Psychosocial Information Research Articles

Interactive effects of outdoor fine particulate matter and metabolic, behavioural, and psychosocial risk factors on cardiovascular disease: analysis of the PURE-China cohort study

Abstract Background Long-term PM2.5 exposure has been associated with an elevated risk of cardiovascular disease (CVD) and its associated risk factors.[1–4] There is a paucity of studies investigating the interactive effects of PM2.5 exposure and a comprehensive list of risk factors including metabolic, behavioural, and psychosocial risk factors on CVD risk.[5] Purpose This study aims to examine the interactive effects of PM2.5 exposure and metabolic, behavioural, and psychosocial risk factors on incident CVD. Methods The Prospective Urban Rural Epidemiology (PURE)-China cohort study is a population-based cohort study recruiting participants aged 35–70 years from 115 communities in 12 provinces of China between 2005 and 2009, and followed up until August 31, 2021.[6] Participants’ metabolic, behavioural, and psychosocial risk factor information was recorded. PM2.5 concentrations were extracted from a 1x1 km2 global model.[7,8] For this analysis, we included participants aged 35–70 years at baseline without a history of CVD, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (CVD deaths, myocardial infarction, stroke, and heart failure). Additive interaction was measured by relative excess risk due to interaction (RERI), the proportion of disease attributable to interaction (AP), and the synergy index (SI).[9,10] To comply with the additive interaction method, we classified concentrations of PM2.5 into low and high levels by the median of 3-year average PM2.5 concentration (45.7 μg/m3, IQR: 33.7-74). Cox proportional hazard models were used to assess the associations of metabolic, behavioural, and psychosocial risk factors on incident CVD by PM2.5 concentrations. Results The PURE-China study recruited 47 931 participants, of which 39 329 are eligible for this analysis. During the median follow-up period of 11.9 years (IQR: 9.6-12.6), 1462 and 2155 major CVD events had occurred in the low and high PM2.5 group respectively. There was a synergistic interaction between PM2.5 and the systolic blood pressure (SBP) for CVD: RERI: 0.363, 95% CI: 0.196-0.531; AP: 0.098, 95% CI: 0.081-0.115; SI: 1.155, 95% CI: 1.132-1.177; high LDL cholesterol: RERI: 0.219, 0.003-0.436; AP: 0.135, 0.008-0.263; SI: 1.549, 0.947-2.533. A significant synergistic interaction was also identified between PM2.5 and household air pollution (RERI: 0.457, 0.292-0.622; AP: 0.277, 0.184-0.37; SI: 3.362, 1.409-8.019). Interactions between PM2.5 and low grip strength on CVD were significantly synergistic, but antagonistic between PM2.5 and low physical activity (RERI: -0.248, -0.485--0.012; AP: -0.174, -0.349-0.001; SI: 0.633, 0.412-0.971). Conclusion Addictive interaction was between PM2.5 and SBP, high LDL cholesterol, household air pollution, low grip strength and low physical activity on incident CVD, indicating the benefit of coordinated control strategies for metabolic, physical, and environmental risk factors for the prevention of CVD.

Medical Team Practices and Interpreter Alterations on Family-Centered Rounds.

Robust evidence demonstrates inequities in communication during family-centered rounds for families who use a language other than English (LOE) for health care. This study aimed to characterize the type of interpreter alterations occurring on family-centered rounds and identify medical team communication practices associated with alterations. In this observational study of interpreter-supported family-centered rounds, we recorded and transcribed family-centered rounds encounters for Spanish-speaking families. We assessed measures of medical team communication behaviors and interpreter alterations (omissions, additions, and substitutions) using previously described instruments. We used a content analysis approach to apply defined codes to each interpreted segment and to characterize the nature of interpreter alterations. We assessed the association between medical team communication behaviors and interpreter alterations using χ2 tests. We recorded, transcribed, and coded 529 interpreted segments of 10 family-centered rounds encounters. At least 1 alteration was present in 72% (n = 382/529) of interpreted segments. Omissions were the most common alteration (n = 242/529, 46%) followed by substitutions (n = 177/529, 34%) and additions (n = 71/529, 13%). Interpretation resulted in a potentially negative alteration in 29% (n = 155/529) and a positive alteration in 9% (n = 45/529) of segments. Greater number of sentences in the segment preceding interpretation was associated with an increase in loss of information (P < .001), loss of social support (P = .003), and loss of partnership (P = .020). To improve communication with families that use an LOE, medical teams must abide by best practices for using an interpreter such as frequent pausing to prevent loss of both biomedical and psychosocial information.

Are we informing our patients correctly? Evaluation of perioperative counselling for paediatric intestinal stoma formation: a national study.

Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. UK paediatric surgery centres were invited to recruit patients aged 6-16years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.

The Crucial Role of Psychosocial Research for Patients and Caregivers: A Narrative Review of Pediatric Psycho-Oncology Research in India

AbstractThe focus of pediatric cancer research in India has largely been medical and clinical, with little focus on psycho-oncological aspects. Receiving a cancer diagnosis can be life altering for both the patients as well as their families and points to a need for psycho-oncological research. The present narrative review examined original articles on pediatric psycho-oncology research conducted in India particularly in the past two decades. There is promising research in various domains such as survivorship and quality of life, patient needs and psychosocial concerns, communication between health care providers, patients, and caregivers, parent and caregiver needs including psychosocial support and information, as well as some intervention-based studies. With much of the research being conducted within clinical setups through surveys and retrospective data, psychosocial issues faced by patients and their families are discussed along with physical, logistical, and financial concerns, while forays into intervention-based research are still in primary phases but show potential in terms of outcomes and feasibility. There is need for more methodologically rigorous research rooted in strong theoretical foundations, culturally sound models, and with evidence-based examination of all stages and stakeholders involved in providing and receiving care in pediatric cancer.

Prevalence and correlates of anxiety and depressive symptoms after Spontaneous Coronary Artery Dissection (SCAD): a cross-sectional study.

Spontaneous coronary artery dissection (SCAD) is recognised as a particularly stressful cause of heart attack. However few studies have documented the prevalence of post-SCAD anxiety and depressive symptoms, or identified patients most at risk. This study documents the prevalence and correlates of post-SCAD anxiety and depressive symptoms. 310 (95% women) SCAD survivors were recruited by the Victor Chang Cardiac Research Institute from a database of 433 SCAD survivors. Participants completed an online questionnaire to gather demographic, medical and psychosocial information, including the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate analyses were undertaken to identify the significant demographic, psychosocial and medical correlates of post-SCAD anxiety and depressive symptoms. Time between SCAD and questionnaire completion varied from 2 months to 18 years (mean = 5.5 years; SD = 3.5 years). Rates of anxiety and depressive symptoms were 20.7% (GAD-7 ≥ 10) and 20.9% (PHQ-9 ≥ 10) respectively, and did not vary by time since event. In bivariate analyses, correlates (p < .05) of anxiety and depressive symptoms were absence of a close confidante, financial strain, mental health diagnosis pre-SCAD, comorbid obesity, not being in paid employment (anxiety only), younger age (depression only), and not knowing another SCAD survivor (depression only). Variables retained in multivariate models were absence of a close confidante, financial strain, not being in paid employment, mental health diagnosis pre-SCAD (depression only), and younger age (depression only). This study demonstrated that over one in four SCAD survivors experience either anxiety or depressive symptoms after SCAD, and identified those who may need additional support in their psychological recovery.

'High hopes for treatment': Australian stakeholder perspectives of the clinical translation of advanced neurotherapeutics for rare neurological diseases.

Advanced therapies offer unprecedented opportunities for treating rare neurological disorders (RNDs) in children. However, health literacy, perceptions and understanding of novel therapies need elucidation across the RND community. This study explored healthcare professionals' and carers' perspectives of advanced therapies in childhood-onset RNDs. In this mixed-methodology cross-sectional study, 20 healthcare professionals (clinicians, genetic counsellors and scientists) and 20 carers completed qualitative semistructured interviews and custom-designed surveys. Carers undertook validated psychosocial questionnaires. Thematic and quantitative data analysis followed. Participants described high positive interest in advanced therapies, but low knowledge of, and access to, reliable information. The substantial 'therapeutic gap' and 'therapeutic odyssey' common to RNDs were recognised in five key themes: (i) unmet need and urgency for access; (ii) seeking information; (iii) access, equity and sustainability; (iv) a multidisciplinary and integrated approach to care and supportand (v) difficult decision-making. Participants were motivated to intensify RND clinical trial activity and access to advanced therapies; however, concerns around informed consent, first-in-human trials and clinical trial procedures were evident. There was high-risk tolerance despite substantial uncertainties and knowledge gaps. RNDs with high mortality, increased functional burdens and no alternative therapies were consistently prioritised for the development of advanced therapies. However, little consensus existed on prioritisation to treatment access. This study highlights the need to increase clinician and health system readiness for the clinical translation of advanced therapeutics for RNDs. Co-development and use of educational and psychosocial resources to support clinical decision-making, set therapeutic expectations and promotion of equitable, effective and safe delivery of advanced therapies are essential. Participant insights into the psychosocial burden and information needto enhance the delivery of care in this formative study are informing ongoing partnerships with families, including co-production and dissemination of psychoeducational resources featuring their voices hosted on the Sydney Children's Hospitals Network website SCHNBrain-AidResources.

POOR MENTAL HEALTH AND ADVERSE PSYCHOSOCIAL EXPERIENCES AND PERCEPTIONS ARE ASSOCIATED WITH HYPERTENSION IN CAPE TOWN

Objective: To determine any differences in mental health (depression and anxiety traits) and poor psychosocial well-being by hypertension status, in adults at high-risk for diabetes. Design and method: In a population-based cross-sectional study, socio-demographic characteristics, lifestyle behaviours (cigarette smoking, alcohol misuse, physical inactivity), and mental health and psychosocial information were collected via administered questionnaires. Depression and anxiety traits were investigated using the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder (GAD-7) screening questions. Blood pressures (BP) were measured, and hypertension defined as systolic BP &gt;=140 mmHg and/or diastolic BP &gt;=90 mmHg, self-reported hypertension diagnosis or on antihypertension medication. Multivariable logistic regressions determined the associations with hypertension; the basic model comprised socio-demographic and lifestyle behaviours. Mental health and psychosocial variables were entered individually in separate models. Results: Among 678 participants, median age among those with (n=384) and without (n=290) hypertension was 54 vs. 49 years (p&lt;0.001). Prevalence of depression scores &gt;=10 (17.4% vs. 10.0%, p=0.004) and anxiety scores &gt;=10 (11.7% vs. 8.2%, p=0.392) were higher in participants with than without hypertension but were only significant for depression. In the basic regression model, only increasing age was significantly associated with hypertension. Participants with depression score &gt;=10 vs. &lt;=4 were twice as likely to have hypertension (OR: 2.07, 95%CI: 1.23-3.46, p=0.006). Increasing anxiety scores were related to hypertension (OR: 1.05, 95%CI: 1.01-2.64, p=0.034). Poor psychosocial well-being, defined as 1) decreasing social support (OR: 1.03, 95%CI: 1.01-1.06, p=0.039), 2) physical health or emotional problems interfering with social activities all/most of the time (OR: 2.07, 95%CI: 1.02-4.17, p=0.043), 3) perception of worsening health (OR: 1.06, 95%CI: 1.02-1.11, p=0.002), and 4) a serious ongoing health problem (OR: 1.52, 95%CI: 1.01-2.30, p=0.048), was associated with hypertension in separate models. Quality of life and increasing number of adverse life events experienced were not significantly associated with hypertension. Conclusions: The high burden and associations of depression and anxiety traits, and poor psychosocial well-being with hypertension suggest a need for strategies to mitigate the effects of these conditions on hypertension.

Informational continuity by midwives during birth at primary care settings in the Western Cape.

Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World Health Organization recognised that ineffective informational continuity during birth contributed to fragmented care and duplication of services, which ultimately influenced the morbidity and mortality rates of the pregnant women. The aim of this study was to delve into the midwives' experiences on informational continuity approaches that enable effective care coordination during birth within the primary health care setting. The study setting was two maternity obstetric units (MOUs) in the Western Cape, South Africa. A qualitative descriptive phenomenological design was used. Participants were recruited by using purposive sampling. Interviews were audiorecorded, transcribed verbatim and analysed. Three themes emerged from the findings. Theme one: adequate sharing of information with women during the intrapartum period. Theme two: efficient transition of information among midwives and other healthcare providers during the intrapartum period. Theme three: challenges to informational continuity during the intrapartum period. Communication with the women as well as with other healthcare providers during birth was effective. However, with minimal challenges, informational continuity was effectuated through communication among the midwives, the pregnant women and other healthcare providers. Informational continuity approaches among the midwives, with the women and between healthcare facilities are a prerequisite to ensure continuity of care and care coordination during birth.

Cohort profile: BioMD-Y (biopsychosocial factors of major depression in youth) – a biobank study on the molecular genetics and environmental factors of depression in children and adolescents in Munich

PurposeBioMD-Y is a comprehensive biobank study of children and adolescents with major depression (MD) and their healthy peers in Germany, collecting a host of both biological and psychosocial information from...

Comparing a fecal immunochemical test and circulating tumor DNA blood test for colorectal cancer screening adherence.

Colorectal cancer (CRC) screening programs are most effective at reducing disease incidence and mortality through sustained screening participation. A novel blood test modality is being explored for CRC screening, but it is unclear whether it will provide sustained screening participation. This study aimed to investigate whether a circulating tumor DNA (ctDNA) blood test improved CRC screening re-participation when compared with a fecal immunochemical test (FIT) and to define the predictors of sustained CRC screening in an Australian population. South Australians who initially participated in CRC screening using a ctDNA blood test (n=36) or FIT (n=547) were offered the same CRC screening test approximately 2years later through an extended phase of a randomized controlled trial. Surveys collected demographic, psychosocial, and clinical information. Predictors of CRC screening re-participation were explored using chi-square, Wilcoxon tests, and logistic regression. Participants offered a second ctDNA blood test were equally likely to re-participate in CRC screening as those who completed a FIT in the first round and who were offered the same test (61% vs 66% re-participation respectively, P=0.6). CRC fatalism, health activation, and self-efficacy were associated with repeated screening participation. Test awareness was predictive of repeated FIT-based CRC screening. Targeted interventions to improve CRC screening awareness and increase patient health activation may improve CRC screening adherence. A ctDNA blood test may be a suitable CRC screening option to maintain CRC screening adherence in people who do not participate in screening with FIT.

Identifying adolescents at risk for suboptimal adherence to tuberculosis treatment: A prospective cohort study.

Adolescents account for an estimated 800,000 incident tuberculosis (TB) cases annually and are at risk for suboptimal adherence to TB treatment. Most studies of adolescent TB treatment adherence have used surveillance data with limited psychosocial information. This prospective cohort study aimed to identify risk factors for suboptimal adherence to rifampicin-susceptible TB treatment among adolescents (10-19 years old) in Lima, Peru. We collected psychosocial data using self-administered surveys and clinical data via medical record abstraction. Applying k-means cluster analysis, we grouped participants by psychosocial characteristics hypothesized to impact adherence. Then, we conducted mixed effects regression to compare suboptimal adherence-defined as <90% (missing >10% of doses)-between clusters. Treatment setting (facility vs. home) and drug formulation (single drug vs. fixed dose combination) were interaction terms. Of 249 participants, 90 (36.1%) were female. Median age was 17 (IQR: 15, 16.6) years. We identified three clusters-A, B, and C-of participants based on psychosocial characteristics. Cluster C had the lowest support from caregivers, other family members, and friends; had the weakest motivation to complete TB treatment; were least likely to live with their mothers; and had experienced the most childhood adversity. Among the 118 (47.4%) participants who received facility-based treatment with single drug formulations, adherence did not differ between Clusters A and B, but Cluster C had six-fold odds of suboptimal adherence compared to Cluster A. In Clusters B and C, adherence worsened over time, but only in Cluster C did mean adherence fall below 90% within six months. Our findings have implications for the care of adolescents with TB. When caring for adolescents with low social support and other risk factors, clinicians should take extra measures to reinforce adherence, such as identifying a community health worker or peer to provide treatment support. Implementing newly recommended shorter regimens also may facilitate adherence.

Informational continuity by skilled birth attendants during antenatal care in Lesotho.

Informational continuity (IC) is one of the four approaches that enables integrated people-centered health services. IC enables the availability of all health and psychosocial information of the pregnant women at all health encounters. World Health Organization (WHO) recognised that ineffective IC results in fragmented health care and duplication of services. Hence, IC may assist in the reduction of maternal morbidity and mortality. The purpose of this study was to explore and describe the experiences of skilled birth attendants (SBAs) with IC during the antenatal period. Three primary healthcare centers in Maseru district, Lesotho. A qualitative descriptive phenomenological design was used with purposive sampling to choose nine participants. Four themes emerged; Theme one: SBAs and pregnant women information communication, theme two: Information communication between the SBAs, theme three: information collection during ANC and theme four: guidelines used during ANC to standardise care. Several challenges regarding information communication form the sources of information, transition of information, information between caregivers and women which demonstrated the frustration between the women and the SBAs during ANC leading to ineffective care coordination. Enabling IC during ANC enables effective data collection from the sources of information, transition of information during care giving within and between health facilities. Effective informational continuity enables effective care coordination in ANC in Lesotho.

Chemotherapy-related symptom networks in distinct subgroups of Chinese patients with gastric cancer

ObjectiveThis study aims to identify distinct subgroups among gastric cancer patients undergoing chemotherapy (CTX), delineate associated symptom networks, and ascertain the clinical and sociodemographic variables contributing to diverse symptom patterns. MethodsConducted in eastern China, our investigation involved gastric cancer patients receiving CTX. We gathered data using the M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module along with clinical and sociodemographic variables. Subgroups were discerned based on symptom severity through latent profile analysis, and subsequent comparisons were made regarding the symptom networks in different subgroups. ResultsThe analysis encompassed 677 eligible gastric cancer patients, revealing three profiles: “Profile 1: low class” (n = 354, 52.3%), “Profile 2: moderate class” (n = 222, 32.8%), and “Profile 3: all high class” (n = 101, 14.9%). Nausea—vomiting exhibited robust associations in the symptom networks of all subgroups, whereas sadness—distress, and taste change—lack of appetite were notably linked with Profile 1 and Profile 2. Distress emerged as a core symptom in Profile 1, lack of appetite dominated the symptom network in Profile 2, and fatigue attained the highest strength in Profile 3. Distinct symptom profiles were influenced by variables such as education level, CTX combined with surgical or herbal treatment, psychological resilience, and social support. ConclusionsPatients within different subgroups manifest individualized patterns of symptom profiles. Analyzing demographics, disease characteristics, and psychosocial information among diverse subgroups facilitates healthcare providers in devising more personalized and targeted symptom management strategies, thereby alleviating the symptom burden on patients.

Factors That Predict Early Return to Work After Myocardial Infarction: Importance of Coworker Support.

Aim Myocardial infarction (MI) affects the working-age group and cause many absences and lost days of work. Some occupational factors effect in the prognosis of MI patients. The objective of this study was to determine predictors of early, late and no return to work (RTW) after MI.Material and methods In this cohort study, 240 pre-employed, male patients with MI from April 2020 through February 2022 provided data about their demographic, occupational, psychosocial, and medical information. Data was also collected about the treatment they received as patients, their feelings about socioeconomic support, and RTW time. RTW within two weeks after MI was defined as early RTW. The relationships of these variables and with early RTW and with late or no RTW were analyzed.Results Ninety-four patients (39.6 %) returned to work within two weeks after MI, whereas 207 patients (87.3 %) returned to work by the end of six months. Many variables, including coworker support, were associated with early RTW in a univariate analysis. Regression analysis revealed that age, coworker support, marital status, the patient's own estimated RTW time, the number of the vessels with occlusion, and comorbidity were predictors of early RTW. Of these factors, only coworker support would be subject to modification.Conclusions This study indicates that improving support from coworkers can increase early RTW after MI.

Associations between self-perceptions of aging and social functioning in older adults: An analysis based on health and retirement study data

ObjectivesSelf-perception of aging (SPA) and social functioning are two important variables in the process of healthy aging, but the relationship between them is still unclear. This study aimed to explore the association between SPA and social functioning in older adults. MethodsWe conducted a longitudinal study utilizing data from the Health and Retirement Study. The sample comprised individuals aged 50 and above. Socio-demographic, psychosocial, and lifestyle information of study participants was systematically collected at baseline (2012 and 2014) and during follow-up four years later (2016 and 2018). SPA was measured using a scale assessing individuals' attitudes toward their aging process. Social functioning was evaluated through 22 questions, reflecting individuals' abilities to engage in and perform various roles and tasks in their daily lives. Multilevel modeling was employed to analyze the relationship between SPA and social functioning. Differences in social functioning changes among various SPA groups were assessed through the Generalized Estimating Equations methodology. ResultsThe study included 8,454 participants with an average age of 68.3 years (SD = 9.92). The multilevel model revealed a significant correlation between SPA and social functioning (β = 0.131; P < 0.001). This relationship persisted after adjusting the model (β = 0.088; P < 0.001). Generalized Estimating Equations indicated noteworthy differences in social functioning changes among distinct SPA groups (P = 0.034). DiscussionPositive SPA is associated with the healthy social functioning of older adults. Healthcare providers could target modifiable aspects of SPA to enhance the social function of older adults and promote successful aging.

Identifying modifiable psychosocial outcomes to maintain physical ACTIVity and promote independence in DEMentia: the ActivDem study

AbstractBackgroundPromoting habitual physical activity (HPA; e.g. walking) may help decelerate dependency and disability in people with dementia (PwD). HPA refers to any movement the skeletal muscles make which requires energy expenditure, including daily tasks (e.g. gardening/housework). Research regarding physical activity in PwD mainly focuses on exercise‐based activities, which may not be feasible for people with chronic health conditions or frailty, or who cannot afford or travel to exercise classes. Promoting participation in HPA may be an inclusive, accessible strategy to support PwD to remain physically active and mobile. PwD participate in less HPA than recommended and disease‐specific factors (e.g. cognition) do not sufficiently explain this. In healthy ageing, HPA participation is associated with multiple socio‐ecological factors (e.g. psychosocial wellbeing/social support/environment) but this has not been explored in dementia. The ActivDem study aims to identify key socio‐ecological influences on HPA change over time in community‐dwellers with dementia. Figure 1 presents ActivDem’s core objectives.MethodPwD and their carers will be recruited from the ongoing cohort study, DETERMIND, they will participate in a continuous seven‐day HPA assessment. This involves wearing an inertial measurement unit on their lower back at baseline and one‐year follow up. Digital mobility outcomes relating to volume (e.g. steps per day), pattern (e.g. mean ambulatory bout length), and variability (i.e. of bout length) will be derived via validated algorithms. PwD will also complete the LASA Physical Activity Questionnaire and Falls Efficacy Scale. Carers will complete the Dementia Management Strategies Scale. Demographic, clinical and psychosocial characteristics and information on care support will be assessed as part of the DETERMIND study (1).ResultLongitudinal statistical methods will identify key predictors of HPA change in PwD, and examine the relationship between HPA and independenceConclusionThe ActivDem study will identify key socio‐ecological predictors of HPA change, these will inform key interventional components to support PwD to remain physically active and mobile following diagnosis of dementia.

Identifying modifiable psychosocial outcomes to maintain physical ACTIVity and promote independence in DEMentia: the ActivDem study

AbstractBackgroundPromoting habitual physical activity (HPA; e.g. walking) may help decelerate dependency and disability in people with dementia (PwD). HPA refers to any movement the skeletal muscles make which requires energy expenditure, including daily tasks (e.g. gardening/housework). Research regarding physical activity in PwD mainly focuses on exercise‐based activities, which may not be feasible for people with chronic health conditions or frailty, or who cannot afford or travel to exercise classes. Promoting participation in HPA may be an inclusive, accessible strategy to support PwD to remain physically active and mobile. PwD participate in less HPA than recommended and disease‐specific factors (e.g. cognition) do not sufficiently explain this. In healthy ageing, HPA participation is associated with multiple socio‐ecological factors (e.g. psychosocial wellbeing/social support/environment) but this has not been explored in dementia. The ActivDem study aims to identify key socio‐ecological influences on HPA change over time in community‐dwellers with dementia. Figure 1 presents ActivDem’s core objectives.MethodPwD and their carers will be recruited from the ongoing cohort study, DETERMIND, they will participate in a continuous seven‐day HPA assessment. This involves wearing an inertial measurement unit on their lower back at baseline and one‐year follow up. Digital mobility outcomes relating to volume (e.g. steps per day), pattern (e.g. mean ambulatory bout length), and variability (i.e. of bout length) will be derived via validated algorithms. PwD will also complete the LASA Physical Activity Questionnaire and Falls Efficacy Scale. Carers will complete the Dementia Management Strategies Scale. Demographic, clinical and psychosocial characteristics and information on care support will be assessed as part of the DETERMIND study (1).ResultLongitudinal statistical methods will identify key predictors of HPA change in PwD, and examine the relationship between HPA and independenceConclusionThe ActivDem study will identify key socio‐ecological predictors of HPA change, these will inform key interventional components to support PwD to remain physically active and mobile following diagnosis of dementia. References • Farina et al., 2020. DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers (DETERMIND): A protocol paper. Int. J. Geriatr.

Patient-centeredness in psychiatric work disability evaluations and the reproducibility of work capacity estimates

ObjectivesTo evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates. MethodsIn our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patient-centeredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant’s WC on a scale from 0% to 100%. ResultsPatient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant’s emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility. ConclusionsMany of the experts’ questions addressed the claimant’s lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. Practice implicationsPatient-centeredness in work disability evaluations should find its entry in continuing education of experts.

Perspectives of healthcare professionals and people living with HIV in dialogue: on information sharing to improve communication at the consultation

ABSTRACT We report on a qualitative Group Survey study involving four healthcare professionals (HCPs) and eight people living with HIV who were recipients of care in the United Kingdom (UK). The survey aimed to bring participants’ perspectives into dialogue and establish consensus about how communication between HCPs delivering HIV care and their patients could be improved in the context of the routine care consultation. Responses from both parties were anonymously collated, thematically analysed, and shared back with participants in two subsequent survey rounds to support consensus-building on matters of concern and identify thematic insights. In this paper, we report three themes for informing future designs of tools and services to support communication between patients and HCPs: Patient-clinician relationship for trusted sharing; Self-reporting psychosocial information to support Whole-person care; and Perceived barriers for online trusted sharing with HCPs. Our findings highlight key areas of concern and further investigation is needed to understand how self-reported information may be meaningfully captured, interpreted and processed by HCPs in ways that are trusted by patients who voice privacy and security concerns.

Transmit Radiant Individuality to Offspring (TRIO) study: investigating intergenerational transmission effects on brain development.

Intergenerational transmission is a crucial aspect of human development. Although prior studies have demonstrated the continuity of psychopathology and maladaptive upbringing environments between parents and offspring, the underlying neurobiological mechanisms remain unclear. We have begun a novel neuroimaging research project, the Transmit Radiant Individuality to Offspring (TRIO) study, which focuses on biological parent-offspring trios. The participants of the TRIO study were Japanese parent-offspring trios consisting of offspring aged 10-40 and their biological mother and father. Structural and functional brain images of all participants were acquired using magnetic resonance imaging (MRI). Saliva samples were collected for DNA analysis. We obtained psychosocial information, such as intelligence, mental health problems, personality traits, and experiences during the developmental period from each parent and offspring in the same manner as much as possible. By April 2023, we completed data acquisition from 174 trios consisting of fathers, mothers, and offspring. The target sample size was 310 trios. However, we plan to conduct genetic and epigenetic analyses, and the sample size is expected to be expanded further while developing this project into a multi-site collaborative study in the future. The TRIO study can challenge the elucidation of the mechanism of intergenerational transmission effects on human development by collecting diverse information from parents and offspring at the molecular, neural, and behavioral levels. Our study provides interdisciplinary insights into how individuals' lives are involved in the construction of the lives of their descendants in the subsequent generation.