Psychosocial Factors Research Articles

Factors Influencing Outcome After Shoulder Arthroplasty (FINOSA Study): Protocol of a Prospective Longitudinal Study With Randomized Group Allocation

Background There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. Objective This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. Methods To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Results Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Conclusions Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. Trial Registration ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267 International Registered Report Identifier (IRRID) DERR1-10.2196/56522

Adrenal Crisis and Adrenal Insufficiency Admissions in Patients 30-59 Years: Contribution of Psychosocial Factors.

Adrenal crises (AC) occur in middle aged adults with adrenal insufficiency (AI). Psychosocial difficulties may impede effective self-management in some cases. This study aimed to investigate associations between psychosocial problems and hospital admissions for AI/AC in middle aged adults. Data on all hospitalisations among patients aged 30-59 years with a diagnosis of AI were extracted from a regional database for the years 2005-2020. Trends in hospitalisations and associations between admissions and comorbid psychosocial problems were assessed. Of the 3948 admissions for AI between 2005 and 2020, 63.4% were in women. Admissions increased by 91.4%, from 61.89 to 118.44/million (p < 0.0001), while AC admission rates increased by 176.5% (from 7.71 to 21.33/million, p=NS). Secondary AI (SAI) admissions rose by 133.0%, from 27.98/million to 65.20/million (p < 0.001). Admissions increased in women in each decade but only in males aged 50-59 years. Comorbid infection was identified in 28.1% of admissions and at least one comorbid contributory psychological problem was found in 25.6%. Males, patients with SAI and those not living in a domestic partnership had a higher combined psychosocial problem burden. Females admitted with at least one sign of an AC had significantly higher psychosocial problem scores than those with less severe presentations. These results suggest that psychosocial factors may play a role in some admissions for AI/AC in adults aged between 30 and 59 years, possibly contributing to the otherwise unexplained rise in hospitalisations for AI.

Determinants of health-related quality of life of patients with focal epilepsy: A systematic literature review.

Focal epilepsy can have significant negative impacts on a person's health-related quality of life (HRQoL). Although studies have been published on HRQoL in persons with focal epilepsy (PWFE), determinants of HRQoL have not been comprehensively examined. This systematic literature review (SLR) queried existing literature to identify aspects associated with HRQoL in PWFE without focus on resective epilepsy surgery, with an interest in identifying modifiable determinants for medical/nonmedical interventions. This SLR was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted in PubMed and Google Scholar for articles published from January 1, 1900, to February 19, 2023, reporting on the association between HRQoL or employability and a range of demographic, psychosocial, or epilepsy-related factors and comorbidities in PWFE. A total of 879 abstracts were identified, with 126 manuscripts reviewed and 37 studies selected for inclusion that quantified the relationship between HRQoL and the variable of interest by multivariate (N = 21) or univariate only (N = 15) methods; 10 multivariate models also included univariate data. In adjusted models, the most commonly examined determinants of HRQoL included depression (n = 15/21), number of antiseizure medications (ASMs; n = 13/21), seizure frequency (continuous seizure count, n = 11/21; seizure freedom, n = 5/21), anxiety (n = 10/21), duration of disease (n = 9/21), and cognition (n = 9/21). Depression, anxiety, and cognition were frequently seen as significant contributors to HRQoL when studied (14/15 [93%], 9/10 [90%], and 7/9 [78%], respectively). Among concepts studied less frequently, ASM severity/adverse event burden was significant each time examined (in 5/19 studies). Attainment of seizure freedom and employability was significant 75% (n = 3/4) and 72% (n = 5/7) of the time, respectively. Poor HRQoL in PWFE can be attributed to a multitude of factors, including depression, anxiety, factors in disease management, and employability. An unmet need remains in addressing elements associated with poor HRQoL in this population.

WOUND MANAGEMENT, HEALING, AND EARLY PROSTHETIC REHABILITATION: PART 1 - A SCOPING REVIEW OF HEALING AND NON-HEALING DEFINITIONS

BACKGROUND: Following lower limb amputation, timely prosthetic fitting enhances mobility and quality of life. However, inconsistent definitions of surgical site healing complicate prosthesis readiness assessment and highlight the need for objective wound management measures. OBJECTIVE: This review aimed to compile definitions of healing and non-healing provided in the literature investigating biomarkers of healing of the tissues and structures found in the residual limbs of adults with amputation. METHODOLOGY: A scoping review was conducted following JBI and PRISMA-ScR guidance. Searches using “biomarkers,” “wound healing,” and “amputation” were performed on May 6, 2023, on Web of Science, Ovid MEDLINE, Ovid Embase, Scopus, Cochrane, PubMed, and CINAHL databases. Inclusion criteria were: 1) References to biomarkers and healing; 2) Residuum tissue healing; 3) Clear methodology with ethical approval; 4) Published from 2017 onwards. Articles were assessed for quality (QualSyst tool) and evidence level (JBI system). FINDINGS: Of 3,306 articles screened, 219 met the inclusion criteria and are reviewed in this article, with 77% rated strong quality. 43% of all included sources did not define healing, while the remainder used specific criteria including epithelialization (14%), wound size reduction (28%), gradings scales (3%), scarring (1%), absence of wound complications (2%), hydroxyproline levels (0.5%), no amputation (0.5%), or neovascularization (0.5%). 84% of included sources did not provide definitions of non-healing. Studies defining non-healing used criteria like wound complications (4%), the need for operative interventions (4%), or lack of wound size reduction (1%). For 10% of included sources, healing and non-healing definitions were considered not applicable given the research content. Total percentages exceed 100% for both healing and non-healing definitions because some sources used two definition classifications, such as epithelialization and wound size reduction. The findings indicate a lack of standardized definitions irrespective of study type. CONCLUSION: This review reveals significant gaps in current definitions of healing and non-healing, often based on superficial assessments that overlook deeper tissue healing and mechanical properties essential for prosthesis use. It emphasizes the need for comprehensive definitions incorporating biomarkers and psychosocial factors to improve wound management and post-amputation recovery. Layman's Abstract After a lower limb amputation, early prosthetic fitting can significantly improve quality of life. However, different definitions of surgical site healing make deciding when a prosthetic can be used difficult. This scoping review collected and compared definitions of healing and non-healing found in research about biological markers (biomarkers) that are used for tracking residual limb healing. On May 6, 2023, searches were conducted using terms like “biomarkers,” “wound healing,” and “amputation” across several databases. Studies were included if they discussed biomarkers, focused on residual limb healing, had clear methods and ethical approval, and were published during or after 2017. Of 3,306 articles screened, 219 met the criteria, with 77% rated as high quality. 43% of the included sources did not define healing. Definitions provided included new skin growth (14%), reduction in wound size (28%), grading scales (3%), scarring (1%), no complications (2%), hydroxyproline levels (0.5%), no need for amputation (0.5%), or new blood vessel formation (0.5%). 84% of sources did not define non-healing, with the remainder based on healing complications (4%), the need for more surgery (4%), or no reduction in wound size (1%). In 10% of included sources healing and non-healing definitions were considered not relevant to their research. Total percentages for healing and non-healing definitions exceeds 100% because some sources used two definitions, for example, new skin growth and reduction in wound size. Overall, the review shows gaps in definitions, many of which are too basic and ignore deeper tissue healing and factors needed for prosthetic use. More thorough definitions that include the physical, mental, and social sides of healing are needed to improve recovery. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43715/33312 How To Cite: Williams-Reid H, Johannesson A, Buis A. Wound management, healing, and early prosthetic rehabilitation: Part 1 - A scoping review of healing and non-healing definitions. Canadian Prosthetics &amp; Orthotics Journal. 2024; Volume 7, Issue 2, No.1. https://doi.org/10.33137/cpoj.v7i2.43715 Corresponding Author: Professor Arjan Buis, PhDDepartment of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland.E-Mail: arjan.buis@strath.ac.ukORCID ID: https://orcid.org/0000-0003-3947-293X

The prevalence of traumatic exposure in women with premenstrual dysphoric disorder (PMDD): a systematic review.

Premenstrual dysphoric disorder (PMDD) is a debilitating illness that affects 3-8% of women worldwide. There are multiple factors underlying the aetiology of PMDD, ranging from neuroendocrine changes to psychosocial factors such as exposure to trauma. This systematic review aims to assess the prevalence of traumatic exposure in women with PMDD. A literature search of MEDLINE, EMBASE and PsycInfo was conducted following PRISMA guidelines. Of the 369 studies identified for abstract and full-text screening, 27 were included for review and 16 studies for the quantitative calculation of average prevalence and 95% confidence intervals. Data extracted included study details, sampling details, demographic details, type of traumatic exposure reported, diagnostic tools used, the prevalence of PMDD (total) and the prevalence of self-reported traumatic exposure in PMDD patients. The reported prevalence of traumatic exposure in PMDD ranged from 18.03 to 90.5%. Using a random effects model, the pooled prevalence was 61% (95%CI, 46-74%). The level of heterogeneity (I2) was 95%, showing considerable variability in the data. Amongst only those studies with a control group, it was shown that those with PMDD are 1.99 times more likely to have a history of traumatic exposure than those without PMDD. Our findings suggest that a history of traumatic exposure is highly represented in women living with PMDD. Trauma exposure may be a risk factor for PMDD and could inform this condition's aetiology. A trauma-informed approach should be considered when assessing and managing women presenting with PMDD.

Chronic Low Back Pain Post-Caesarean Delivery: A Physiotherapist’s Perspective

This short review investigated the connection between neuraxial anaesthesia and chronic low back pain (CLBP) following caesarean sections, highlighting an important area of concern as the prevalence of such surgeries increases. Several risk factors for developing CLBP were identified, including needle size and patient posture during the procedure. Emphasis was placed on the crucial role of physiotherapists in distinguishing between pregnancy-related back pain and pain resulting from anaesthesia, as well as monitoring postoperative symptoms. Effective physiotherapy interventions were discussed, focusing on improving posture, enhancing mobility, and addressing psychosocial factors that may impact recovery. By advocating for a multidisciplinary approach, the review highlighted the necessity for comprehensive strategies that consider both physical and psychological aspects of recovery, ultimately aiming to optimise outcomes for women after caesarean delivery. Keywords: Chronic low back pain, Neuraxial anaesthesia, Caesarean section, Physiotherapy interventions, Risk factors, Multidisciplinary approach

Novel Techniques to Manage Temporomandibular Disorders – A Multidisciplinary Approach

ABSTRACT Temporomandibular joint is a compound, bilateral, ginglymoarthroidal joint articulating the condyle to temporal glenoid fossa. TMDs often project a constellation of signs and symptoms. Therefore, the treatment plan for TMD’s should be more holistic. Current literature supports the interrelationship between chronic pain and behavioral, psychological, and psychosocial factors. This review elicits various treatment strategies for TMD’s and emphasizes combination of various therapies in resolution of pain and discomfort in patients with such disorders.

Evaluation of Maternal Factors Affecting Postpartum Insulin Resistance Markers in Mothers with Gestational Diabetes—A Case–Control Study

Background: Gestational diabetes mellitus (GDM) is defined by an insufficient insulin response to counteract the insulin resistance (IR) that arises from the physiological adaptations associated with pregnancy. However, the pathophysiology of IR is complex and unclear, as it encompasses elements such as epigenetics, environmental factors, modifiable lifestyle factors, and psychosocial factors. Aim: The objective of this study was to evaluate the influence of GDM and other maternal factors on IR markers in comparison to mothers with normal glucose tolerance during pregnancy in the first week postpartum. Material and Methods: The study population comprised 70 participants, including mothers with gestational diabetes who were treated with a diet and physical activity (GDM G1), with insulin (GDM G2), and a control group of healthy mothers without gestational diabetes (non-GDM). A series of statistical techniques were employed to facilitate the comparison of data between the study groups, with the objective of identifying potential associations with maternal factors. A taxonomic analysis was conducted using the following factors: classification by study group, a history of hypothyroidism in the maternal medical interview, and maternal gestational weight gain, which were identified as the best-fitting predictors. Results: The analysis resulted in the identification of four clusters of patients. Comparison of the insulin resistance markers between mothers assigned to the abovementioned clusters showed differences in the incidence of excessive weight loss and in the results of glucose screening tests during pregnancy. Also, differences concerning fasting glucose levels in the first and second/third trimesters of pregnancy and glucose levels at 1 h post-OGTT were found. For the clusters, the results of the HOMA-IR and the QUICKI did not show any differences in the first week after delivery (p &gt; 0.05). HbA1c results varied significantly. Conclusions: Degree of glucose metabolism disorders, hypothyroidism, and weight gain in pregnancy influence maternal insulin resistance markers in the first week postpartum. Additionally, gestational weight fluctuation has a significant influence on the outcome of pregnancy, particularly with regard to fetal growth and, consequently, the infant’s birth weight and adipose tissue accumulation.

Trajectories of work ability and associated work unit characteristics from pre-COVID to post-COVID pandemic period

ObjectivesTo identify trajectories of work ability from pre-COVID to post-COVID-19 pandemic period and to examine work unit characteristics associated with these trajectories.MethodsThe study population was a cohort of Finnish public sector employees (n=54 651) followed from 2016 until 2022. We used trajectory analysis to identify trajectories of work ability and multinomial regression to examine their associations with prepandemic work unit characteristics and pandemic-related changes at workplaces.ResultsWe identified three trajectories of work ability: (1) suboptimal work ability decreasing over time (12%); (2) relatively consistent good work ability (73%) and (3) consistent optimal work ability (15%). The strongest associations with belonging to the suboptimal work ability trajectory were found for employees in work units characterised by high job strain (OR 2.29, 95% CI 1.82 to 2.88), poor team climate (OR 0.74, 95% CI 0.64 to 0.86) and low organisational justice (OR 0.64, 95% CI 0.57 to 0.72) when compared with the most optimal trajectory. The least favourable work ability trajectory was also associated with team reorganisation (OR 1.22, 95% CI 1.04 to 1.44) and a low share of those working from home (OR 0.86, 95% CI 0.78 to 0.94) during the pandemic.ConclusionPrepandemic psychosocial risk factors and pandemic-induced changes at work were associated with poor and declining work ability during the COVID-19 pandemic. Employers and occupational health services should better identify and support vulnerable employees to enhance their work participation.

Mental Health Risk and Protection Among First-Generation Latinx Immigrant Youth: A Latent Profile Analysis.

First-generation Latinx immigrant youth from the Northern Triangle (NT; El Salvador, Guatemala, and Honduras) face unique risks for experiencing stressors across the phases of migration, which could exacerbate their mental health. This study aimed to (a) identify and characterize unique latent profile groups based on response patterns to immigrant minority stress and psychosocial protective factor items and (b) examine the associations of latent profile membership with depression and anxiety symptoms among NT immigrant youth, controlling for study covariates (i.e., postmigration victimization and forced immigration-related family separation). Primary surveys assessing immigrant minority stress and psychosocial protective factors (i.e., ethnic identity importance, and family, peer, and school support) were administered (N = 172, age range = 14-21, 63% female). Latent profile analysis (Aim 1) and multiple linear regression (Aim 2) were conducted to examine the study aims. A three latent profile model was identified: (a) moderate immigrant minority stress and low psychosocial protection (weak resources), (b) moderate immigrant minority stress and moderate psychosocial protection (average resources), and (c) low immigrant minority stress and high psychosocial protection (strong resources) during postmigration. Multiple linear regression demonstrated that latent profile membership was significantly associated with mental health. Protective associations with mental health were consistently present among the strong resources group. Detrimental associations with mental health were consistently present among the weak resources group. The average resources group demonstrated both protective and detrimental associations with mental health. Postmigration victimization and forced immigration-related family separation covariates were significantly associated with mental health. Findings provide a foundation for further mental health prevention research with NT immigrant youth.

Exploring sex differences in the needs and priorities of people with lower limb amputations: An adaptation of the Prosthesis Evaluation Questionnaire

Background: Females with lower limb amputations have different risk factors and lower success with their prostheses overall. Studying priorities of this population, specifically in how they differ between sexes, through survey methods may improve understanding of female-specific needs and inform sex-specific prosthetic design. Objectives: To adapt the Prosthesis Evaluation Questionnaire and use this to assess sex differences in needs and priorities of people with lower limb amputations (pLLAs). Study design: Cross-sectional questionnaire study. Methods: A committee was formed to modify the Prosthesis Evaluation Questionnaire. The modified questionnaire was completed online by 26 pLLAs (13 females, 13 males). Sex differences in subscale and individual closed-question responses were analyzed using Mann-Whitney U tests. Sex differences in open-ended question responses were analyzed using affinity diagramming. Results: Significant sex differences were found in subscale scores and separate closed questions, with resulting qualitative themes further suggesting sex-specific priorities and perspectives. Females reported lower satisfaction with prosthetic appearance, poorer overall ambulation abilities, and greater perception of social burden than males. Sex differences were also found in themes related to prosthesis satisfaction and other psychosocial factors including social adjustment. Conclusions: Findings demonstrated all-encompassing sex differences in the priorities and needs of pLLAs. This work can be used to better understand and target female's unique priorities through sex-specific considerations in research and prosthetic design.

Abstract 4121672: Multi-level Factors Mediated the Associations Between Perceived Neighborhood Measures and Type 2 Diabetes: The Midlife in the United States III

Introduction: The determinants of type 2 diabetes (T2D) are multifaceted, encompassing individual, psychosocial, health, and neighborhood factors. While these factors have been explored, the mechanisms underlying perceived neighborhood measures and T2D remain understudied. We aimed to test whether psychosocial, health, and inflammatory factors mediate the association between perceived neighborhoods and T2D among adults. We hypothesized that these factors mediate the relationship between perceived neighborhoods and T2D. Methods: Data from the Midlife in the United States 3 (MIDUS3, 2013-2014; MUDIS3 Biomarker Project, 2017-2022) were used (n=564, mean age: 60.7y, female:53.2%, White adults:95.7%). Higher perceived neighborhood scores (social cohesion, safety, quality) represent favorable neighborhoods. T2D (y/n) was defined as either A1c≥6.5%, FGL≥126mg/dL or self-reported T2D. Physical activity (PA), BMI, depression, stress, and CRP were tested as mediators in the cross-sectional association between perceived neighborhood measures and T2D using linear regression (reported odds ratio [OR]) with bootstrap-generated 95% bias-correct confidence intervals (BC CIs) adjusted for covariates (Table). Results: Higher neighborhood social cohesion was indirectly related to lower odds of T2D by PA (OR: 0.93 [95%BC CI: 0.86, 0.98]), BMI (OR: 0.90 [0.80, 0.99]), depression (OR: 0.86 [0.75, 0.97]), stress (OR: 0.88 [0.78, 0.97]), and CRP (OR: 0.91 [0.82, 0.98]). Higher neighborhood safety was indirectly related to lower odds of T2D by depression (OR: 0.90 [0.79, 0.98]) and stress (OR: 0.89 [0.77, 0.97]). Higher neighborhood quality was indirectly related to lower odds of T2D by PA (OR: 0.90 [0.82, 0.98]), depression (OR: 0.82 [0.68, 0.96]), stress (OR: 0.83 [0.70, 0.96]), and CRP (OR: 0.88 [0.75, 0.98]). Conclusions: Favorable perception of neighborhoods had significant indirect associations with T2D via PA, BMI, depression, stress, and CRP. These mediators could be potential targets for intervention alongside promoting better neighborhoods to improve T2D outcomes. Future studies should replicate this line of research in diverse cohorts to address T2D disparities by socioeconomic status.

Abstract 4121589: Sex differences in Social Determinants of Health and Adverse Outcomes in Atrial Fibrillation: A UK Biobank Study

Background: Beyond the risk of thromboembolic stroke, people with atrial fibrillation (AF) are substantially burdened with a higher incidence of cardiovascular mortality, even among patients treated with anticoagulants. The reasons behind these outcomes are only partially understood. Social determinants of health (SDOH), strong independent predictors of major adverse cardiovascular events (MACE) in several cardiac diseases, may play a role; however, their impact on AF prognosis and the differences in SDOH by sex have been insufficiently explored. Objective: We investigated the sex differences in the association between SDOH and MACE in patients with AF. Methods: Data from the UK Biobank included participants enrolled from 2006 to 2010. An incident AF patient cohort, free of stroke and MI was created. Seventeen SDOH derived from three domains:: socio-economic status, psychosocial factors, and neighborhood/living environment were identified Cox proportional hazards models were used to evaluate the associations of individual SDOH components with the risk of MACE stratified by sex. Covariates including all variables of the CHA 2 DS 2 -VASc Score (Congestive heart failure, Hypertension, Age, Diabetes, prior stroke or transient ischemic attack, Vascular disease and Sex), current use of antiplatelet therapy or anticoagulation, smoking and body mass index. The primary outcome was a composite of MACE (including stroke, transient ischemic attack and arterial thromboembolic event, MI and cardiovascular mortality) and all-cause mortality. Results: A total of 23,113 participants with AF (mean age, 62.44 ± 5.88 years; female sex 39.7%) were included. The composite outcome occurred in 5,151 (22%) of participants over 10-year follow up. In the multivariate adjusted model, several SDOH were independently associated with an increased risk of adverse outcomes. Males showed a broader range of SDOH that were significantly associated with outcomes, including unfavourable economic factors and low social support. Despite females had fewer significant SDOH, education-related factors and local crime rates were significant predictors of adverse outcomes (Figure 1). Conclusions: Adverse SDOHs are associated with a higher risk of MACE and all-cause mortality in AF, with sex-specific variations. These findings underscore the need of incorporating routinely SDOH assessment into clinical practice to more accurately stratify risk and tailor preventive strategies based on sex-specific data.

Abstract 4115222: Distinct Demographic, Cognitive, and Psychosocial Factors Associated with Different Types of Self-Care in Patients with Type 1 Diabetes and in Patients with Type 2 Diabetes

Background: Poor self-care in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) leads to increased diabetes complications and health costs. While the goal of self-management for patients with T1DM and T2DM is to maintain normal blood glucose levels, the major methods for achieving this differ (exogenous insulin delivery vs. a combination of self-care techniques, respectively). This implies that factors associated with self-care in the two groups may differ. Hypothesis: Distinct demographic, cognitive, and psychosocial factors are associated with overall self-care, diet, exercise, blood glucose testing, foot care, and smoking in patients with T1DM and T2DM, in separate models. Methods: In this cross-sectional, correlational study, data were collected from 148 patients with T1DM (n = 64, mean age: 51.3 years) or T2DM (n = 84, mean age: 62.5) using REDCap during 2023. The participants were recruited from various organizations, institutions, and ResearchMatch in the United States. Several multiple regression analyses were done to test the hypothesis. Results: Patients with T1DM had better self-care, including overall diabetes self-care, exercise, and blood glucose testing than the T2DM group. Older age (p = .003), lower body mass index (BMI) (p = .040), and stronger knowledge (p = .028) in the T1DM group (F[10,53]= 2.290, p = .026, R 2 = .302), while lower BMI (p = .045) and higher levels of self-efficacy (p &lt; .001) in the T2DM group were associated with better overall diabetes self-care (F[10,73] = 3.219, p = .002, R 2 = .306). Older age, lower BMI, stronger knowledge, stronger resilience, and lower self-esteem were associated with better self-care in diet, blood glucose testing, and/or foot care in the T1DM group, while lower BMI, stronger knowledge, higher levels of self-efficacy, and less severe depressive symptoms were associated with better self-care in diet, exercise, and/or blood glucose testing in the T2DM group. None were associated with smoking in both groups. Diabetes distress, self-compassion, and social support were not associated with any types of self-care. Conclusions: Factors associated with self-care differed based on types of self-care and types of diabetes, thus, supporting the hypothesis. When healthcare providers provide interventions to improve diabetes self-care in individual patients with diabetes, they need to consider types of diabetes, types of self-care, and distinct factors associated with each type of self-care.

Post-traumatic Distress in Adults with Congenital Heart Disease: Protective Factors and Clinical Implications.

Due to various reasons explored in previous studies, adults with congenital heart disease (ACHD) are at risk of developing post-traumatic stress symptoms (PTSS). The aim of this study is to explore multiple potential psychosocial protective factors in ACHD and to understand their role in different complexities of congenital heart disease (CHD) and PTSS. This study was part of the "ABS-AHF" study, where 234 ACHD were recruited from November 2021 to August 2022 at a tertiary CHD care center. Data were collected on PTSS (PDS), resilience (RS-13), sense of coherence (SOC-L9), and social support (F-SozU K-14). The mean scores were 70.55 + / - 12.31 [21-91] for resilience, 35.83 + / - 4.81 [15-60] for sense of coherence (SOC), and 4.30 + / - 0.79 [0.93-5] for social support. SOC (OR, .91; p = .024 [.84; 9.98]) and social support (OR, .48; p = .001 [.29; 7.96]) were shown to reduce the likelihood of PTSS. Low resilience (OR, 2.40, p = .0248 [1.18; 5.18]) seems to increase this likelihood. Integrating parents and relatives early on seems to be an important protective resource. Parental support in childhood affects the development of SOC which is in line with social support related to lower PTSS. With regard to resilience and SOC, a brief and manageable screening option for personal resources is available to refer potentially vulnerable patients to specialized psychosocial care. Care offers should address coping styles and life with CHD. Offering multidisciplinary care, integrating the patient's social network, and education for patients to increase resilience and SOC might provide a way to enhance psychosocial outcomes, quality of life, and adherence in ACHD.

Traditional and Online Bullying Victimization Among School-going Adolescents: The Role of Sociodemographic Factors

Background: Bullying in school is a vital issue as researchers increasingly find that it can be detrimental to students’ well-being and academic excellence. From an ecological systems theory perspective, examining school bullying reveals that numerous psychosocial factors influence student behavior. Hence, the present study aims to investigate the role of sociodemographics—at the individual (age, gender), microsystem and mesosystem (grade level, school type), exosystem (region), macrosystem (socioeconomic status), and chronosystem (shift from traditional to virtual classroom during COVID-19) levels—in the victimization of traditional and online bullying. Methods: After obtaining ethical clearance, an online survey form was deployed to collect sociodemographic information and assess traditional and online bullying victimization among 120 school-going adolescents from the Southern regions of India. Results: A linear regression analysis showed age and region (urban and rural) predicting traditional and online victimization, respectively. Other sociodemographic factors of gender, school type, and grade level did not predict either victimization type. Conclusions: Sociodemographic factors play a significant role in the victimization experiences of students both in traditional and online.

Abstract 4147638: Food Security, Depression, and the Association of Depression with Adherence to Cardiovascular Disease Risk Reduction Measures among Rural Caregivers of Patients with Chronic Diseases

Introduction: Caregivers are at high risk of cardiovascular disease (CVD) and depression compared to non-caregivers. Food security has been suggested to be a risk factor for depression. Depression may be connected to poor self-care. Studies exploring food security, depression and its relationship to adherence to CVD risk reduction measures among rural caregivers are lacking. Aims: To determine: 1) the association between food security and depression in rural caregivers, and 2) the relationship between depression and caregiver burden, and reported adherence to recommended CVD risk reduction measures in rural caregivers of patients with chronic diseases. Method: In this cross-sectional study, 277 rural caregivers (mean age 54 ± 14 years; 76% were female; and 70% were married) provided self-reported data on their sociodemographic factors, food insecurity (US Household Food Security Survey Module), caregiver burden (Zarit Burden Interview), depression (Patient Health Questionnaire-9), and adherence to recommended CVD risk reduction measures (Medical Outcomes Study Specific Adherence Scale). Hierarchical regression analysis was performed. Results: In this study, food insecurity and high depressive symptoms were prevalent in 23% and 25% of rural caregivers, respectively. Food insecurity was associated with higher depressive symptoms ( β = 0.21; p &lt;.01), controlling for covariates. Caregivers who reported higher depressive symptoms had higher caregiver burden ( β = 0.49; p &lt;.01) and poor adherence to recommended CVD risk reduction measures ( β = 0.18; p &lt;.01) compared to those with low or no depressive symptoms, controlling for covariates. Conclusion: In rural caregivers, food insecurity was associated with higher depressive symptoms. Depressive symptoms were negatively associated with adherence to recommended CVD risk reduction behaviors. Greater attention should be given to food security and psychosocial factors to reduce CVD risk in this population.

Current Concepts of the Management of Painful Traumatic Peripheral Nerve Neuromas

Painful neuromas are a complex clinical condition that results in notable disability and functional impairment after injury to a peripheral nerve. When regenerating axons lack a distal target, they form a stump neuroma. Up to 60% of neuromas are painful because of mechanical sensitivity and crosstalk between nerve fibers. Clinical evaluation includes a thorough history and physical examination followed by directed diagnostic imaging and procedures to assess pain generators and their effect on quality of life. Nonsurgical management options may include pharmacological interventions, desensitization strategies, injections, and therapies to reduce pain perception and improve function. Surgical interventions, such as nerve reconstruction by direct repair or grafting, redirection to alternative targets, and containment of regenerating axons by relocation into innervated tissues or in grafts, are considered when conservative measures fail. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas. The plan should consider the underlying pathology, pain generators, and psychosocial factors contributing to the patient's pain.

Exploring Sex-Based Neuropsychological Outcomes in Pediatric Brain Cancer Survivors: A Pilot Study

Background: The increasing survival rates among pediatric cancer patients underscore the critical need to understand the long-term psychosocial impacts of cancer treatments, such as cisplatin and carboplatin. While these treatments are lifesaving, they may pose risks to neurodevelopmental processes. Despite the substantial body of research highlighting cognitive impairments associated with cancer treatments, there remains a gap in understanding how these effects differ by sex. As sex differences could inform tailored interventions and support mechanisms for affected individuals, this pilot study aimed to examine the sex differences in neuropsychological outcomes in patients treated for brain cancer with cisplatin and/or carboplatin. Methods: Our study employed rigorous/structured neuropsychological assessments to evaluate executive functions in pediatric cancer survivors treated with cisplatin and/or carboplatin. We utilized the BRIEF and TOL tests to assess the key domains of executive function, including inhibitory control, cognitive flexibility, and problem-solving abilities. Additionally, psychosocial factors were evaluated using the Resiliency Scale to measure resilience and the PAT test to assess family psychosocial risk. Results: In our cohort of 17 patients, significant sex differences emerged, where males outperformed females in areas such as inhibitory control, impulse regulation, and strategic planning. Conclusions: These findings highlight the complexity of cognitive outcomes in pediatric cancer survivors. Understanding sex-specific differences is essential for developing tailored interventions that optimize cognitive and psychosocial outcomes. Future research should focus on larger cohorts and longitudinal studies to validate these findings and guide targeted interventions to improve survivorship outcomes.

QLTI-19. PEDIATRIC NEURO-ONCOLOGISTS NAVIGATING AN ADULT WORLD: A TALE OF TWO CENTERS

Abstract BACKGROUND Adolescent and Young Adult Neuro-Oncology(AYA-NO) patients are a distinct cohort with an overlap of tumors found in childhood and adulthood. For adult patients with pediatric-type Central Nervous System tumors, optimal work-flow to manage these patients is unclear. METHODS We examine the work-flow of pediatric neuro-oncologists starting AYA-NO clinics within two high volume adult institutions: the University of Miami(Florida, USA) and the Princess Margaret Cancer Centre(Toronto, Canada). RESULTS Over 18 months, the AYA-NO clinics managed 167 patients total with several key differences emerging in both institutions between the pediatric and adult work-flows. Adult providers commonly have neurology backgrounds, while pediatric providers mostly have hematology/oncology backgrounds. In pediatrics, providers typically meet the patient inpatient before pathology results, adult providers meet their patients in outpatient settings once histopathology results are available. Outpatient management in pediatric oncology centers typically includes labs, infusion centers, provider rooms, and social workers in one area while adults, due to the larger volume, have these services on separate units. Chemotherapy related differences included the primary provider for inpatient admissions and the emphasis of adult institutions on outpatient administration when feasible. Psychosocial factors such as the variety of caregivers, increased opportunity for patient autonomy in decision-making, and the increased fragmentation in care magnifies the importance of providers forming a strong rapport with AYA-NO patients. End of life care is vastly different including the inability for adult patients to receive palliative treatment in hospice care and the availability medically-assisted death. CONCLUSION Pediatric neuro-oncologists building AYA-NO workflows within adult settings can provide unique expertise for AYA-NO patients with pediatric-type tumors. Growing AYA-NO clinics can benefit from allocating AYA CNS specific resources such as chemotherapy/targeted therapy provider education, a dedicated hospital/clinic space, chemotherapy nursing, a care coordinator, and a social worker with experience treating this patient population.