneously. Accordingly, for each country the protocol is adjustable to specific national legal requirements, regional differences and distinct local regulations of prison administrations. However, extensive modularity inevitably comes with significant limitations of comparability and generalizability of the results.

Reproductive Coercion: Prevalence and Risk Factors Related to Relationship Health Knowledge and Skills.

Reproductive coercion is any behavior that limits a person's reproductive decision-making and can lead to negative health and safety outcomes. Previous research has explored reproductive coercion prevalence rates in clinical samples, as well as demographic risk factors for experiencing reproductive coercion. The purpose of this study is to assess the prevalence rates of two specific forms of reproductive coercion, pregnancy coercion and condom manipulation, in an ethnically and racially diverse sample of young females. We also explore the association between relationship health knowledge and skills with reproductive coercion. We used a sample of 143 females with previous sexual activity. Participants were diverse in terms of race, ethnicity, sexual orientation, and family immigration status. Descriptive statistics and logistic regression analyses were used to determine prevalence rates of pregnancy coercion and condom manipulation and the likelihood of experiencing reproductive coercion based on participants' knowledge and skills related to relationship health. Results revealed that 16.1% of the sample had experienced reproductive coercion, with all participants in this group reporting lifetime experiences of pregnancy coercion. Lifetime experiences of condom manipulation were reported by 6.3% of the sample. The most common form of reproductive coercion experienced by participants was being told by a partner not to use any birth control. Furthermore, results indicate that higher relationship health knowledge may be a protective factor for pregnancy coercion and condom manipulation. Likewise, higher decision-making skills in relationships and higher confidence in relationships may also protect against condom manipulation. Results from this study suggest implications for sexual and relationship health programming that expands education around consent, choice, decision-making, and communication around the use of contraception.

Provision of digital health interventions for young people with ADHD in primary care: findings from a survey and scoping review

BackgroundPeople with attention-deficit hyperactivity disorder (ADHD) are at risk of negative health outcomes, with risks reduced through evidence-based treatments. Therefore, ensuring continued access to treatment for young people with ADHD, especially as they transition from child to adult services, is a priority. Currently many young people with ADHD are unable to access adequate care, with negative consequences for patients and their communities. Preliminary evidence suggests digital health interventions (DHIs) may act as an effective adjunct to usual care, helping overcome barriers to access, and improving outcomes by increasing understanding of ADHD as a long-term condition. The aim of this mixed methods study is to explore the healthcare information preferences of people with lived experience of ADHD in the primary care context and considers these in the light of the emerging body of literature on DHIs for ADHD. To explore this, a descriptive summary of cross-sectional survey responses was compared and discussed in the context of DHIs identified in a scoping review.ResultsDigital apps, followed by support groups, were deemed the most useful information resource types by survey respondents, but were the least currently used/provided. Over 40% participants indicated a preference for signposting to all resource types by their general practitioner (GP), suggesting that GPs are credible sources for ADHD healthcare information. The scoping review identified nine studies of DHI for ADHD, consisting of games, symptom monitoring, psychoeducation, and medication reminders, with limited evidence of effectiveness/implementation.ConclusionsPeople with ADHD state a preference for digital apps as an adjunct to usual care. However, these are currently the least provided information resource in primary care, indicating a key area for future development. The limited evidence base on DHIs for ADHD suggests combining digital apps and support networks, and utilising multimodal delivery methods may also enhance the delivery of healthcare information.

Initial Witnessing on Future Witnessing: A Mediation Analysis of Chronic Community Violence, Post-Traumatic Stress, and Delinquency in Urban, African American Youth.

Witnessing community violence can predict negative mental health outcomes for youth such as post-traumatic stress symptoms and delinquent behavior. Such outcomes differ by gender. Variables that predict witnessing community violence in youth are less understood. This study aims to explore potential pathways between initial witnessing and continued witnessing for early adolescents. The relationship between witnessing as a predictor and witnessing as an outcome is hypothesized to be mediated by both post-traumatic stress and delinquency and moderated by gender. A sample of 153 African American, sixth-grade students (M= 11.65, 59% female) in high crime, high poverty areas completed self-report surveys at baseline, 12 and 24 months. Moderated serial mediation was used to assess longitudinal associations. For the full model, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. Gender moderated several paths. For girls, witnessing at Time 1 was predictive of high post-traumatic stress (aggregate) at Time 2 and high delinquency at Time 3. For girls, witnessing at Time 1 also was predictive of higher hyperarousal and higher intrusion subscale symptoms than other symptoms at Time 2. Analyses also indicated that hyperarousal at Time 2 significantly predicted witnessing at Time 3 for girls only. Lastly, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. For boys, no analyses indicated witnessing at Time 1 as a significant predictor. Results contribute to our understanding of the trajectory of witnessing community violence and the roles both post-traumatic stress subscales and delinquency play in that trajectory, especially among girls.

Association between adverse childhood experiences and current use of e-cigarettes or electronic vaping products across sex race ethnicity and age based on 2020–2022 BRFSS data

IntroductionThe use of e-cigarettes or other electronic vaping products (EOEVP) has been on the rise since their introduction. Concurrently, Adverse Childhood Experiences (ACEs) have been linked to various negative behavioral health outcomes. We explore the association between ACEs and current EOEVP use, with a focus on variations across sex, race/ethnicity, and age.MethodsUtilizing data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2020–2022, we analyzed responses from 202,126 adults in the United States in a cross-sectional study. Multivariable logistic regression models were used to evaluate the adjusted odds ratios (aORs) of current EOEVP use for different levels of ACEs. Stratified and interaction analyses were used to examine potential effect modification.ResultsAmong adults 54 years of age and younger, even a lower number of ACEs [1 (aOR 1.52), 2 (aOR 2.01), and 3 (aOR 1.51)] was associated with higher odds of current EOEVP use. Stratified analyses revealed significant differences in the odds of current EOEVP use among Non-Hispanic White adults between 1 ACE (95% CI 1.75–2.28) and 4 ACEs (2.34–3.17). Hispanic adults with ≥ 1 ACEs (p-value 0.001) and 8 ACEs (p-value 0.005) showed strong associations compared to Non-Hispanic White adults. The influence of ACEs on current EOEVP use was observed to decrease with age, particularly in older adults with fewer ACEs. The aORs did not very by sex.ConclusionThe findings emphasize the importance of considering any number of ACEs in public health strategies targeting current EOEVP use, especially among younger adults and specific minority groups. These insights are crucial for tailoring interventions and policies to address the nuanced impacts of early life adversities on health risk behaviors.

The effectiveness of a 6-month intervention with sit-stand workstation in office workers: Results from the SUFHA cluster randomized controlled trial.

Prolonged periods of sitting have been linked to negative health outcomes. Implementation of sit-stand desks in the workplace has been one strategy to reduce prolonged sitting. To assess the effectiveness of sit-stand workstations on reducing sitting time and improving other health outcomes of office-based workers. 39 Portuguese office workers were randomized into a 6-month parallel-group cluster RCT consisting by the implementation of sit-stand desks in the workplace. The primary outcome of sitting time was assessed using ActivPAL. Secondary outcomes included biometric, psychological, and diet-related variables. All outcomes were assessed at baseline and 6 months for the whole sample and at 3 months for a sub-sample of the intervention group (n = 11). No significant time*group interaction was found for the primary or secondary outcomes, apart from waist circumference favoring the control group (Δ-1.81 cm, pinteraction = 0.04). There were significant changes within the intervention group for sitting time (-44.0 min/day), prolonged sitting (>30 min) (-45.3 min/day) and standing time (51.7 min/day) at 3 months in the sub-sample and in prolonged sitting (>30 min) (-26 min/day) in the full intervention group (p < 0.05). Changes were also observed within the intervention group for percent body fat (Δ-3.7%) and ratings of quality of life (Δ2.2), musculoskeletal discomfort (Δ-4.9), overall fatigue (Δ-2.2), and the need for recovery after work (Δ-1.7) at 6-month follow-up (p < 0.05). Although not being effective for reducing sitting time, the implementation of sit-stand desks in the Portuguese workspace was shown to be feasible over the long term, received well by users, and may offer other health benefits. OSF Registration, OSF.IO/JHGPW. Registered 15 November 2022. https://doi.org/10.17605/OSF.IO/JHGPW.

Evaluating the effectiveness of Smoke-Free Home SafeCare, an integrated intervention, among families at risk for secondhand smoke exposure and child maltreatment in the United States: a study protocol for a hybrid type 1 trial

BackgroundSecondhand smoke exposure (SHS) and child maltreatment (CM) are preventable yet have negative lifelong impacts on health. When considered together, the risk for negative health outcomes may be compounded, especially for people living in low-resource settings. Evidence-based interventions exist for preventing CM and reducing SHS among families with low resources; however, no programs jointly target SHS exposure and maltreatment risk.MethodsThis study is a hybrid type 1 trial to examine the effectiveness of a systematically braided intervention to target CM risk and SHS in the home. Fifty SafeCare Providers will be randomized to deliver either standard SafeCare (i.e., the SafeCare model alone; active treatment control; n = 25) or Smoke-Free Home SafeCare (SFHSC; treatment condition; n = 25), the braided intervention that includes both SafeCare and the Smoke-Free Homes: Some Things are Better Outside intervention to N = 500 families. Aim 2 is to assess family-level outcomes. The primary outcome is a full home smoking ban, validated by air nicotine monitors; secondary outcomes include parenting and smoking outcomes. Aim 3 is to evaluate process and implementation outcomes, including cost–benefit. We will use multilevel models and ROC analyses to evaluate and validate the primary outcome. We will use tests of non-inferiority to evaluate secondary outcomes. Cost-effectiveness analyses will be used to assess cost–benefit of SFHSC.DiscussionThis study will be the first to document the outcomes of a multi-component intervention to address cumulative risk factors that impact cancer risk among children whose parents are at risk or involved in child-protective services. Integrating an evidence-based intervention that targets SHS exposure in the home with a broadly disseminated CM prevention intervention may be a sustainable way to help reduce the compounded effects of SHS in the home and CM.Trial registrationClinicaltrials.gov, NCT05000632. Registered on August 11, 2021.

Perceived discrimination and pain outcomes among black adults with chronic musculoskeletal pain: identifying modifiable psychosocial risk factors.

Chronic musculoskeletal pain (CMP) is highly prevalent, frequently associated with negative health outcomes, and disproportionately impacts Black Americans. Perceived racial and ethnic discrimination has emerged as a factor that may influence the experience of chronic pain in this population. Identifying modifiable psychosocial factors that influence the link between perceived discrimination and pain and that can be directly targeted in treatment is vital to reducing the disproportionate burden of CMP among Black individuals. The present study examines the moderating role of five risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) on the relationship between perceived discrimination and pain outcomes (i.e., pain intensity and interference) in a sample of 401 Black adults with CMP. We recruited 401 Black individuals (Mage = 35.98, 51.9% female) with self-reported CMP and assessed their self-reported perceived discrimination, pain intensity, pain interference, and pain-related psychosocial risk factors. Results indicated that higher scores on each of the psychosocial risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) were significantly associated with greater pain intensity and pain interference (all ps < 0.01). Further, pain avoidance (B = 0.12, p = .006), pain fusion (B = 0.13, p = .002), and pain anxiety (B = 0.13, p = .002) each significantly moderated the relation between perceived discrimination and pain intensity. Greater perceived discrimination was associated with greater pain intensity at higher levels of avoidance and fusion, and was associated with less pain intensity at lower levels of avoidance and pain anxiety. In interaction models predicting pain interference, both pain fusion (B = 0.14, p = .001) and pain anxiety (B = 0.10, p = .01) significantly moderated the relation between perceived discrimination and pain interference. Perceived discrimination was associated with greater pain interference at higher levels of pain fusion and pain anxiety, and was not associated with pain interference at lower levels of pain fusion and pain anxiety. The present findings provide important insights into psychosocial risk factors that moderate the link between perceived discrimination and pain outcomes, providing important clinical implications for the treatment of Black adults with chronic musculoskeletal pain.

Impact of Loneliness and Social Support on Acute Health Service Use and Symptom Exacerbation Among Adults with Asthma and COPD.

Loneliness and low social support are associated with negative health outcomes among adults with asthma or COPD. Although social support is correlated with loneliness, low social support is neither necessary nor sufficient for the experience of loneliness. This study compares the relative association of loneliness and social support on symptom exacerbation (i.e., acute deteriorations in respiratory health) and acute health service utilization (i.e., hospitalizations, emergency department visits) among 206 adults with asthma and 308 adults with COPD. Separate logistic regression models were used to simultaneously examine the association of loneliness and social support with each outcome. Among adults with asthma, loneliness was associated with greater odds of hospitalization (AOR = 2.81, 95%CI [1.13, 7.02]), while low social support was not (AOR = 1.44, 95%CI [0.78, 2.65]). However, neither loneliness nor social support were associated with any other acute health service use or symptom exacerbation among adults with asthma. Among adults with COPD, loneliness, and greater social support were associated with increased odds of symptom exacerbation (AOR = 1.67, 95%CI [1.03, 2.69]; AOR = 1.36, 95%CI 1.02, 1.83]) and hospitalization (AOR = 3.46, 95%CI [1.65, 7.24]; AOR = 1.92, 95%CI [1.15, 3.22]), but only social support was significantly associated with ED visits (AOR = 1.72, 95%CI 1.12, 2.66]). These findings support prior research demonstrating that loneliness and social support are related but separate determinants of patients' physical symptoms and service utilization.

7080 Copy Number Variation (CNV) in Self-Limited Delayed Puberty (SLDP)

Abstract Disclosure: Y. Al-Sayed: None. M. Ishida: None. C.L. Hall: None. S. Howard: None. SLDP is where the onset of puberty is more than 2-2.5 standard deviations later than the population mean age and is often familial with strong genetic determinants. The reproductive axis is regulated by gonadotropin-releasing hormone (GnRH), which plays a crucial role in initiating puberty and maintaining fertility through its pulsatile secretion. Disruption in GnRH neuron development or hypothalamic function can lead to DP. UK Biobank data has identified negative health outcomes associated with SLDP including early menopause/andropause and cognitive and psychosocial disabilities. Consequently, there has been extensive research to investigate genes affecting the hypothalamic-pituitary-gonadal (HPG) axis that might be implicated in the pathogenesis of DP by our group and others which has identified sequence variation contributing to the aetiology of SLDP. However, factors beyond nucleotide variations, such as epigenetic changes and CNVs can also lead to pubertal timing disorders. Moreover, CNVs are seen in multiple individuals (n=92) from the Deciphering Developmental Disorders study (https://www.deciphergenomics.org) with a phenotype including DP (HP:0000823). We performed whole genome sequencing on 49 probands with SLDP and subsequently, analysed the data for CNV. The data was initially called, annotated, filtered then partitioned for classification of CNVs using a command-line tool that implements the ACMG guidelines to evaluate the pathogenicity of germline duplications and deletions. Using an unbiased candidate gene approach, we identified several deletions that affected 60 known/predicted dosage sensitive genes and combines with functional enrichment analysis; This approach revealed potential molecular pathways and biological processes involved in the pathogenesis of SLDP, including histone acetylation, and neural plate development. To refine our findings, we applied additional filters, including known HPG axis genes, GWAS loci associated with pubertal timing, decipher CNV tracks, and DP gene panels, to narrow down large number of rare predicted damaging CNVs and prioritize those with potential relevance to DP. Our study highlights the potential role of CNVs in DP and expands our understanding of the molecular pathways and biological processes involved in this condition, shedding light on the complex mechanisms underlying DP. Presentation: 6/2/2024

9205 Copy Number Variation (CNV) in Self-Limited Delayed Puberty (SLDP)

Abstract Disclosure: Y. Al-Sayed: None. M. Ishida: None. C.L. Hall: None. S.R. Howard: None. SLDP is where the onset of puberty is more than 2-2.5 standard deviations later than the population mean age and is often familial with strong genetic determinants. The reproductive axis is regulated by gonadotropin-releasing hormone (GnRH), which plays a crucial role in initiating puberty and maintaining fertility through its pulsatile secretion. Disruption in GnRH neuron development or hypothalamic function can lead to DP. UK Biobank data has identified negative health outcomes associated with SLDP including early menopause/andropause and cognitive and psychosocial disabilities. Consequently, there has been extensive research to investigate genes affecting the hypothalamic-pituitary-gonadal (HPG) axis that might be implicated in the pathogenesis of DP by our group and others which has identified sequence variation contributing to the aetiology of SLDP. However, factors beyond nucleotide variations, such as epigenetic changes and CNVs can also lead to pubertal timing disorders. Moreover, CNVs are seen in multiple individuals (n=92) from the Deciphering Developmental Disorders study (https://www.deciphergenomics.org) with a phenotype including DP (HP:0000823). We performed whole genome sequencing on 49 probands with SLDP and subsequently, analysed the data for CNV. The data was initially called, annotated, filtered then partitioned for classification of CNVs using a command-line tool that implements the ACMG guidelines to evaluate the pathogenicity of germline duplications and deletions. Using an unbiased candidate gene approach, we identified several deletions that affected 60 known/predicted dosage sensitive genes and combines with functional enrichment analysis; This approach revealed potential molecular pathways and biological processes involved in the pathogenesis of SLDP, including histone acetylation, and neural plate development. To refine our findings, we applied additional filters, including known HPG axis genes, GWAS loci associated with pubertal timing, decipher CNV tracks, and DP gene panels, to narrow down large number of rare predicted damaging CNVs and prioritize those with potential relevance to DP. Our study highlights the potential role of CNVs in DP and expands our understanding of the molecular pathways and biological processes involved in this condition, shedding light on the complex mechanisms underlying DP. Presentation: 6/2/2024