Psychosocial Indicators Research Articles

THE EFFECTIVENESS OF A FAMILY THERAPEUTIC PROGRAM FOR THE REHABILITATION OF THE PSYCHOLOGICALLY- DISORDERED CHILDREN AFTER A SHOCK AN EXPERIMENTAL STUDY ON A SAMPLE OF CHILDREN SUFFERING DOMESTIC DISASSOCIATION

This study belongs to the pattern of semi-experimental studies aimed at measuring the effectiveness of the family therapy program in reducing PTSD for children as a result of parental separation,The study was based on theories of family therapy, theory of behavior and behavioral theory in its theoretical premise. The sample size of the study was single children in late childhood who receive psychological and family counseling services within Al-Iman Family Care Foundation. The study relied on two tools namely family therapy program and a measure to determine the effectiveness A family therapy program for disturbed children after the shock of separation of spouses, and the results of the study found that there are significant differences statistically significant at the level (0.05) between pre and post measurement in the self-confidence index on the scale of the effectiveness of the family treatment program in favor Yas Al-Baadi. There are also significant statistical differences (0.05) between the pre- and post-measurement in the psychological pressure index on the scale of the effectiveness of the family therapy program in favor of telemetry. There are significant differences (0.05) between the pre- and post-measurement in the emotional disorders index. (0.05) between pre and post measurement in the psychosocial compatibility index on the scale of the effectiveness of psychological rehabilitation programs in favor of telemetry.

NOTEWORTHY: THE IMPACT OF A CHOIR FOR OLDER ADULTS WITH DEMENTIA ON THE WELL-BEING AND QUALITY OF LIFE OF CAREGIVERS

Informal caregivers provide 80% of the care needed to support community-dwelling older adults with dementia. Over time caregivers often face adverse effects on their health, quality of life and well-being; particularly those caring for someone with dementia. This study examines the impact of participation in the Voices in Motion (ViM) choir on caregiver burden, mood and quality of life. A measurement burst approach was used to investigate intraindividual variability on key psychosocial and health indicators. Results indicate that choir participation significantly improves caregiver well-being (e.g. mood, burden) and quality of life. Findings suggest that choirs offer significant caregiver support and respite. The discussion focuses the public policy and on the potential economic implications which suggests a shift is needed in the services available to older adults with dementia and their caregivers.

Long working hours and mortality in Central and Eastern Europe: the HAPIEE study

Abstract Background Long working hours are common in countries of Central and Eastern Europe (CEE). A wide range of epidemiological studies have showed that long working hours had an adverse effect on health but the evidence mostly comes from Western Europe, East Asia and North America. This study aimed to assess the relationship between long working hours and the risk of mortality in employed people in three Eastern European countries. Methods Participants, aged 45-69 years at baseline, were from the Health, Alcohol and Psychosocial Indicators in Eastern Europe (HAPIEE) cohort study conducted in Russia, Poland and the Czech Republic. Baseline survey included a structured questionnaire and examination in the clinic during 2002-2005. Working hours were assessed by a self-reported questionnaire at baseline. Participants have been followed-up for all-cause mortality and cause-specific mortality for an average of 11 years. Impact of long working hours on mortality was analysed by Cox proportional hazards regression. In all-cause mortality analysis, a total of 10878 men and women were included, and 10399 participants were included in cause-specific mortality analysis. Results During the follow-up, there were 1187 deaths from all causes, 288 from CVD, and 251 from cancer. Those who worked 61 hours or more in a week showed higher risk of mortality compared to those working 36-45 hours per week: HR 1.32 (95%CI 1.01 to 1.74) for all-cause mortality and 1.73 (95% CI 1.03-2.93) for CVD mortality. There was no significant increase in risk of cancer mortality associated with working long hours. There was no significant association between working 46-60 hours a week and risk of mortality, including all-cause mortality and cause-specific mortality. Conclusions The risk of all-cause and CVD mortality in three CEE was significantly higher among employees working extensive hours. These findings suggest that more attention should be paid to shortening working hours for those who work extensively. Key messages Long working hours increase risk of all cause and CVD mortality. Cancer mortality is not related to long working hours.

Diversity of Psychosocial Syndemic Indicators and Associations with Sexual Behavior with Male and Female Partners Among Early Adolescent Sexual Minority Males.

Purpose: Psychosocial syndemic indicators (e.g., internalizing symptoms, alcohol/substance use, and violence exposure) have been associated with increased risk for HIV among older adolescent sexual minority males and adult sexual minority men. No studies have examined these concerns among early adolescents (<16 years old). The purpose of this study was to examine syndemic indicators among early adolescent sexual minority males and their associations with sexual behavior. Methods: Sexual minority males (N = 207; ages 14-17; drawn from 40 U.S. states) completed a cross-sectional online survey. Descriptive statistics were used to document profiles of syndemic indicators. Firth logistic regressions tested the associations between count of syndemic indicators and sexual behavior with male and female partners. Results: Psychosocial syndemic indicators were highly prevalent and co-occurring, with diverse psychosocial profiles. After controlling for age, race, and ethnicity, having more syndemic indicators was significantly positively associated with condomless anal sex with male partners (adjusted odds ratio [AOR] = 1.37, 95% confidence interval [CI] 1.02-1.84) and vaginal and/or anal sex with females (AOR = 1.75, 95% CI 1.25-2.47). Conclusions: This study documents the psychosocial profiles of syndemic indicators with a sample of early adolescent sexual minority males and the association of syndemic indicators with sexual behavior. Among early adolescent sexual minority males, psychosocial concerns were prevalent, similar to rates seen among adult sexual minority males, and conferred vulnerability to HIV transmission. Behavioral and psychosocial interventions must reach sexual minority males in early adolescence to address mental health and substance use concerns and to help reduce the risk of HIV acquisition.

Depressive disorder and psychosocial indicators in high school and college students from Mexico City: data from two censuses

Introduction. Almost 5% of the Mexican general population (18-65 years old) has suffered depression once in their lives, and 2% of them more than once without receiving treatment. Objetive. To measure the prevalence of depressive disorder and to calculate its relationship with psychosocial indicators. Method. Data were collected through two censuses with high school and college students from a university in Mexico City (n = 116 214). Participants completed the CES-D and other scales. Multivariate logistic regression models were used. Results. The prevalence of depressive disorder was 16%. Predictors of depressive disorder were: having suffered psychological or sexual violence, having a family member who had been injured during an assault, history of depression in the family, poor quality in family and social relationships, among others. Discussion and conclusion. The prevalence of depressive disorder increases with age. As prevention and treatment at an early age are essential, intervention and monitoring strategies must be created and systematized taking gender and other elements into account, such as the relationship with the parents, violence, and a history of depression in the family.

Social Integration, Marital Status, and Ovarian Cancer Risk: A 20-Year Prospective Cohort Study.

Low social integration and divorce/widowhood are chronic psychosocial stressors that may affect health. When assessed after cancer diagnosis, they have been associated with poorer survival, but their role in cancer development, particularly ovarian cancer (OvCA), is less understood. We investigated whether social integration and marital status were related to OvCA risk in a large population-based study. Women from the Nurses' Health Study completed the Berkman-Syme Social Network Index and reported their marital status every 4 years starting in 1992 (N = 72,206), and were followed up until 2012 (20-year follow-up period). Multivariate Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of OvCA risk, considering relevant potential confounders, in lagged analyses whereby psychosocial indicators were assessed 4 to 8 years (n = 436 cases) and 8 to 12 years (n = 306 cases) before diagnosis to account for the effects of prediagnostic symptoms on social measures. Secondary analyses evaluated the stability of and cumulative exposure to these social factors on OvCA risk. Being socially isolated versus integrated was related to an increased OvCA risk 8 to 12 years later (HR = 1.51, 95% CI = 1.07-2.13), but not 4 to 8 years later. Compared with married women, OvCA risk was significantly higher in widowed but not in separated/divorced individuals, with both time periods (e.g., 8-12 years later: HRwidowed = 1.57 [95% CI = 1.15-2.14] versus HRseparated/divorced = 1.13 [95% CI = 0.74-1.72]). Estimates were comparable or stronger when investigating stability in and cumulative effects of social indicators. Results suggest higher OvCA risk among socially isolated and widowed women, particularly when such psychosocial stressors were experienced a decade before diagnosis or were sustained over time.

Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study

BackgroundThis study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18–60 years in the Philippines.MethodsPrevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups.ResultsOverall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58–4.98%) for men and women aged 18–60 years. Genital warts prevalence was 3.39% (95% CI: 3.13–3.65%) and 8.0% (95% CI: 7.69–8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66–18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively).ConclusionsGenital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.

The Promise of Intergenerational Choir for Improving Psychosocial and Cognitive Health for those with Dementia: The Voices in Motion Project

Rates of dementia continue to increase along with life expectancy. As neither dementia’s causenor its cure is well understood from the perspective of medical science, further investigations ofcomplementary lifestyle and non-pharmaceutical interventions are imperative. Although arts-basedtherapies have been explored selectively, the significance of these interventions for persons withdementia (PwD) remains undervalued in both the general population and scientific literature. Thisstudy aims to examine one promising lifestyle intervention, the effect of intergenerational choirparticipation, on psychosocial and cognitive function for PwD. Participants (n = 32), in partnershipwith their family caregivers and local high school students, participated in an intergenerational choirfor as many as three choir seasons spanning up to 18 months of follow-up. Participants underwent anexpansive assessment of psychosocial, physiological, and cognitive function every four to six weeksas part of an intensive repeated measures design. Here, the potential benefits of choir for PwD wereexplored in relation to change for select cognitive (Mini-Mental State Examination: MMSE; TrailMaking Task A: TMT-A; Word Recall) and psychosocial (Patient Health Questionnaire: PHQ-9)indicators. Multilevel modelling was used to index initial levels (at baseline) and change (spanningup to eight follow-up assessments) in function for measures of global cognition, executive functioning,episodic memory, and depressive symptoms. Notably, no significant declines were observed for MMSEor TMT-A tasks. As expected, episodic memory function continued to decline, with a significantlessening of depressive symptoms and signs observed for the PHQ-9. These results suggest thatdespite the progressive nature of underlying neuropathology for dementia subtypes like Alzheimer’sDisease, preservation of select cognitive functions as well as mitigation of psychosocial comorbidities(depressive symptoms) is possible through participation in an intergenerational choir.

The Fear Reduction Exercised Early (FREE) approach to management of low back pain in general practice: A pragmatic cluster-randomised controlled trial

BackgroundEffective and cost-effective primary care treatments for low back pain (LBP) are required to reduce the burden of the world’s most disabling condition. This study aimed to compare the clinical effectiveness and cost-effectiveness of the Fear Reduction Exercised Early (FREE) approach to LBP (intervention) with usual general practitioner (GP) care (control).Methods and findingsThis pragmatic, cluster-randomised controlled trial with process evaluation and parallel economic evaluation was conducted in the Hutt Valley, New Zealand. Eight general practices were randomly assigned (stratified by practice size) with a 1:1 ratio to intervention (4 practices; 34 GPs) or control group (4 practices; 29 GPs). Adults presenting to these GPs with LBP as their primary complaint were recruited. GPs in the intervention practices were trained in the FREE approach, and patients presenting to these practices received care based on the FREE approach. The FREE approach restructures LBP consultations to prioritise early identification and management of barriers to recovery. GPs in control practices did not receive specific training for this study, and patients presenting to these practices received usual care. Between 23 September 2016 and 31 July 2017, 140 eligible patients presented to intervention practices (126 enrolled) and 110 eligible patients presented to control practices (100 enrolled). Patient mean age was 46.1 years (SD 14.4), and 46% were female. The duration of LBP was less than 6 weeks in 88% of patients. Primary outcome was change from baseline in patient participant Roland Morris Disability Questionnaire (RMDQ) score at 6 months. Secondary patient outcomes included pain, satisfaction, and psychosocial indices. GP outcomes included attitudes, knowledge, confidence, and GP LBP management behaviour. There was active and passive surveillance of potential harms. Patients and outcome assessors were blind to group assignment. Analysis followed intention-to-treat principles. A total of 122 (97%) patients from 32 GPs in the intervention group and 99 (99%) patients from 25 GPs in the control group were included in the primary outcome analysis. At 6 months, the groups did not significantly differ on the primary outcome (adjusted mean RMDQ score difference 0.57, 95% CI −0.64 to 1.78; p = 0.354) or secondary patient outcomes. The RMDQ difference met the predefined criterion to indicate noninferiority. One control group participant experienced an activity-related gluteal tear, with no other adverse events recorded. Intervention group GPs had improvements in attitudes, knowledge, and confidence compared with control group GPs. Intervention group GP LBP management behaviour became more guideline concordant than the control group. In cost-effectiveness, the intervention dominated control with lower costs and higher Quality-Adjusted Life Year (QALY) gains. Limitations of this study were that although adequately powered for primary outcome assessment, the study was not powered for evaluating some employment, healthcare use, and economic outcomes. It was also not possible for research nurses (responsible for patient recruitment) to be masked on group allocation for practices.ConclusionsFindings from this study suggest that the FREE approach improves GP concordance with LBP guideline recommendations but does not improve patient recovery outcomes compared with usual care. The FREE approach may reduce unnecessary healthcare use and produce economic benefits. Work participation or health resource use should be considered for primary outcome assessment in future trials of undifferentiated LBP.Trial registrationACTRN12616000888460

Study of the Mental Health Continuum Short Form (MHC-SF) amongst French Workers: a Combined Variable- and Person-Centered Approach

Keyes’s theory-driven model of mental health uses a diagnosis which leads to three levels of positive feelings and positive functioning: languishing, moderately mentally healthy and flourishing (Keyes 2002). Although these three-level categories may be justified for a unidimensional factor structure, or a factorial structure using summated scales, the recent works supporting a multidimensional structure of the Mental Health Continuum Short Form (MHC-SF) suggest the adoption of shape-based rather than level-based categories of mental health (Morin et al. 2017). This research aims at testing the empirical validity of Keyes’s taxonomy and its relationship to psychosocial functioning. We first adopted a variable approach by selecting the optimal factor structure for the MHC-SF: the bifactor exploratory structural equation modeling (Bi-ESEM). Following with a person-centered approach, we used a latent profile analysis on the factor scores of the Bi-ESEM. Psychosocial risks indicators were used as outcomes for testing the criterion validity of the models on a sample of 1065 French workers. Results show that the mental health subgroups are more intricate than the three-levels categories originally theorized by Keyes (2002, 2005). While the general Bi-ESEM factor warrants three levels akin to those of Keyes, accounting for the specific factors reveals two profiles of languishing: the hedonic languishers characterized by a low level of emotional wellbeing, and the eudaimonic languishers characterized by a low level of psychological wellbeing. Both variable and person-centered approach confirm Keyes’s initial statements (Keyes 2007) that those who are languishing exhibit the highest levels of psychosocial risks while those flourishing display the lowest. A rule-based diagnosis derived from a decision tree method is suggested as an alternative to a level-based taxonomy.

An Investigation on Psychosocial Challenges Facing Boy Child in Absentee Father Figure: A Case of Embakasi Central Constituency, Nairobi County, Kenya

This study sought to find out psychosocial impact of absentee father in upbringing of the boy child in Embakasi Central Constituency, Nairobi County. The study focussed on the relationship between present and absent father figure in relation to boy child deliquency, truancy, drug and substance abuse as well as academic performance in Embakasi Constituency. To realize its objective, the study was majorly descriptive and adopted both qualitative and quantitative methodologies to collect, analyse and report the required data. The study was undertaken among boys brought up in absentee father figure families’ as well as present father figure families with age bracket between 12 and17, in Embakasi Central Constituency, Nairobi County. The study also sought to investigate the causes of absentee father figure in the same geographical location. In this study, a total of 90 respondents were sampled; 45 of them involved boys brought up with absent father figures, while the other 45, included boys brought up by both parents. The study sample for single mothers was 45. Non probability sampling method of single mothers with boys was used. Other than the questionnaire, oral interviews were conducted on mothers to find out the cause of single motherhood to collect the data. The study was founded on Social Learning and Structural functioning theories. There was focus on the family as a major player that creates social environment and determines the upbringing of the boy child. The study’s objectives aimed at finding out how parenting is conceptualized today; as well as seeking to find out the psychosocial indicators of upbringing the boy child in absentee father figure families. On academic performance, the research found out that boys from present father figure families perform better in school at an average grade of B as compared to those from absentee father families who perform at an average grade of C-. In regard to drugs and substance abuse, the study was able to tell that boys from absentee father figure are prone to drugs and substance abuse in relation to boys from present father figure. The research findings states that 47% of single mothers in Embakasi Central Constituency are single by choice. Gambling is almost at per from both present and absentee father figure boys; 81% and 91% respectively. However, from the research findings, it is also evident that some single mother have come up with alternative coping mechanism which are helping them provide overall support to the boy child this is according to the study findings which show that there are boys (11.1%) brought up by absentee father figure but they are equally doing well in school (C+) with very low delinquency rates (17%). In conclusion that study observes that boys brought up in the absence of father figure are likely to experience more psychosocial challenges as compared to those brought up with father figure families.

Association between Psychosocial Stress and Cardiovascular Disease in Relation to Low Consumption of Fruit and Vegetables in Middle-Aged Men.

Stress has been reported to affect dietary intake and chronic disease. This study aimed to investigate the association between psychosocial stress and cardiovascular disease (CVD) in relation to dietary intake. This cross-sectional analysis was performed on 23,792 men enrolled in the Korean Genome and Epidemiology Study from 2004 to 2013. Stress was assessed by the Psychosocial Well-Being Index. Stress level was positively associated with the risks of CVD (odds ratio (OR) for quartile 4 compared to quartile 1 = 1.30 (95% confidence interval 1.24–1.37), p-trend < 0.0001), including hypertension (OR = 1.26 (1.20–1.33), p-trend < 0.0001), heart disease (OR = 1.55 (1.34–1.80), p-trend = 0.0001), and cerebrovascular disease (OR = 2.47 (1.97–3.09), p-trend < 0.0001). As the level of stress increased, the intake of fruits and vegetables, as well as antioxidant nutrients, was decreased. Stress level showed an inverse association with dietary variety score (p-trend = 0.0001). In addition, dietary variety score was inversely associated with fruits and vegetables consumption (p-trend < 0.0001). These results suggest that the CVD risks for those with higher stress levels may be partially related to the decreased consumption of fruits and vegetables and dietary variety score.

Associations between socioeconomic status, psychosocial stress, and urinary levels of 8-iso-prostaglandin-F2α during pregnancy in Puerto Rico

BackgroundLower socioeconomic status (SES) and psychosocial stress during pregnancy have been associated with adverse birth outcomes. While hypothalamic-pituitary-axis activation is thought to be the primary driver, oxidative stress may also be involved mechanistically. We used data from the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort (N=476) to examine associations between self-reported psychosocial stress measures, SES indicators, and urinary oxidative stress biomarker concentrations, hypothesizing that women with lower SES and increased psychosocial stress would have elevated oxidative stress biomarkers. MethodsMaternal age, education, marital status, insurance status, alcohol use and smoking status were obtained via self-reported questionnaires and were used as indicators of SES. Perceived stress, depression, negative life experiences, neighborhood perceptions, and social support were self-reported in questionnaires administered during pregnancy. Responses were grouped into tertiles for analysis, where the highest tertile corresponded to highest level of psychosocial stress. Urinary concentrations of 8-iso-prostaglandin F2α (8-iso-PGF2α) and its primary metabolite were measured at three study visits (median 18, 24, 28 weeks gestation) and averaged to reflect oxidative stress across pregnancy. Linear models were used to examine associations between SES indicators, tertiles of psychosocial stress and oxidative stress biomarkers. ResultsAverage levels of 8-iso-PGF2α and the 8-iso-PGF2α metabolite were higher among pregnant women who were younger, who had public compared to private insurance, and who were unemployed compared to employed. However, no associations were observed between psychosocial stress measures and biomarker concentrations in adjusted analyses. ConclusionsPsychosocial stress during pregnancy, as indicated by self-reported questionnaire measures, was not associated with biomarkers of oxidative stress in the PROTECT study. However, results suggest that these biomarkers are elevated among women of lower SES, which is typically associated with stress. Notably, compared to other populations, self-reported psychosocial stress measures were lower in PROTECT compared to other populations.

INDICADORES DE RIESGO PSICOSOCIAL EN FUNCIÓN DE LOS PUESTOS DE TRABAJO

El presente trabajo es un manuscrito de revisión bibliográfica de los indicadores de riesgo psicosocial que se encuentran presentes en los trabajadores. La importancia de evaluar los riesgos psicosociales, radica en que su naturaleza está intrínsicamente relacionada con afectaciones prolongadas en los trabajadores si estos no son controlados adecuadamente. Los trabajadores que se sienten expuestos a riesgos psicosociales, tales como sobrecarga de trabajo, tareas repetitivas o tareas de muy corta duración, exceso de carga mental, entre otros, son aquellos que tienen porcentajes de respuestas de sintomatología psicosomática más elevados. Una vez revisadas las estadísticas de los factores de riesgo psicosocial, podemos notar que los mismos, afectan a un porcentaje significativo de la población trabajadora que fue muestreada en un estudio realizado por el Instituto Nacional de Seguridad e Higiene en el Trabajo (España), por lo cual, es necesario evaluar en cada centro de trabajo si estos factores están presentes en la organización, para de esta forma, garantizar al trabajador un adecuado bienestar en el trabajo, derecho adquirido según normativas legales tanto nacionales, como internacionales. Finalmente, debe considerarse que no todos los factores de riesgo psicosocial, están presentes en todos los puestos de trabajo, sino que existen puestos de trabajo en donde un factor puede estar más arraigado que otro. Palabras clave: trabajador, seguridad, salud, riesgo laboral, riesgo psicosocial.

Traumatic dental injuries and experiences along the life course - a study among 16-yr-old pupils in western Norway.

The study assessed risk factors for traumatic dental injuries (TDI) using experiences along the life course. A retrospective longitudinal study, including historical clinical data, was conducted on 16-yr-old pupils in western Norway. All first-grade pupils born in 1997 and attending public high schools were invited to participate (n=5,184). Participants responded to an electronically administered closed-ended questionnaire (39.6%, n=2,055). Information on the occurrence of TDI and events during the life course (categorized as socio-economic, biological, psychosocial, and behavioural indicators) was collected. Variables with a significant bivariate association with three different dependent variables (TDI, severity of TDI, and multiple episodes of TDI) were tested in a hierarchical logistic regression analysis. Traumatic dental injuries were more frequent among boys, adolescents of higher socio-economic status, and adolescents with adverse psychosocial and behavioural scores. Moderate and severe TDIs were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in the sport of wrestling. Multiple episodes of TDI were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in sports activities. Incorporation of different life-course indicators is important in evaluating TDI severity and repeated incidents.

879-P: Using Telehealth to Enhance Engagement and Reduce Patient Burden in the Management of Gestational Diabetes: A Randomized Trial in a Diverse Community Setting

Optimal management of gestational diabetes (GDM) is critical to ensure successful maternal and fetal birth outcomes, yet various factors limit uptake of GDM management education interventions. We developed a psychoeducational intervention for GDM management using a video telehealth platform (TH) as an alternative to routine in-person (RC) sessions to improve patient access and engagement. Both groups were guided by the same providers and received similar educational materials. However, all RC visits were held in-person while all TC visits (except for pre and post assessment) were held virtually. Clinical and psychosocial indicators including out of range blood glucose (BG), birth outcomes, BG monitoring behavior, and patient satisfaction were assessed. Between group comparisons were performed using independent samples t-tests and Fisher’s exact test. Sixty ethnically diverse women with GDM were randomized to TH (n=30) or to RC (n=30). At post assessment, GDM knowledge improved significantly and similarly in both groups (p=0.009), but no group differences were observed on the clinical (including out of range BGs) and psychosocial variables assessed. In late pregnancy, BG monitoring was significantly better in TH (84%) vs. RC (68.4%) (p&amp;lt;0.05). Similarly, attendance at all intervention visits was higher in TH (63.3%) vs. RC (36.7%). Total interaction time for participants completing all intervention visits was significantly shorter in TC (202 min) than in RC (255 min, p&amp;lt;0.001). Although, satisfaction was high in both groups, all but one participant indicated preference for TH for future GDM education. The impact of TH was found to be equivalent to RC on various clinical and psychosocial indicators, but superior in terms of patient engagement, BG monitoring adherence, and patient burden. Disclosure H. Singh: None. M. Sendejas: None. L.B. Pallivathucal: None. M. Gonzalez: None. S. Decker: Advisory Panel; Self; Sanofi-Aventis. A.R. Pimentel: None. M.D. Mills: None. D.T. Ahn: Advisory Panel; Self; Ascensia Diabetes Care, MannKind Corporation. J. Billimek: None. Funding Hoag Hospital Foundation

1688-P: Component Causes of HbA1c Trajectories among Adolescents/Young Adults with Type 1 Diabetes

We sought to examine trajectories in glycemic control across the transition from adolescence into early adulthood and identify component causes related to co-occurring psychosocial and behavioral changes. The cohort included 48,137 HbA1c values for 10,174 participants (ages 13-25) with T1D (49% female; 51% pump users) enrolled in the T1D Exchange registry. Multivariate mixed effects models were used to identify HbA1c trajectories; interactions between age and predictors were used to quantify how each predictor moderated trajectory shape. Mean HbA1c for the cohort was high (8.66), with only 14.0% meeting the adult target of &amp;lt;7.0%. Key indicators of self-management, including frequency of daily testing and testing before administering insulin, declined steadily into early adulthood while diabetes distress peaked in early 20s; in adjusted analyses, these strongly influenced the shape of HbA1c trajectories (see Figure) whereby increases in HbA1c were exacerbated with suboptimal self-management/distress. These psychosocial and self-management indicators were more influential than treatment regimen for predicting glycemic control. Late adolescence/early adulthood are periods of distinct vulnerability that warrant additional efforts to improve disease control via affecting self-management and distress. Disclosure L.E. Wisk: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01)

Power and Trust Dynamics of Sexual Violence: A Textual Analysis of Nassar Victim Impact Statements and #MeToo Disclosures on Twitter

Employing a natural language processing approach, we analyzed textual content derived from publicly-available athlete victim impact statements (VIS) from the Larry Nassar trial (N = 111) to examine psychosocial responses to sexual violence. To explore potential differences in a non-sports context, we conducted similar analyses on a sample of #MeToo tweets (N = 45,848). Our research focused on the semantic content of VIS, including positive and negative affect, power and trust dynamics, well-being, and post-traumatic growth. We hypothesized that athletes’ reactions to sexual violence would be more likely to contain language related to power and trust. Traditional null-hypothesis significance testing and network analyses were used to identify the psychosocial indicators unique to sexual violence disclosures in a sports context. Results indicated differential use of language related to negative affect, trust, power dynamics, and post-traumatic growth in sports versus non-sports contexts. We discuss clinical, practical, and policy-based implications for risk reduction and intervention.

Exploring the Effects of Telemedicine on Bariatric Surgery Follow-up: a Matched Case Control Study.

Telemedicine offers a potential solution for bariatric surgery (BS) aftercare for patients living in rural areas with limited access to healthcare services. This study aimed to compare post-BS appointment adherence, psychosocial, and body mass index (BMI) outcomes in patients that did or did not use telemedicine. In total, 192 (96 telemedicine and 96 non-telemedicine) patients were matched on gender, age, time since surgery, BMI, and travel distance from program. Additional psychosocial and demographic variables including rurality index (RIO) were collected. Telemedicine users had a significantly higher RIO (p < 0.001) than non-telemedicine users. Appointment attendance, BMI, and psychosocial outcomes were not significantly different between the two groups. Therefore, our results suggest that telemedicine could help overcome geographical barriers to provide comparable quality healthcare services to more remote regions.

Using Hair Cortisol to Examine the Role of Stress in Children's Health Inequalities at 3 Years

ObjectiveChildren exposed to early adversity (eg, financial hardship, family violence, parent mental health difficulties) are at greater risk of poor health outcomes. Physiological stress is one mechanism thought to explain this pathway. We investigated associations between adversity and young children's health and whether child stress (measured using hair cortisol) mediated these associations. MethodsThis was a cross-sectional study of 3-year-old children whose mothers were recruited during pregnancy, through the right@home trial, for their experience of adversity. Using total counts of 9 sociodemographic and 9 psychosocial indicators of adversity, regression models examined relationships among adversity risk counts, child hair cortisol (potential mediator), and 5 health outcomes: externalizing and internalizing problems, physical and socioemotional wellbeing, and overweight/obesity. ResultsHair cortisol data were available for 297 out of 500 (59%) participating children. When examined separately, sociodemographic adversity risk was associated with higher externalizing problems, and psychosocial adversity risk was associated with higher externalizing problems and poorer physical/socioemotional wellbeing. When examined together in a single model, psychosocial (but not sociodemographic) adversity was associated with higher externalizing problems (unstandardized mean difference [β], 0.53; P = .002) and poorer physical wellbeing (β, 1.19; P = .009); higher hair cortisol was associated with higher externalizing problems (β, 0.76; P = .02). There was no evidence that stress (hair cortisol) mediated associations between adversity and health. ConclusionsIn 3-year-old children, we found no evidence that physiological stress (hair cortisol) mediated associations between adversity risk and children's health. Hair cortisol may be limited as a single measure of stress, or physiological stress may not be a mechanism for explaining the effects of adversity on these young children's health.