Patient Health Research Articles

Health-Related Quality of Life Among Discharged Patients With Hemophagocytic Lymphohistiocytosis: A Follow-Up Study.

Evaluating the post-discharge health-related quality of life (HRQoL) in hemophagocytic lymphohistiocytosis (HLH) and exploring its influencing factors. The study was conducted at a regional pediatric medical center and involved pediatric patients diagnosed with HLH between July 2017 and July 2022. Healthy children of the same age and sex were included as the control group. The HRQoL and its associated factors in pediatric patients were assessed using the PedsQL 4.0 Parent Proxy Report and a general information survey. In the first year following diagnosis, psychological health and overall score in HLH patients were worse than those of the control group. However, scores for emotional functioning, school functioning, physical health, psychosocial health, and overall scores in the HLH group increased over the years since diagnosis. By the 5-year post diagnosis, there were no significant differences between the HLH group and the control group in social functioning, school functioning, physical health, psychosocial health, and overall scores (p>0.05). Generalized linear model analysis revealed that HLH patients who underwent transplantation have worse social functioning, physical health, overall score, while HLH patients with HLH recurrence have worse social functioning, psychosocial health, overall score (p<0.05). The HRQoL of HLH patients is compromised after discharge; however, it progressively returns to levels comparable to those of healthy cohorts over time since diagnosis. Transplantation, and HLH recurrence are identified as factors affecting the HRQoL in HLH patients.

The Impact Of Nutrition And Diet On Bone Health In Adolescent Patients Receiving Orthopedic And Orthodontic Treatment: A Cross Sectional Observational Study

The Impact Of Nutrition And Diet On Bone Health In Adolescent Patients Receiving Orthopedic And Orthodontic Treatment: A Cross Sectional Observational Study

The impact of curative cancer treatment on sexual health – clinical results from the EORTC QLQ-SH22 validation study

BackgroundThe European Organization of Research and Treatment of Cancer (EORTC) has recently developed and validated a patient-reported outcome measure (PROM) for sexual health (SH) in cancer patients. Here, we present results from a secondary analysis of the EORTC QLQ-SH22 validation study. The objective was to investigate the impact of cancer treatment on SH over the disease trajectory into survivorship in patients who underwent curative treatment.MethodsParticipants completed the EORTC QLQ-SH22 and the EORTC QLQ-C30 assessing SH and Quality of Life. We analyzed differences in SH of patients on active cancer treatment compared to patients off-treatment (cross sectional group comparison) as well as changes in SH during the course of treatment (from pre-treatment to follow-up).ResultsOur sample consisted of n = 394 (66.2% females) curatively treated cancer patients with 34% of patients being on-treatment and 66% of patients being in their follow-up after primary treatment (off-treatment group). Compared to patients off- treatment, patients on active cancer treatment experienced less sexual satisfaction (p = .021, Cohen’s d = .36) and libido (p < .001, d = .60) and had higher levels of fatigue (p < .001, d = .50). Importance of sexual activity, masculinity and femininity did not differ between groups. Treatment effects on sexual activity decreased with treatment completion (p < .001, d = .50). Patients undergoing intensified treatment (chemotherapy, radiation, or endocrine treatment) reported more treatment effects (subscale EORTC QLQ-SH22) compared to patients undergoing surgery only.ConclusionOur results highlight the negative impact of oncological treatment on SH and how increasing treatment intensity further impair SH. Sexual satisfaction and libido improve after treatment completion while other aspects (e.g. masculinity/femininity) do not change during survivorship. We suggest monitoring of SH from the start of cancer treatment on and beyond into survivorship using PROMs as part of routine cancer care. Routine monitoring allows systematic identification of patient’s SH problems and may improve awareness as well as target intervention for those in need of care.

Effects of task-shifting from primary care physicians to nurses: an overview of systematic reviews.

Task-shifting from primary care physicians (PCPs) to nurses is a means of overcoming PCP shortages and meeting the needs of patients receiving primary care. The aim of this overview of systematic reviews is to assess the effects of delegation or substitution of PCPs' activities by nurses on patient relevant, clinical, professional and health services-related outcomes. We conducted a systematic literature search for secondary literature in Medline, Embase, Pubmed, the Cochrane Library, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). We included systematic reviews and meta-analyses that analysed randomised controlled trials (RCTs) and controlled, prospective trials in English and German. Abstracts and full-text articles were screened independently by two reviewers. Full-text articles were assessed using the Overview Quality Assessment Questionnaire. After data extraction a narrative synthesis was performed. We defined patient-relevant outcomes as our primary outcomes. We included six systematic reviews. The interventions included first contact, history taking and assessment, patient education, review of drug treatment, referrals to GPs and other health professionals, ordering further investigations and ongoing care. Two meta-analyses showed a relative risk reduction of mortality in favour of nurse-led care, whereby the reduction in one analysis was significant. The effect was highest in the group of more highly qualified nurse practitioners (RR 0.19), as opposed to nurse practitioners (RR 0.76) and registered nurses (RR 0.92). Two meta-analyses showed a relative risk reduction in hospital admissions and patient satisfaction. Whereas care conducted by physicians and registered nurses led to the same outcomes, care conducted by nurse practitioners led to better outcomes (RR 0.74). An analysis according to nursing group showed that patients were more satisfied with treatment by registered nurses (SMD 1.37) than with treatment conducted by nurse practitioners and more qualified nurse practitioners (SMD 0.17). In terms of patient-relevant outcomes, no differences were observed between physician-led care and nurse-led care in terms of physical function, quality of life and pain. Nurse-led care is probably as safe or safer than physician-led care in terms of mortality and hospital admissions. However, the impact of nursing staff training has not been sufficiently examined.

QOL-10. AN ASSESSMENT TOOL FOR MEASURING CAREGIVERS’ DEATH ANXIETY IN PRIMARY BRAIN TUMOR: A CONFIRMATORY FACTOR ANALYSIS

Abstract BACKGROUND Caregivers of patients with primary brain tumor describe significant emotional distress regarding their loved one’s impending trajectory and eventual mortality—a construct known as death anxiety. Our team adapted a pre-existing, validated scale for patients with advanced cancer (the Death and Dying Distress Scale; DADDS) to measure this latent variable in caregivers of patients with primary brain tumors. Our adapted scale (DADDS-CG) demonstrated preliminarily strong internal consistency and construct validity. We now seek to confirm the factor structure, internal consistency, and convergent validity of the DADDS-CG in a second sample of neuro-oncology caregivers in accordance with best practices of measure development. METHODS Caregivers of those with primary brain tumors (N=221) completed an online battery of self-report questionnaires, including the 15-item Death and Dying Distress Scale-Caregiving (DADDS-CG), the Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaire (PHQ-9). To verify the two-factor structure of the DADDS-CG, we used confirmatory factor analysis. Cronbach’s alpha measured internal consistency, Pearson correlations assessed convergent validity, and descriptive statistics determined the prevalence of death anxiety. RESULTS Caregivers (Mage=46.2) were primarily White (85.5%) female (72.4%) spouses (75.6%). The two-factor model demonstrated adequate fit (X2/df=4.24; CFI-.89; NFI=.87; RMSEA=.06), suggesting two correlated subscales of death anxiety: Finitude and Dying (r=.80). The DADDS-CG demonstrated strong internal consistency (a=.95) and was moderately correlated with the GAD-7 (r=.73) and PHQ-9 (r=.68), suggesting adequate convergent validity. Mean scores fell within the moderate range (M=40.5, SD=18.7), with 20.8%, 36.2%, and 43.0% of caregivers reporting low, moderate, and severe death anxiety, respectively. CONCLUSION The DADDS-CG is a valid and reliable assessment tool for measuring death anxiety in caregivers of those with primary brain tumors. Given the high prevalence of death anxiety, future investigations are needed to understand caregiver’s death anxiety throughout the disease trajectory and to inform intervention development for neuro-oncology caregivers.

Functional Food Potential of Chrysanthemum morifolium, Perilla frutescens, and Sophora japonica in Managing Hyperuricemia through Dual Enzyme Inhibition.

Amid growing concerns regarding gout and hyperuricemia associated with high-protein and purine-rich diets, the need for effective prevention and management strategies with minimal side effects has become increasingly critical. This study evaluates the potential of three commonly consumed plant-based functional foods, Chrysanthemum morifolium, Perilla frutescens, and Sophora japonica, inhibiting xanthine oxidase (XO) and adenosine deaminase (ADA), key enzymes in uric acid metabolism. Results from hyperuricemia model mice indicate that this blend significantly reduces serum uric acid levels, mirroring the efficacy of conventional prevention and management strategies such as allopurinol but with fewer adverse effects. Liquid chromatography-mass spectrometry (LC-MS) analysis confirms that flavonoids are the primary bioactive agents, exhibiting a strong affinity for XO. These findings highlight the viability of integrating plant-based functional foods into comprehensive gout management strategies, underscoring their role in enhancing patient health through dietary innovation.

Mindfulness buffers the association of pain with depression and anxiety among people with spinal cord injury: A cross-sectional study.

Chronic pain is common among people with spinal cord injury (PwSCI) and impacts mental health (MH). Mindfulness may buffer the association of pain with MH, but few studies have examined this among PwSCI. This study examines the extent to which mindfulness moderates the association of pain intensity with MH among PwSCI. PwSCI (N = 64) and chronic pain provided demographic and disability information, ratings of pain intensity (0-10 Numeric Rating Scale), pain interference, depression (eight-item Patient Health Questionnaire [PHQ-8]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), positive affect/wellbeing (SCI-QOL Positive Affect and Well-Being Short Form [PAWB-SF]), stress (Perceived Stress Scale-4 [PSS-4]), and mindfulness (15-item Five Facet Mindfulness Questionnaire [FFMQ-15]) at the time of their enrollment in a randomized controlled trial of a mindfulness intervention. The present, cross-sectional study used baseline data. Pain intensity, pain interference, mindfulness (FFMQ-15), the Pain Intensity × FFMQ-15 interaction, and relevant covariates were regressed on the four outcome measures (PHQ-8, GAD-7, PAWB-SF, and PSS-4). There was a significant Pain Intensity × FFMQ-15 interaction effect on PHQ-8 (p = .008) and GAD-7 (p = .021), such that mindfulness buffered the positive relation of pain intensity with depression and anxiety. Additionally, there was a significant Pain Intensity × FFMQ-15 interaction effect on PAWB-SF (p = .032), but contrary to the hypothesis, mindfulness intensified a positive relation between pain intensity and positive affect/well-being. Dispositional mindfulness may buffer the association of pain intensity with depression and anxiety. Examining interventions to enhance mindfulness among PwSCI is warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors Associated With Motivation to Reduce Alcohol Use Among Patients With Chronic Liver Disease.

Alcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking. Participants (N = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety-net hospital (SN, N = 54) and two Veterans Affairs Healthcare Systems (VA, N = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Alcohol Use Disorders Identification Test (AUDIT), COVID-19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1-10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre-specified variables' associations with importance and confidence. The sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1-Q3) AUDIT score was 16 (12-24), importance was 9 (6-10) and confidence was 8 (5-9). On multivariable analysis, VA site (vs. SN) participants had a 0.97-point lower importance score (p = 0.02); higher symptoms of depression (PHQ-8 score ≥ 10 vs. < 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, p < 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes. Depression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology-based interventions.

Grade prediction of lesions in cerebral white matter using a convolutional neural network.

We established a diagnostic method for cerebral white matter lesions using MRI images and examined the relationship between the MRI images and the medical checkup data. There were approximately 25 MRI images for each patient's head, from the top of the head to near the eyes. To order these images, we defined the unit of axial for convenience. We varied conditions, such as the location and extent of the images to be loaded, into a convolutional neural network model and verified the changes in discrimination performance on the test data. Co-occurrence network diagrams were also used to determine the relationship between the grade of cerebral white matter lesions and the biochemical test items, which were treated as categorical variables, the progression of cerebral white matter lesions, and patient health status. The convolutional neural network showed the highest discrimination performance when the images were loaded into the model with 80 pixels per side, axial from 9 to 15, along with FLAIR and T1-weighted images. The area under the curve for each grade was 0.9814 for grade 0, 0.9800 for grade 1, 0.9905 for grade 2, 0.9977 for grade 3, and 0.9998 for grade 4. In the co-occurrence network diagram, patients with no or mild cerebral white matter lesions, such as grade 0 and grade 1, had near normal blood pressure, whereas grade 2 patients were closer to (isolated) systolic hypertension. This indicates that patients with higher-grade cerebral white matter lesions tend to experience more severe hypertension.

Big Data in Pharmacy: Transforming Patient Care with Analytics

The integration of big data analytics in pharmacy is revolutionizing patient care by providing insights that enhance medication management and therapeutic outcomes. By leveraging vast amounts of health data, pharmacists can deliver more personalized treatment and optimize drug therapy. Despite the potential benefits, existing methods in pharmacy often suffer from data silos, lack of interoperability, and insufficient analytical capabilities, leading to suboptimal patient outcomes and inefficient medication management. These limitations hinder the effective utilization of data for real-time decision-making in patient care. To address these challenges, it propose the Patient Care Transformation using Big Data Analytics (PCT-BDA) framework, which facilitates a holistic approach to patient data integration and analysis within smart grid systems. This framework enables seamless data flow between various healthcare entities, improving collaboration and fostering a comprehensive view of patient health profiles. The proposed method emphasizes real-time analytics, predictive modeling, and machine learning algorithms to enhance decision-making processes in medication management. By utilizing big data analytics, pharmacists can better predict patient responses, identify potential drug interactions, and tailor therapy plans to individual needs. Preliminary findings from the implementation of the PCT-BDA framework indicate significant improvements in patient outcomes, including reduced medication errors, enhanced adherence to treatment protocols, and overall increased satisfaction with pharmacy services. This innovative approach highlights the transformative potential of big data analytics in optimizing patient care in the pharmacy sector.

Secure Electronic Health Records Against Insider Attacks Using Blockchain

Patient health information is provided by Electronic Health Record (EHR) systems. The security, integrity, and management of electronic health records are critical issues. EHRs facilitate online data storage and lessen human labour by making data maintenance simple. Traditional EHRs are currently vulnerable to a variety of assaults, such as internet and insider transactions. Diverse fraudulent schemes attempt to manipulate data in order to profit from it globally. Usually, this entails manipulating or hacking the data to produce fictitious reports. This is primarily due to the fact that patients are unable to follow their records. Here, a unique framework utilising the blockchain concept in the healthcare industry has been introduced. Implementing Block Chain for electronic health records (EHR) is the main objective of this proposed study. The decentralised nature of Block Chain lessens the possibility of a single point of failure, resulting in a robust system. Together with addressing the extensibility issue that Block Chain shares, the proposed approach makes use of an off-chain data source. The findings show that, as compared to the conventional health record system, computers is far more safe and scam-free. Lastly, the suggested method offers situations, like in EHR, where the given method ought to work well.

Association between triglyceride glucose-body mass index and depression among US adults: A cross-sectional study

ObjectivesThe triglyceride glucose-body mass index (TyG-BMI) is a well-established surrogate marker for insulin resistance. While an association between insulin resistance and depression has been identified, that between TyG-BMI and depression remains unclear. Therefore, we used data from the National Health and Nutrition Examination Survey (NHANES) database to investigate this. Study designThis cross-sectional study included 9673 adults (aged ≥20 years) from the NHANES in the United States from 2011 to 2020. MethodsDepressive symptoms were assessed using a nine-item version of the Patient Health Questionnaire. The covariates included age, sex, race/ethnicity, marital status, educational level, poverty-income ratio, smoking status, alcohol intake, diabetes status, cardiovascular disease, hypertension, physical activity, high-density lipoprotein, low-density lipoprotein, and total cholesterol. Multivariate logistic regression models, subgroup analyses, and threshold saturation effect analyses were conducted. ResultsAfter adjusting for age, sex, race/ethnicity, marital status, education level, poverty-income ratio, smoking status, drinking status, diabetes status, cardiovascular disease, hypertension, physical activity, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, the threshold saturation effect showed a TyG-BMI inflection point of 174.4. Below the inflection point, a 10-unit increase in TyG-BMI was associated with a 12 % lower prevalence of depression. Above the inflection point, each 10-unit increase in TyG-BMI was associated with a 4 % increase in prevalence of depression. ConclusionsTyG-BMI had a U-shaped relationship with prevalence of depression. There was a significant link between higher TyG-BMI levels and increased prevalence of depression. When the TyG-BMI value was below 174.4, any further increase in TyG-BMI was associated with a significantly lower prevalence of depression.

Depression among Saudi international university students and its associated risk factors

IntroductionDepression disorders are one of the most widespread mental disorders among college students. In university students, depression has been associated with lower academic performance, worse work performance, and increased dropout risk. his study aims to assess the prevalence of depression and highlight risk factors among Saudi international university students (IUS) in the United States (US), the United Kingdom (UK), and Australia.Subject and methodsThis cross-sectional study was conducted among Saudi students who chose to study abroad. A self-administered online questionnaire was sent to the students using an online survey. The questionnaire includes socio-demographic data (e.g., age, gender, specialty, etc.), medical characteristics, social status, and the Patient Health Questionnaire (PHQ-8) to assess the student's depression.ResultsOf the 401 students, 52.4% were younger (age 18 – 25 years), and more than half were males (53.9%). Most of the participants were studying in the US (46.6%), followed by the UK (40.6%) and Australia (12.7%). The rate of major depression among Saudi students studying abroad was 40.4%. In univariate analysis, major depression was influenced by age, marital status, specialty, personal and family history of mental illness, contact with family and friends, and feeling like a stranger. However, after conducting multivariate regression analysis, previous diagnoses of mental illness and feeling a stranger were identified as the significant independent risk factors for major depression.ConclusionThis study provides insights into the prevalence and risk factors associated with depression among Saudi IUS. The prevalence of major depression among Saudi IUS was 40.4%. Previous history of mental illness and feeling like strangers were identified as the most prominent risk factors in this study. Identifying the prevalence and contributing factors of depression can guide academic institutions and governments in the development of effective interventions and support for IUS’s mental well-being. Future research could diversify the sample and employ longitudinal designs.

Implementing Adaptive Neuro-Fuzzy Inference Systems (ANFIS) for Risk Assessment of Drug Interactions

Novel drug development is time-consuming, difficult, and often unsuccessful. This has made combining therapies increasingly common and profitable in recent years. Healthcare professionals in the pharmaceutical sector are interested in the combination, but we must instantly solve drug-drug interactions. In few cases, single-perspective DDI evaluations are insufficient. Pharmacological therapy and patient safety depend on accurate drug interaction risk assessments. This work uses an Adaptive Neuro-Fuzzy Inference System (ANFIS) to assess and predict medication interaction hazards. The proposed method uses neural networks' generative skills and fuzzy logic to construct a robust decision-making framework that can handle drug interaction scenarios and their unpredictability. Fuzzy rules provide all the necessary risk assessment components. This includes dose, patient health issues, drug interaction profiles, and pharmacological properties. Accuracy, specificity, and Mean Squared Error evaluate the model after training with known drug interactions. These metrics evaluate model performance. These measures are essential for machine learning evaluation. The ANFIS-based model outperforms previous risk assessment methods in risk classification and prediction. This study found that the ANFIS architecture may improve medication management security and prevent dangerous drug interactions.

QOL-06. OPTIMIZING NEUROFIBROMATOSIS CARE: A COMPREHENSIVE ECONOMIC EVALUATION OF A SPECIALIZED EXPERTISE CENTER’S IMPACT ON PATIENT OUTCOMES

Abstract Neurofibromatosis type 1 (NF1), NF2-related schwannomatosis (NF2) and other schwannomatoses represent a spectrum of genetic disorders characterized by the development of tumors on nerve tissues, profoundly impacting patients’ quality of life and posing complex challenges. Recognizing the imperative for comprehensive care delivery, we undertook to implement a Neurofibromatosis Expertise Center (CE) at the Centre hospitalier de l’Université de Montréal (CHUM), Quebec, Canada. Employing a robust analysis framework, we aimed to assess the economic viability of the CE by quantifying the Quality-Adjusted Life Years (QALYs) gained through centralized multidisciplinary neurofibromatosis care (cost-utility ratio = CAD/QALY gained). Leveraging data from validated questionnaires including the SF-6D, our preliminary analysis revealed significant enhancements in patients’ quality of life across diverse domains, including physical pain, visible cutaneous lesions, cognitive dysfunction, hearing loss, malignancies, psychiatric comorbidities, unemployment, physical disability, and social isolation. Notably, among the respondents (N = 115), patients receiving CE services reported a 12% increase in general health compared to a 25% decline among those without CE services. Moreover, 28% of CE patients reported improved overall health compared to 12% of those without CE services. Using the Work Productivity and Activity Impairment questionnaire (WPAI-GH), we found that cohorts followed in CE for ≥ 1 year (N = 45) experienced less work productivity losses compared to the most recent cohort (N = 32), which presented scores exceeding 6 on a 1-to-10 scale. We hypothesize that the establishment of the CE will yield profound improvements in patient health outcomes and alleviate financial strains on the Ministère de la Santé et des Services Sociaux du Québec (MSSS). Therefore, our next steps include discussing a strategy for funding application to the MSSS to ensure the accessibility of necessary care for patients. Continuing data collection and analysis will also provide a more comprehensive overview of patient characteristics and needs.

Experiences and psychological issues affecting parents of children born with atypical genitalia in India.

Parents of children with differences of sex development (DSD) are known to suffer from psychological distress at the time of diagnosis and thereafter. We analyzed the prevalence of anxiety and depression in Indian parents of children with DSD and its associated risk factors, as well as their experiences, perceptions and expectations from the healthcare system. This cross-sectional study included parents of children aged ≤6 years with atypical genitalia. Data was collected through face-to-face semi-structured interview using specially designed questionnaire. Depression and anxiety have been assessed using PHQ9 (Patient health questionnaire) and GAD-7 (Generalized anxiety disorder scale), respectively. The current mean age of the 43 children (46,XY=26, 46,XX=16 and chromosomal DSD=1) was 36.5±21.4months with a median age of diagnosis of 5months (range- 0-60months). 68 parents (35 mothers and 33 fathers) were interviewed. The score was above the cut-off for clinically significant depression in 27.2 and 25.7 % of the fathers and mothers, respectively; and for clinically significant anxiety in 15.1 and 28.6 % of the fathers and mothers, respectively. The most significant factor associated with psychological distress was rearing a boy with lower EMS in fathers and lower literacy levels (with higher perception of stigma) in mothers. Absence of family support was associated with high levels of distress in both parents. There is a high level of depression and anxiety amongst Indian parents of children born with atypical genitalia and requirement for psychological support and counseling.

Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modelling Approaches for Individualized Treatment: La stratification des soins pour l'orientation vers une thérapie cognitivo-comportementale: une évaluation comparative des approches de modélisation prédictive pour un traitement individualisé.

In response to high demand and prolonged wait times for cognitive behavioural therapy (CBT) in Ontario, Canada, we developed predictive models to stratify patients into high- or low-intensity treatment, aiming to optimize limited healthcare resources. Using client records (n = 953) from Ontario Shores Centre for Mental Health Sciences (January 2017-2021), we estimated four binary outcome models to assign patients into complex and standard cases based on the probability of reliable improvement in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. We evaluated two choices of cut-offs for patient complexity assignment: models at an ROC (receiver operating characteristic)-derived cut-off and a 0.5 probability cut-off. Final model effectiveness was assessed by assigning treatment intensity (high-intensity or low-intensity CBT) based on the combined performance of both GAD-7 and PHQ-9 models. We compared the treatment assignment recommendations provided by the models to those assigned by clinical assessors. The predictive models demonstrated higher accuracy in selecting treatment modality compared to provider-assigned treatment selection. The ROC cut-off achieved the highest prediction accuracy of case complexity (0.749). The predictive models exhibited large sensitivity and specificity trade-offs (which influence the rates of patient assignment to high-intensity CBT) despite having similar accuracy statistics (ROC cut-off = 0.749, 0.5 cut-off = 0.690), emphasizing the impact of cut-off choices when implementing predictive models. Overall, our findings suggest that the predictive model has the potential to improve the allocation of CBT services by shifting incoming clients with milder symptoms of depression to low-intensity CBT, with those at highest risk of not improving beginning in high-intensity CBT. We have demonstrated that models can have significant sensitivity and specificity trade-offs depending on the chosen acceptable threshold for the model to make positive predictions of case complexity. Further research could assess the use of the predictive model in real-world clinical settings.

A Chinese conundrum: Does higher insurance coverage for hospitalisation reduce financial protection for the patients who most need it?

This paper evaluates the relationship between the degree of cost-sharing and the utilization of outpatient and inpatient health services in China. Using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), we estimated the association between outpatient and inpatient service utilization and cost-sharing levels associated with outpatient and inpatient services, as well as a comparative metric that quantifies the relative cost-sharing burden between the two. We found that patients in areas with higher levels of cost-sharing for outpatient services exhibit a lower propensity to use outpatient care and a higher inclination to utilize costly hospitalisation services. Conversely, as the ratio of cost-sharing for outpatient services to that for inpatient services increases, the likelihood of patients forgoing doctor-initiated hospitalisation correspondingly increases. This suggests that when cost-sharing for outpatient care rises relative to inpatient care, observed increases in inpatient care utilization reflect an escalation in moral hazard rather than a correction for the underutilization of inpatient services. We conclude that both substitution and complementary roles exist between outpatient and inpatient services. Our findings suggest that a more effective design of cost-sharing is needed to enhance the equity and efficiency of China's health system.

Mental health and lifestyle-related behaviors in medical students in a Jordanian University, and variations by clerkship status

BackgroundThe rigors of medical education often take a toll on students' mental well-being, resulting in heightened stress, anxiety, depression, somatization, and thoughts of self-harm. This study aimed to determine the prevalence of mental health problems among Jordanian medical students (Yarmouk University), explore the links between mental state and demographic and lifestyle factors, and compare mental health profiles between pre-clinical/pre-clerkship (years 1–3) and clinical/clerkship (years 4–6) students.MethodsAn online survey was distributed to undergraduate medical students at Yarmouk University. Mental health was measured using validated tools (depression: Patient Health Questionnaire, PHQ-9; eating disorders: SCOFF; Generalized Anxiety Disorder Scale, GAD-7; Somatic Symptoms: Patient Health Questionnaire, PHQ-15; overall stress (single-item measure); ability to handle stress; stressors and coping mechanisms. Data on sociodemographic factors, academic performance, and lifestyle choices, also were collected. Bivariate and multivariable analyses evaluated the associations between academic level and mental health, accounting for sociodemographic and lifestyle factors.ResultsOf the 618 medical students who responded, 48.4% screened positive for depression, 36.7% for anxiety, and 63.6% for high level of stress. Slightly over half experienced somatic symptoms, and 28.6% exhibited signs of eating disorders. Roughly, 26% had suicidal thoughts, as measured by item 9 of the PHQ-9 scale. Low reported rates of healthy behaviors were observed (e.g. balanced diets, 5.7%; vigorous physical activity, 17.0%). Smoking prevalence was 24.6%, notably higher among clinical students. At the multivariable level, stress, insomnia, eating disorders and cigarette smoking were significantly associated with depression, anxiety and somatization. Higher physical activity scores were associated with lower depression risk. Females were significantly more likely than males to fall in more severe somatization categories.ConclusionThis study highlights the need to address the alarming rates of mental health problems among Jordanian medical students. While few significant differences were observed between pre-clinical and clinical students, the high rates of depression, anxiety, stress, and negative health practices in both groups suggest the need for interventions that begin at enrollment as well as during transitions to clinical settings. Prioritizing mental health support and promoting healthier lifestyles among medical students are vital steps toward nurturing resilient, well-rounded future medical professionals.

Nutritional disorders and nutrition-related conditions: an underestimated clinical problem in systemic sclerosis

Nutritional disorders are significant but often underestimated complications in patients with systemic sclerosis (SSc). The most prevalent nutritional disorders in SSc are malnutrition, affecting up to 62.5% of patients, and sarcopenia, with a frequency of up to 42%. Thus, clinical vigilance is recommended for the detection of eating disorders in SSc patients, particularly those with gastrointestinal involvement, cardiopulmonary complications, an advanced disease stage, and high disease activity. Nutritional treatment should be carefully tailored to the patients’ clinical condition to ensure that it effectively addresses their specific needs. Studies focusing on enteral nutrition in SSc patients demonstrate its effectiveness in stabilizing or improving nutritional status in malnourished patients. In severe cases, parenteral nutrition offers viable options to support patient health. The findings highlight the importance of early nutritional assessment and intervention in improving patient outcomes and suggest that individualized nutritional therapy can be a critical component of comprehensive care for SSc patients.