Negative Outcomes Research Articles

Landscape of healthcare transition services in Canada: a multi-method environmental scan

BackgroundPoorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the “Transition Hub”, established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.MethodsOur project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers’ perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.ResultsFifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.ConclusionsWhile national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.

The Cumulative Impact of Recurrent Experiences of Intimate Partner Violence on Emotion Dysregulation: A Longitudinal Investigation.

Intimate partner violence (IPV) disproportionately affects women and has been linked to a range of negative psychological outcomes, including emotion dysregulation. Although IPV is often recurrent and tends to escalate in severity over time, few studies have examined the potential effects of recurrent experiences of IPV on emotion dysregulation. The current study employed a longitudinal design to examine the cumulative impact of recurrent experiences of IPV on emotion dysregulation. Participants were 491 young adult community women (Mage = 21.74; 61.3% White, 35% African American/Black) who completed self-report measures of IPV and emotion dysregulation every 4 months for 28 months. Multilevel structural equation modeling techniques revealed that, at the within-person level, increases in cumulative IPV were associated with increases in global emotion dysregulation across the 28 months. In particular, the accumulation of IPV experiences over time was associated with increases in difficulties controlling impulsive behaviors when distressed and accessing effective emotion regulation strategies. At the between-person level, greater average cumulative IPV was associated with greater mean levels of global emotion dysregulation, as well as four specific dimensions of emotion dysregulation, including difficulties accepting emotional responses, accessing effective emotion regulation strategies, and both engaging in goal-directed behaviors and controlling impulsive behaviors when distressed. These findings suggest the potential cumulative impact of IPV on both global and more specific dimensions of emotion dysregulation. Results also highlight emotion dysregulation as a potentially important construct to assess and target in interventions for women experiencing recurrent IPV.

Carers in post-stroke aphasia: a scoping review of interventions and outcomes beyond communication partner training

Purpose Carers of people with aphasia face unique challenges. Research has demonstrated that these carers have a higher burden of care and more negative stroke-related outcomes in comparison to carers of stroke survivors without aphasia. The aim of this scoping review was to map the range of interventions for carers other than communication partner training and to examine their outcomes. Materials and methods We conducted a scoping review on this topic. Results Twenty studies were included. Most studies were case series with four randomised control trials. Both quantitative and qualitative approaches were used. Most studies occurred during the long-term phase of care. Two interventions had only carers as participants. Interventions were comprised of different combinations of intervention components including psychoeducation, skill-building, and support. There was high variability on who led the interventions, the format, and the dose/schedule. Twenty-eight different outcome measures for carers and dyads were used across various domains with overall positive outcomes post-intervention. Conclusions This review uncovered a wide range of formats, dosages, and outcome measures in interventions for carers. Encouragingly, the majority of these interventions included psychoeducation, skill-building, and support components. While most studies were case series, there are promising interventions that have the potential to enhance carer wellbeing.

Older and heavier: How obesity is experienced by older adults?

ABSTRACT The interplay between obesity and mental health in old age is complex and widely impacted by different biological, psychological, and social factors. The primary objectives of this qualitative research study are: a) To explore the influence of obesity on older adults’ well-being; b) to understand emotional experiences related to obesity in old age and; c) to explore how obesity influences the mental health of older adults. This study included 692 participants aged 65 to 84 years (M = 73.9; SD = 5.61) from three different nationalities (English, Spanish, and Portuguese). The study involved in-depth interviews conducted via telephone or online, with questions designed to elicit detailed narratives about participants’ experiences, and the data were analyzed using content analysis to identify key themes and patterns. This study identified four main themes regarding the influence of obesity on older adults’ well-being: (1) Body image dissatisfaction (66%); (2) Fat shaming (65%); (3) Increased isolation (57%); and (4) Loss of opportunities (46%). Three main themes for emotional experiences were frequently verbalized by the participants: (1) Shame (81%); (2) Guilt (78%); and (2) Worthlessness (76%). Finally, three main influences in mental health due to obesity were reported: (1) Self-esteem (88%); (2) Distress (78%); and (3) Depression (63%). These results highlighted that obesity negatively influences older adults’ well-being and emotional experiences and has serious mental health-related negative outcomes for older adults. Interventions like community-based weight loss programs can be effective in controlling weight and improving the social interaction of obese older adults.

Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study.

Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient-care team relationships and providing information to enable care tailored to individual needs and values. This study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting. We recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data. In total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients' key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner-IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium. This study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting.

Dysbiosis of gut microbiota is associated with pathogenesis of peptic ulcer diseases through inflammatory proteins: A Mendelian randomization study.

The gut microbiota and inflammatory proteins may affect the development of peptic ulcer disease. However, this association remains unclear. We analyzed genome-wide association study data of gut microbiota, inflammatory proteins, and peptic ulcer disease using Mendelian randomization with instrumental variables to assess causal relationships. Various statistical methods, including inverse variance weighting, Mendelian randomization Egger regression, and sensitivity analysis were employed to evaluate the data and calculate mediation ratios. Our findings reveal that the genus Butyriciccus plays a role in mitigating the adverse effects of gastric ulcers by 7.9%, primarily through reducing beta-negative growth factor levels. Additionally, the genus Lachnospiraceae UCG004 can significantly alleviate the negative outcomes of gastric ulcers and reduces hepatocyte growth factor and beta-reserve growth factor levels by 6.39% and 7.45%, respectively. This study highlights the independent and mediating effects of the gut microbiota and inflammatory proteins on peptic ulcers, offering insights on potential pathways and targets for future preventive interventions.

Effects of Pharmacist-Led Interventions Regarding Adult Patients with Type 2 Diabetes Mellitus in Mexico: A Systematic Review.

In Mexico, type 2 diabetes mellitus (T2DM) is a serious public health concern. As experts in drug therapy, pharmacists are essential additions to multidisciplinary diabetes patient care teams. There have been no systematic reviews or meta-analyses performed on pharmacist-led interventions (PIs) in Mexico; therefore, the impact of PIs on patients remains poorly explored. An electronic search of the PubMed, SciELO and BVS databases and certain institutional repositories was conducted in English and Spanish through 24 August 2021 with a subsequent update through June 2024. A total of 1302 potentially relevant studies were identified in the initial search, of which nine met the eligibility criteria and were included in this systematic review. The results suggest that PIs, such as pharmacotherapeutic follow-up and patient education, may have positive effects on outcomes in Mexican patients with T2DM. PIs led to significant reductions in glycosylated hemoglobin, fasting blood glucose, triglycerides, total cholesterol, LDL cholesterol and arterial blood pressure levels, general reductions in body mass index and negative outcomes associated with medication, as well as significant improvements in therapeutic adherence and patient knowledge in the intervention group during follow-up periods of 3-12 months. Further well-designed research, including controlled studies with adequate sample sizes and standardized tools, is essential to fully understand the effects of PIs regarding patients with T2DM in Mexico.

'Leaving the Door Open': Perspectives on Decision-Making for Non-Emergency Diabetes-Related Amputation.

Having a lower extremity amputation is a life-changing decision for people living with a diabetes-related foot ulcer. Although previous research has described both positive and negative lifestyle and function outcomes of diabetes-related amputations, limited research has been conducted on the decision-making processes leading up to the amputation. This study aimed to explore the perspectives of persons, healthcare practitioners and experts (including academics and specialists) on decision-making for people with a diabetes-related foot ulcer who may require a non-emergency amputation. A qualitative descriptive study using semi-structured interviews enabled people to share their thought processes when making decisions for amputation. Twenty-six participants were interviewed, including nine people with a diabetes-related foot ulcer or amputation, nine health practitioners and eight experts located across five countries. There were 13 female and 13 male participants. Thematic analysis was used for data analysis. Four themes described the decision-making considerations for amputation: 'Balancing the evidence in decision-making', 'Trust, respect and timing of conversations inform decision-making', 'Tailoring decisions for individual circumstance' and 'Reaching the tipping point in decisions for the future'. Work commitments, functional and lifestyle impacts of amputation, the presence of support networks and clinical wound features formed the evidence for a decision for amputation. Understanding quality of life needs ensured that decisions for amputation addressed expectations and lifestyle needs. Living with a diabetes-related foot ulcer presented daily challenges that pushed people to a tipping point, at which amputation was considered to overcome these hardships and enable them to move on to the next chapter of their life. Further research is required to understand how person-centred factors can be better incorporated alongside objective clinical assessments in decisions for amputation. People with diabetes-related foot ulcers, health practitioners and experts shared their perspectives on the decision-making process for amputation through one-to-one interviews. Consideration of the person in the context of their life, environment and personal needs alongside the pathological factors is warranted.

Childhood maltreatment, social connectedness, and depression: A prospective analysis of trajectories over time.

Childhood maltreatment is associated with a range of negative social and psychological outcomes at different developmental stages. Using data from a prospective longitudinal study of the consequences of childhood maltreatment, we examine whether childhood maltreatment predicts lower levels of social connectedness and more depression symptoms over a 30-year time period and examine the directionality of the trajectories from childhood into middle adulthood. Children (ages 0-11 years) with documented histories of maltreatment and demographically matched controls were followed into adulthood across four waves: 1989-1995 (n = 1,196; Mage = 29.2 years, SD = 3.9), 2000-2002 (n = 896; Mage = 39.5 years, SD = 3.6), 2003-2005 (n = 808; Mage = 41.2 years, SD = 3.6), and 2009-2010 (n = 649; Mage = 47.0 years, SD = 3.5). Social connectedness and depressive symptoms were measured at all four time points. Random intercept cross-lagged panel models were used to estimate bidirectional relationships between social connectedness and depression symptoms and the extent to which the trajectories differed for the maltreated and control groups. Individuals with documented histories of childhood maltreatment generally had significantly lower levels of social connectedness and higher levels of depression compared to matched controls. Depression was associated with lower levels of social connectedness concurrently at ages 39, 41, and 47. Depression predicted lower social connectedness, and social connectedness predicted lower depression in middle adulthood, but not young adulthood. Better understanding of the long-term impact of childhood maltreatment on social connectedness and depression has implications for designing effective interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Polydopamine-coated chondroitin sulfate methacryloyl multifunctional microspheres for wound treatment

The disappearance of the protective barrier after skin injury leads to the overproduction of reactive oxygen species (ROS) in response to various stimuli. Oxidative stress is one of the most important causes of delayed wound healing, leading to negative outcomes, such as excessive inflammatory response and impaired angiogenesis. In this study, we used microfluidic technology to integrate Prussian blue nanozymes and vascular endothelial growth factor and constructed multifunctional microspheres that improved local oxidative stress. In order to enhance the adhesion of the microspheres on the wound surface and prolong the release of the drug, we coated them with dopamine, ensuring uniform encapsulation on their surface. The microspheres adhered well to the wound surface and promoted wound healing by scavenging ROS, reducing the inflammatory response, and promoting angiogenesis. This strategy of integrating nanozymes and growth factors can have a synergistic effect, which is significant for wound healing.

Understanding the Role of H2O in Heterogeneous Catalysis of COx Hydrogenation

AbstractThe effects of H2O in heterogeneous catalysis of COx (CO2, CO) hydrogenation have been intricate and controversial for many years. On the one hand, H2O molecules and their derivatives (O, H, OH) serve as reactants or co‐reactants, playing a role in modulating the reaction pathway through specific mechanisms. On the other hand, the presence of H2O can influence the catalytic performance by altering the physicochemical properties of the catalyst, such as particle size and chemical state, among others. More importantly, the dual role of H2O leads to both positive and negative outcomes, challenging our understanding of its impact. In this mini review, the relevant research results are summarized in terms of the promoting and inhibiting effects of H2O of the COx hydrogenation reaction (e. g., synthesis of methanol, Fischer‐Tropsch synthesis, methanation, etc.) and discussed from the perspective of catalyst and reaction mechanism, which may provide a certain theoretical basis for the design and development of high‐performance catalysts and referable experience for the further exploration and utilization of H2O effects on related fields as well.

Polish adaptation and validation of a family appraisal of caregiving questionnaire for palliative care (FACQ-PC)

Increasing numbers of people are taking on the role of informal caregivers of oncology patients in the advanced stages of the disease. The outcomes of such a decision are both positive (e.g. strengthening of bonds) and negative (e.g. strain). Their assessment is necessary to customise appropriate interventions for caregivers and is made possible by the FACQ-PC (multi-dimensional Family Appraisal of Caregiving Questionnaire for Palliative Care) – a tool used to assess the functioning of informal caregivers of patients receiving home-based palliative care. The aim of this study was to determine the psychometric properties of the Polish adaptation of the FACQ-PC. The study involved 150 informal caregivers of patients receiving palliative care at home, including 106 women and 44 men aged between 22 and 77 years. Study participants completed the Polish version of the FACQ-PC and a series of questionnaires measuring positive and negative feelings (SUPIN), stress (PSS-10) and satisfaction with family life (SOR- H). The study did not confirm the four-factor structure of the questionnaire; instead, a three-factor structure was found to be more appropriate. The following factors were determined: negative outcomes, positive caregiving appraisals and family well-being. Based on a validation review, the high reliability of the individual scales was established, and internal relevance was confirmed. FACQ-PC-PL was adopted as the abbreviated name of the tool. This tool can be used in scientific research and for initial assessments conducted in a clinical setting.

The impact of digital inequities on salivary gland cancer disparities in the United States.

Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC). The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality. Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01-1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01-1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91-0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods. Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.

Effectiveness of the Antenatal Training Program on Reducing Anxiety and Pain Levels in Mothers During Gestation at the Sobang Community Health Center in 2024

Women often experience anxiety and fear during pregnancy due to concerns about the pain of childbirth. This anxiety can lead to mental and physical tension, resulting in unnatural stiffness in muscles and joints. Such stress is associated with negative pregnancy outcomes, mood disturbances, and various somatic complaints. Physical exercise during pregnancy can be an effective intervention to reduce anxiety and pain, benefiting both maternal and fetal health. This study aimed to evaluate the effectiveness of the Antenatal Training Program in reducing anxiety and altering pain perception during pregnancy. The research involved 30 pregnant women at the Sobang Community Health Center, Pandeglang Regency, who completed pre-test and post-test questionnaires. The study results showed a significant improvement (p < 0.05) in reducing anxiety and pain perception among participants, confirming the effectiveness of antenatal exercise. The findings suggest that consistent participation in antenatal exercises positively impacts the childbirth experience. Additionally, pregnant women are advised to maintain proper nutrition and monitor their activities to ensure a healthy pregnancy and delivery activities carried out during the gestation period.

Oligohydramnios at term in the high-risk population- how severe is severe?

The term oligohydramnios is linked to pregnancy complications. We previously presented the outcome of the low-risk population (no pregnancy complications) with term oligohydramnios. This study aims to address the high-risk group (Any maternal complication during pregnancy, such as gestational diabetes, pre-gestational diabetes, chronic hypertension, preeclampsia, anemia, asthma, obesity, and multi parity.). This retrospective cohort study of 1,114 singleton term (≥37), oligohydramnios (AFI <50 mm) pregnancies from Shamir Medical Center between 2017 and 2021. Compering the low-risk to high-risk groups with subdivision by severity of oligohydramnios. A total of 211 subjects (19 %) were high-risk cases and 903 (81 %) low-risk cases. Comparing these two groups, subjects of the high-risk group were older (31.34±5.85 vs. 29.51 vs. 4.96), had earlier gestational age at delivery 39.53±1.18 vs. 40, had higher mean AFI (35±12.7 vs. 33±14.5), were subject to more labor inductions (81 vs. 69.7 %), and CS rate (19.9 vs. 12.4 %). Logistic regression revealed a need for more cesarean sections in the high-risk group. Additionally, more labor inductions and a higher risk of negative fetal outcomes. This study highlights the importance of considering pregnancy risk factors when we are approaching oligohydramnios in high-risk pregnancies.

Violent Victimization in Emerging Adulthood and Its Longitudinal Impacts on Well-Being: A Study of Ever-Homeless Persons.

Persons who have experienced homelessness have higher lifetime risks of violent victimization relative to the general population. However, the long-term impacts of violent victimization on various facets of well-being are poorly understood among ever-homeless persons, particularly when violence is experienced in early adulthood. Here, using data from the National Longitudinal Study of Adolescent to Adult Health, we focus on a subsample of emerging adults who reported ever suffering homelessness (N = 481). Drawing primarily from Waves III and IV of the data, a series of regression models are specified to determine whether violent victimization in emerging adulthood is related to a range of negative outcomes later in life among ever-homeless persons (economic hardship, binge drinking, drug use, depression, offending, and victimization). Results indicate that victimization in emerging adulthood increases the risks for subsequent victimization for ever-homeless persons, but that it has no robust associations with any other outcomes examined. We explain these findings through processes of disadvantage saturation, in which the consequences of victimization may be more subdued among individuals who experience an array of hardships and disadvantages in their lives. The implications of these findings for policy are future research are discussed, and we emphasize the need for a context-contingent approach to the study of victimization and its life course consequences.

This is Too Much! Social media integration and adults’ psychological distress: the mediating role of cyber and place-based information overload

ABSTRACT The present study examined the predictive role of social media use on adults’ psychological distress through the mediating role of one of the digital stress factors, i.e. information overload. A sample of 295 participants aged 18–41 (M age = 21.15, SD = 3.67, 82% females) filled out self-reported questionnaires measuring social media integration, anxiety, depression, and stress symptoms, as well as cyber-based and place-based information overload. Results suggested significant associations between social media integration and emotional connection, cyber-based information overload, and psychological distress symptoms. Cyber-based information overload was positively associated with place-based information overload and psychological distress symptoms. SEM analyses suggested a partial positive and statistically significant mediation between social integration and emotional connection and psychological distress by information overload: high scores on social integration and emotional connection were marginally positively associated with high scores on information overload and with high scores on psychological distress as direct effects. However, on the second mediation path, high scores on information overload were positively associated with high scores on psychological distress, but no significant total effect was observed. We discuss the present findings considering their implications for digital stress awareness and practical strategies for preventing information overload-related negative outcomes.

Prognostic criteria for surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women

Background. The relevance of the problem of stress urinary incontinence (SUI) in combination with cystocele has increased significantly over the past decades, due to the high prevalence of the disease in the population, as well as increased awareness of patients about treatment options. It is known that one-stage surgical treatment significantly reduces the need for re-intervention and, accordingly, the rehabilitation period. The identification of significant criteria that are decisive in the effectiveness of various methods of surgical correction of SUI in combination with cystocele dictates the need for further research in this direction.The purpose of the study. To determine outcome criteria for surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women based on a comprehensive preoperative examination.Materials and methods. A prospective randomized study was conducted, which included 80 women with stress urinary incontinence in combination with postmenopausal cystocele, who were routinely hospitalized in the gynecological department of the Federal State Budgetary Institution Research Institute of OMM for surgical treatment. All patients, after signing voluntary informed consent to participate in the study and conducting a comprehensive preoperative examination using a random number generator, were randomized into two groups of equal size. The first group included 40 women who received surgical treatment including anterior colporrhaphy in combination with urethropexy with a synthetic loop; the second group consisted of 40 patients who underwent surgical treatment using the method of paraurethral injection of a volume-forming gel in combination with anterior colporrhaphy.Results and discussion. Criteria for predicting the outcome of surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women were determined based on a comprehensive preoperative examination. Conclusion: Analysis of complex urodynamic and ultrasound examination methods in women revealed statistically significant differences between groups of women with positive and negative outcomes of surgical treatment. The identified criteria for predicting the outcome of surgical treatment serve to assist the clinician in choosing the optimal, most effective method of treating SUI in combination with cystocele in postmenopausal women.Conclusions. Analysis of complex urodynamic and ultrasound methods of examination in women revealed statistically significant differences between groups of women with positive and negative outcomes of surgical treatment. The identified criteria for predicting the out-come of surgical treatment serve to assist the clinician in choosing the optimal, most effective method of treating SUI in combination with cystocele in postmenopausal women.

Impulsivity mediates the relationship between sleep quality and interpersonal functioning: a cross-sectional study in a sample of university students

BackgroundAmid the current mental health pandemic, research continues to investigate potential contributors associated with increasing levels of negative mental health. Among such contributors is sleep, which is vital for physiological and psychological functioning with potential downstream behavioral consequences, including in relation to impulsivity and social functioning. Given the significant rates of disordered sleep behaviors reported in the literature, our study sought to investigate the relationship between sleep quality, impulsivity and interpersonal functioning among university students.MethodsAn anonymous online survey was administered to university students (Ages 18 + ; N = 526; 33% male, 67% female) addressing demographics, sleep quality, impulsivity, and interpersonal functioning.ResultsOur findings indicate a substantial proportion of students reporting poor sleep quality and impulsivity. Moreover, higher levels of impulsivity and lower interpersonal functioning were associated with poor sleep quality. Mediation analysis revealed a significant mediating role of attentional impulsivity in the relationship between sleep quality and interpersonal functioning.ConclusionsRepeated reports of significant levels of impulsivity underlying numerous psychiatric disorders, its prevalence socially, and the fundamental issue that impulsivity reflects (i.e., lack of self-control/self-discipline/self-regulation), suggests a necessity to reorient therapeutic efforts towards the root of the problem. Thus, efforts should seek to maximize preventative behaviors that strengthen the individual (e.g., improving sleep-related behaviors), and contribute to the building of character/virtue, through self-discipline, perseverance and consistency, in order to reduce negative outcomes (e.g., impulsivity, dysfunctional interpersonal functioning).

Pain and unhealthy alcohol use among people living with HIV: A prospective cohort study.

Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time. The current study examined whether pain was associated with indices of unhealthy alcohol use, namely heavy drinking and alcohol use disorder (AUD) assessed 12 months later. The study sample (n = 207) was from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) Cohort, a prospective cohort of PLWH with a history of illicit substance or unhealthy alcohol use. We conducted logistic regression analyses to examine the associations between pain and both heavy drinking and AUD status (DSM-5 criteria) (yes/no) over time. In secondary analyses, we examined whether pain was associated with greater AUD severity and whether pain interference was associated with heavy drinking and AUD outcomes. We found that pain at baseline was associated with greater odds of AUD [aOR = 2.29 (95% CI: 1.13, 4.64), p = 0.02] but not heavy drinking [aOR = 0.91 (95% CI: 0.44, 1.88), p = 0.79] at 12 months. Pain was also associated with more severe AUD. Analyses of pain interference showed similar results. Pain is prospectively associated with higher odds of AUD among PLWH with a substance/unhealthy alcohol use history. Providers should routinely address pain among PLWH to improve AUD outcomes.