Psychosocial Scores Research Articles

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.

Health-related quality of life in young adults with perinatal HIV after transfer to adult health care in the Netherlands.

Health-related quality of life (HRQoL) in adult people with HIV is lower than that of the general population. Previously, no differences were detected in HRQoL of Dutch children with perinatal HIV (PHIV) compared to norm groups. In this study we compared HRQoL of PHIV young adults (PHIV-YA, aged 18-30) to two norm groups; the healthy Dutch YA population and YA with various chronic conditions. Participants received questionnaires on HRQoL, adherence and demographics. Additional social and healthcare-related variables were collected from patients' medical files. We explored correlations between HRQoL and demographic characteristics. Effect sizes (ES, Hedges' g with confidence intervals) were calculated to quantify the difference between PHIV-YA and norm groups. Of 81 participants, 53 filled out the questionnaires. Compared with the healthy Dutch YA population, PHIV-YA 18-30 had significantly lower HRQoL scores in the school/work subscale. PHIV-YA aged 26-30 had significantly lower total, physical and psychosocial HRQoL scores as well. Participants in the older age category had lower HRQoL scores throughout all subcategories as compared to the younger age group.For PHIV-YA aged 18-25 lower scores on the school/work subscale were correlated with substance use and being born outside the Netherlands. PHIV-YA had low HRQoL scores in school/work functioning compared with the healthy Dutch YA population. The circumstances driving these outcomes are likely to be multi-dimensional, including HIV infection, social background and challenges in growing up with a chronic condition.

Long-term outcomes and quality of life in congenital diaphragmatic hernia survivors treated with extracorporeal life support: A cross-sectional survey.

Few reports have shown Quality-of-Life long-term outcomes in children with congenital diaphragmatic hernia (CDH) who received extracorporeal membrane oxygenation (ECMO) support. We reviewed the short- and long-term outcomes in CDH patients that were supported with ECMO during their neonatal treatment. Telephone interviews of parents of CDH children were performed. The Functional Status Scale (FSS) and the Paediatric Quality of Life Inventory (PedQL, Version 4.0) were completed with the parents. All children with a CDH and supported with ECMO from 2010 to 2023 were included in the study. Twenty children were identified, with two having two ECMO runs. Birth weight was 3.2 kg (median). ECMO support lasted for (median) 13.6 days (range 3.8 to 39). Twelve patients were alive at the time of the survey. The age (median) at time of the interview was 6.3 years (range 1 to 12). The FSS score showed no impairment (FSS score 6) in any domain in eight patients. Two patients had a score of 7, and two patients had a score of 8 and 9, respectively. The PedQL showed a median score 84.5, with a physical health summary score of 92.5 and a psychosocial health summary score of 78.7. The cardiac specific PedQL inventory score was 77. ECMO support for CDH patients is associated with functional and Quality of Life outcomes that are similar to that in other PICU discharge populations. Denying ECMO support to CDH patients on the basis of predicted poor long-term outcomes does not appear to be justified.

Assessment of health-related quality of life of children with idiopathic nephrotic syndrome and their caregivers in China

AimsThe primary aim of this study was to characterize the health-related quality of life (HRQoL) and identify the associated factors among children aged 2 to 18 in China diagnosed with idiopathic nephrotic syndrome (INS). Additionally, the study aimed to evaluate the HRQoL and caregiving burden of their caregivers and investigate the correlation between the HRQoL of the children and that of their caregivers.MethodsThis study recruited 181 children diagnosed with INS from Children’s Hospital, Zhejiang University School of Medicine in China. The proxy-reported PedsQL Generic Core Module (PedsQL™ 4.0 GCM) was used to measure the HRQoL of children, and the EuroQol five-dimensional questionnaire, five-level version (EQ-5D-5L) was applied to measure caregivers’ HRQoL. Differences in scale scores and total scores of PedsQL™ 4.0 GCM were assessed using t-tests and one-way ANOVA. Multivariate linear regression analysis was used to identify the factors associated with children’s HRQoL. Pearson correlation analysis evaluated the correlation between children’s HRQoL and caregiver’s HRQoL.ResultsHRQoL of Children with INS declines with increasing age, and children aged 5-18 had lower scores in physical functioning, emotional functioning, school functioning, psychosocial health summary score, and total PedsQL™ 4.0 GCM score compared to healthy children. Various factors, including the mother filling out the questionnaire, the father being unemployed, and the use of other medications except for steroids, were associated with worse HRQoL of children (p values < 0.05). Additionally, a correlation exists between children’s HRQoL and their caregivers’ HRQoL.ConclusionThis study evaluated the HRQoL of children aged 2-18 years diagnosed with INS in China, along with the HRQoL of their caregivers. Multiple factors potentially influence the HRQoL of children. A significant correlation was observed between the HRQoL of children and their caregivers, who frequently experienced varying levels of caregiving burden. Therefore, it is recommended that healthcare professionals prioritize optimizing HRQoL for children with INS and their caregivers.

Assessment of psychosocial parameters in adolescents seeking orthodontic treatment

AimThe aim of this study was to investigate the psychosocial impact of malocclusion and the motivation for seeking orthodontic treatment among adolescents.MethodsA cross-sectional study included 102 adolescents (ages 11–18) whose malocclusion was rated using 3 occlusal indices: IOTN, DAI, and PAR. The participants answered three structured questionnaires selected to measure Oral Health Related Quality of Life (OHRQoL) through the short form of the Child Oral Health Impact Profile (COHIP), the patient's perceived impact related to orthodontics through the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and self-esteem through the Rosenberg Self-Esteem Scale (RSES). Independent two-tailed t-tests, one-way mixed analysis of variance (ANOVA), and Spearman's correlations were used to test various associations.ResultsPatients with higher malocclusion scores displayed increased psychosocial impact with weak to moderate correlations (0.2 < r < 0.3; p < 0.05), but 98% wished their teeth looked better, and 70% were unhappy about their smile esthetics. The IOTN esthetic component AC was better associated with psychosocial implications of malocclusion (p < 0.01). Self-motivated patients (over 80%) had higher impactful psychosocial scores than patients whose parents were motivated for treatment. Sex did not influence the findings. Older adolescents and bullied individuals were more affected by the psychological burden of malocclusion.ConclusionThe results indicate the prevalence of psychosocial and esthetic impacts of malocclusion over oral and functional problems. PIDAQ discriminated better than COHIP between varying degrees of dental aesthetics. The results suggest that the orthodontist should explore patients' expectations of treatment outcomes, not only the chief complaint.

Physical (in)activity and screen-based media use of adolescents with juvenile idiopathic arthritis over time - data from a German inception cohort

BackgroundRegular physical activity (PA) has been proven to help prevent non-communicable diseases and is beneficial for disease management in chronically ill populations. Physical inactivity and recreational screen-based media (SBM) use are related to poor health outcomes and common among youth. This study aimed to (1) investigate PA levels and recreational SBM use of adolescents with JIA over time and (2) compare these behaviours with those of their peers.MethodsData from JIA patients and their peers enrolled in the inception cohort study ICON at 11 German centers were analyzed. Individuals aged 13 and over were followed prospectively with questionnaires concerning PA level, recreational SBM use, and health-related quality of life (HRQoL) at a two-year interval. Group by time interactions were analyzed using linear mixed models.ResultsData of 214 patients (mean age at first documentation 14.4 ± 0.9 years, female 63%) and 141 peers could be considered. At first documentation, patients were less physically active compared to their peers (p < 0.001). In contrast to their peers, patients’ PA levels increased over time (OR 3.69; 95% CI: 1.01–13.50, p = 0.048). Mean screen time did not differ significantly between patients and peers (first documentation: 3.5 h vs. 3.0 h, p = 0.556; follow-up: 3.6 h vs. 3.3 h, p = 0. 969). During the observation period, male patients reported higher PA levels than female patients, but also higher screen time levels. While low socioeconomic status (SES) (OR 14.40; 95%-CI: 2.84–73.15) and higher cJADAS-10 score (OR 1.31; 95%-CI: 1.03–1.66) increased the likelihood for high SBM use (≥ 4.5 h/d), higher PedsQL psychosocial health score (OR 0.93; 95%-CI: 0.88–0.99) was associated with a decreased likelihood.ConclusionsAdolescents with JIA become more physically active over the disease course and achieve comparable levels of PA and recreational screen time to their peers. However, the vast majority appear to be insufficiently physically active. Future interventions to promote healthy lifestyles should include gender and SES as important determinants to reach most vulnerable groups.

A study of a PERMA-based positive psychological intervention programme in subthreshold depressed patients with newly diagnosed breast cancer: formulation and application.

Depression seriously affects the quality of life of breast cancer patients and even hinders treatment and recovery after diagnosis. Subthreshold depression should be worthy of attention, and the risk of subthreshold depression developing into depression increases if timely intervention is not available. However, there is limited research on interventions for subthreshold depression, especially for newly diagnosed breast cancer patients. Exploring the efficacy of a PERMA-based positive psychological intervention programme in newly diagnosed breast cancer patients with subthreshold depression. Using PERMA as a framework, we constructed the intervention programme through a literature review and expert discussion approach, and revised the programme using the Delphi method. Then we selected 84 newly diagnosed breast cancer patients for a randomised controlled trial. The control group received conventional care (primary care, specialist care, psychological care, etc.), and the observation group received a PERMA-based positive psychological intervention programme. Patient data were collected before and after the intervention, and the dataset consisted of patient responses to general information, the Depression Screening Scale (CES-D), the Hamilton Depression Inventory (HAMD-17), and the Questionnaire on Psychosocial Adjustment in Breast Cancer Patients. A total of 79 patients completed the study (38 patients in the observation group and 41 patients in the control group), and before the intervention, there were no statistical differences in the comparison of general information, subthreshold depression scores, and psychosocial adaptation scores between the two groups (p > 0.05). After the intervention, the subthreshold depression (CES-D and HAMD-17 scores) scores of the observation group were lower than those of the control group (p < 0.01), and the psychosocial adaptation scores were significantly higher than those of the control group (p < 0.01). A positive psychological intervention programme using PERMA as a framework was more effective in reducing subthreshold depression levels and promoting levels of psychosocial adjustment in newly diagnosed breast cancer patients. Interventions for subthreshold depression are not limited to the traditional aftercare model, but rather from a positive psychology perspective. Especially for patients newly diagnosed with breast cancer, this is a new endeavour that has important implications for them. Because, instead of focusing on their negative emotions, we help them gradually adapt to their new identity and treatment process from a positive aspect during their most difficult period, thus reducing their subthreshold depression level and preventing it from developing into a more severe depression.

Analysis of Longitudinal Trajectory and Influencing Factors of Supportive Care Needs in Colorectal Cancer Patients With Enterostomy.

The aim of this study was to understand the dynamic changes in the needs of patients with enterostomy during the 3 months after discharge and its possible influencing factors. A prospective observational design. This study investigated the supportive care needs of patients who underwent colorectal cancer surgery with colostomy in three Chinese hospitals from May 2023 to October 2023 during the 3 months following discharge from the hospital. The growth mix model was used to describe the needs trajectory and analyse the heterogeneity of the trajectory. Univariate analysis was used to find the factors that might affect the heterogeneity of needs trajectory of patients with enterostomy, and then logistic regression analysis was used to determine the influencing factors of the heterogeneity of needs trajectory of patients with enterostomy. The reporting of this study adhered to the STROBE checklist. A total of 232 patients with enterostomy completed follow-up. There was heterogeneity in the developmental trajectories of supportive care needs of enterostomy patients and the trajectories of the five dimensions of supportive care needs. The heterogeneity factors affecting the trajectory of supportive care needs included the enterostomy patient's psychosocial adjustment score, type of enterostomy, and educational background and the heterogeneity factors affecting the five dimensions trajectory of supportive care needs include psychosocial adjustment score, tumour staging, type of enterostomy, smoking, chemotherapy and enterostomy self-care knowledge score. The needs of patients with enterostomy within 3 months after discharge were dynamic. Identifying and meeting the unmet needs of patients with enterostomy was crucial to improving the health-related quality of life of patients with enterostomy. None. The needs of patients with enterostomy were dynamic, with the needs of most patients with enterostomy decreasing within 3 months of discharge, but some patients with enterostomy continued to have high needs at 3 months after discharge, and clinical nurses were expected to pay special attention to these patients.

5184 Tirzepatide Improved Mental and Psychosocial Health-Related Quality of Life in Adults with Obesity or Overweight: Results from the SURMOUNT-4 phase 3 Trial

Abstract Disclosure: T.M. Gibble: Employee; Self; Employment and stockholder, Eli Lilly and Company. D. Cao: Employee; Self; Employment and stockholder, Eli Lilly and Company. M. Murphy: Employee; Self; Employment and stockholder, Eli Lilly and Company. I. Jouravskaya: Employee; Self; Employment and stockholder, Eli Lilly and Company. B. Liao: Employee; Self; Employment and stockholder, Eli Lilly and Company. Background: Tirzepatide is a once weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved in the U.S. for treatment of type 2 diabetes (T2D) and obesity. In the phase 3 SURMOUNT-4 trial with randomized withdrawal of tirzepatide maximum tolerated dose (MTD) after the first 36 weeks, continuing tirzepatide for a total of 88 weeks led to a mean weight reduction of 25.3% from baseline compared to 9.9% for those who switched to placebo (PBO).[1] This analysis evaluated the effect of tirzepatide versus PBO on mental and psychosocial health-related quality of life (HRQoL) outcomes using the SURMOUNT-4 trial data. Methods: Adults (n=783) with body mass index ≥30 or ≥27 kg/m2 and ≥1 obesity-related complication (excluding T2D) were enrolled in an open-label lead-in period to receive tirzepatide once weekly subcutaneously for 36 weeks, escalated to MTD (10 mg or 15 mg). At week (W) 36, 670 participants were randomized 1:1 to continue tirzepatide MTD (n=335) or were switched to PBO (n=335) for 52 weeks. HRQoL was evaluated from W0 to W88 using the Short Form-36 Version 2 Health Survey (SF-36 v2) acute form and Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), where the last observation before discontinuation was carried forward. Higher scores of SF-36v2 (Mental Component Summary [MCS], role-emotional, and mental health), and IWQOL-Lite-CT (psychosocial composite) reflected better levels of mental function. Least square mean (LSM) changes and estimated treatment differences (ETD) between tirzepatide and PBO were calculated using an analysis of covariance model. Results: LSM changes in mental domain scores for SF-36 v2 and IWQOL-Lite-CT were comparable during lead-in (W0 to W36) between participants randomized to tirzepatide and PBO. Significant improvements were observed from W36 to W88 in SF-36v2 mental domain scores for tirzepatide versus PBO, with LSM scores ( ETD) as follows: MCS, 54.6, 52.9 (1.7, p=0.001); role-emotional, 53.0, 51.1 (1.9, p=0.001), and mental health, 55.4, 52.9 (2.4, p&amp;lt;0.001), respectively. LSM change from W36 to W88 in SF-36 v2 mental domain scores for tirzepatide and PBO were: MCS, 0.1 and -1.6; role-emotional, 0.6 and -1.2, and mental health, 0.3 and -2.1, respectively. Tirzepatide showed significant improvements in IWQOL-Lite-CT psychosocial scores versus PBO from W36 to W88, with LSM scores ( ETD) of 87.7, 75.6 (12.1; p&amp;lt;0.001), respectively. LSM change from W36 to W88 in IWQOL-Lite-CT psychosocial scores for tirzepatide and PBO were 5.1 and -7.0, respectively. Conclusion: In the SURMOUNT-4 trial, adults with overweight or obesity continuing on tirzepatide MTD showed significant and sustained improvements in mental and psychosocial HRQoL compared to those switching to placebo. [1] Sattar N. 59th Annual Meeting European Association for the Study of Diabetes; Oct 2023; Hamburg, Germany. Presentation: 6/1/2024

9229 Tirzepatide Improved Mental and Psychosocial Health-Related Quality of Life in Adults with Obesity or Overweight: Results from the SURMOUNT-4 phase 3 Trial

Abstract Disclosure: T.M. Gibble: Employee; Self; Employment and stockholder, Eli Lilly and Company. D. Cao: Employee; Self; Employment and stockholder, Eli Lilly and Company. M. Murphy: Employee; Self; Employment and stockholder, Eli Lilly and Company. I. Jouravskaya: Employee; Self; Employment and stockholder, Eli Lilly and Company. B. Liao: Employee; Self; Employment and stockholder, Eli Lilly and Company. Background: Tirzepatide is a once weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved in the U.S. for treatment of type 2 diabetes (T2D) and obesity. In the phase 3 SURMOUNT-4 trial with randomized withdrawal of tirzepatide maximum tolerated dose (MTD) after the first 36 weeks, continuing tirzepatide for a total of 88 weeks led to a mean weight reduction of 25.3% from baseline compared to 9.9% for those who switched to placebo (PBO).[1] This analysis evaluated the effect of tirzepatide versus PBO on mental and psychosocial health-related quality of life (HRQoL) outcomes using the SURMOUNT-4 trial data. Methods: Adults (n=783) with body mass index ≥30 or ≥27 kg/m2 and ≥1 obesity-related complication (excluding T2D) were enrolled in an open-label lead-in period to receive tirzepatide once weekly subcutaneously for 36 weeks, escalated to MTD (10 mg or 15 mg). At week (W) 36, 670 participants were randomized 1:1 to continue tirzepatide MTD (n=335) or were switched to PBO (n=335) for 52 weeks. HRQoL was evaluated from W0 to W88 using the Short Form-36 Version 2 Health Survey (SF-36 v2) acute form and Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), where the last observation before discontinuation was carried forward. Higher scores of SF-36v2 (Mental Component Summary [MCS], role-emotional, and mental health), and IWQOL-Lite-CT (psychosocial composite) reflected better levels of mental function. Least square mean (LSM) changes and estimated treatment differences (ETD) between tirzepatide and PBO were calculated using an analysis of covariance model. Results: LSM changes in mental domain scores for SF-36 v2 and IWQOL-Lite-CT were comparable during lead-in (W0 to W36) between participants randomized to tirzepatide and PBO. Significant improvements were observed from W36 to W88 in SF-36v2 mental domain scores for tirzepatide versus PBO, with LSM scores ( ETD) as follows: MCS, 54.6, 52.9 (1.7, p=0.001); role-emotional, 53.0, 51.1 (1.9, p=0.001), and mental health, 55.4, 52.9 (2.4, p&amp;lt;0.001), respectively. LSM change from W36 to W88 in SF-36 v2 mental domain scores for tirzepatide and PBO were: MCS, 0.1 and -1.6; role-emotional, 0.6 and -1.2, and mental health, 0.3 and -2.1, respectively. Tirzepatide showed significant improvements in IWQOL-Lite-CT psychosocial scores versus PBO from W36 to W88, with LSM scores ( ETD) of 87.7, 75.6 (12.1; p&amp;lt;0.001), respectively. LSM change from W36 to W88 in IWQOL-Lite-CT psychosocial scores for tirzepatide and PBO were 5.1 and -7.0, respectively. Conclusion: In the SURMOUNT-4 trial, adults with overweight or obesity continuing on tirzepatide MTD showed significant and sustained improvements in mental and psychosocial HRQoL compared to those switching to placebo. [1]Sattar N. 59th Annual Meeting European Association for the Study of Diabetes; Oct 2023; Hamburg, Germany. Presentation: 6/1/2024

8366 Weight Reduction is Associated with Improved Quality of Life in Patients in SURMOUNT-3

Abstract Disclosure: T.H. Gibble: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. D. Cao: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. T.D. Forrester: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. J.F. Brumm: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, is approved in the US for treatment of type 2 diabetes and obesity. In SURMOUNT-3, a phase 3, 72-week, randomized, double-blind clinical trial in adults with obesity/overweight, after 12 weeks intensive lifestyle intervention, treatment with tirzepatide resulted in significantly greater weight reduction than placebo. This post-hoc analysis assessed whether weight reduction was associated with patient-reported outcomes (PRO) improvements in adults treated with tirzepatide. Of 806 adults with obesity (body mass index [BMI] ≥30 kg/m2)/overweight (BMI ≥27 kg/m2) + ≥1 obesity-related complication enrolled in SURMOUNT-3, 579 achieved ≥5% weight reduction with 12 weeks of intensive lifestyle intervention and were randomized to placebo (N=292) or tirzepatide (10/15mg, N=287) for 72 weeks. Adults completed patient-reported outcomes (PRO) questionnaires at randomization and endpoint (72 weeks or early discontinuation), including Short Form-36 Version 2 Health Survey acute form (SF-36v2) and Impact of Weight on Quality of Life-Lite Clinical Trials Version (IWQOL-Lite-CT). Mean change in SF-36v2 norm-based and IWQOL-Lite-CT scores from randomization to endpoint were summarized descriptively by weight reduction targets (≥5%, ≥10%, ≥15%, ≥20%, ≥25%) for adults who received TZP, using the last observation carried forward method. At endpoint, adults with weight reduction showed improvements from randomization in most PRO scores. For SF-36v2, improvements by weight reduction target were seen for General Health (≥5%, 2.6; ≥10%, 2.7; ≥15%, 3.0; ≥20%, 3.3; ≥25%, 3.4), Physical Functioning (3.4, 3.4, 3.8, 4.4, 4.3), Mental Health (0.4, 0.4, 0.7, 0.8, 0.4), Bodily Pain (2.3, 2.5, 3.1, 3.7, 3.9), Role-Physical (1.9, 1.8, 2.2, 2.9, 2.8), Vitality (1.3, 1.3, 1.5, 1.8, 1.4), Social Functioning (0.8, 0.9, 1.1, 2.2, 2.4), Role-Emotional (0.9, 0.8, 1.0, 1.5, 0.9), and Physical Component Score (3.2, 3.3, 3.8, 4.5, 4.7); improvements were less consistent for Mental Component Score (-0.1, -0.2, -0.1, 0.3, -0.2). For IWQOL-Lite-CT, improvements by weight reduction target were seen for total (18.2, 18.6, 19.7, 22.9, 24.1), Physical Function composite (13.6, 14.1, 14.9, 17.1, 17.3), Physical Composite (14.3, 14.9, 15.7, 18.3, 19.3), Physical Pain/Discomfort Composite (16.0, 16.7, 17.8, 21.1, 24.1), and Psychosocial Composite Scores (20.3, 20.6, 21.8, 25.3, 26.7). Adults meeting greater weight reduction targets generally showed greater improvements from randomization in PRO scores. Weight reduction was associated with improvement in most domains of health-related quality of life, including those relating to physical function and mental health. Adults who lost the most weight generally showed the greatest quality of life improvements. Presentation: 6/1/2024

The predictive power of coping strategies of pediatric oncology patients on their quality of life and their attitudes toward diseases.

Pediatric oncology patients face several physical and psychological challenges that can significantly impact their quality of life (QoL) and attitudes toward their illness. Coping strategies are pivotal in managing the emotional and physical burdens of disease. This study aimed to examine the impact of coping strategies of pediatric oncology patients on their QoL and attitudes towards their illness. The descriptive, correlational, and cross-sectional study was conducted with 112 pediatric oncology patients aged 10-18 years. The Sociodemographic Form, Pediatric Cancer Coping Scale (PCCS), Pediatric Quality of Life Inventory (PedsQL), and Child Attitude Towards Illness Scale (CATIS) were used for data collection. Significant correlations were identified between cognitive coping, defensive coping, and CATIS (p<.001). The PCCS and subdimensions significantly predicted CATIS (p<.001), accounting for 15.3% of the cognitive and defensive coping variation. However, there was no relationship between PCCS total and subdimension scores on PedsQL (p=.534). The PedsQL and subdimensions significantly predicted CATIS (p<.001) and accounted for 27.2% of the variation in physical health summary score, emotional functioning, psychosocial health summary score, and total PedsQL score. The study reveals that cognitive coping strategies positively predict attitudes toward illness, whereas defensive coping strategies have an inverse effect. The study proposes that comprehensive care models in pediatric oncology support effective coping mechanisms and enhance the QoL of those who receive them.

Psychosocial profiles influencing healthy dietary behaviors among adolescents in Shandong Province, China: a cross-sectional study.

We aimed to assess the influence of psychosocial profiles on dietary behaviors among school-aged adolescents in China. A cross-sectional study was conducted involving 7,862 adolescents from 100 schools in Shandong, China. Psychosocial profiles and dietary behaviors were assessed using the Junior High School Students' Psychosocial Profiles Questionnaire (JPPQ) and the Chinese Diet Quality Questionnaire (DQQ), respectively. Linear regression models were used to investigate the association between adolescents' psychosocial profiles and dietary behaviors. The mean age of the participants was 13.18 1.15 years; 48.5% of them were boys. The majority of participants (97.90%) were Han Chinese, and approximately half of the participants (50.90%) resided in rural areas. After adjusting for sociodemographic characteristics and family computer and Internet ownership and usage, healthy dietary behavior was positively correlated with higher psychosocial profile scores (p < 0.05). The stratified analysis results revealed that the group with the highest psychosocial profile score was associated with an increased overall global dietary reference (GDR) score in "households without a family computer and Internet" ( : 5.357, 95% Cl: 4.931-5.784, p < 0.05). Good psychosocial profiles exhibit a positive influence on healthy dietary behaviors. Therefore, policymakers should focus on Internet usage to maximize the positive effects on global youth health behaviors.

Topiramate added to metformin for obesity control in women with polycystic ovary syndrome: a randomized clinical trial.

Polycystic ovary syndrome (PCOS) is often linked with obesity, and weight management can improve endocrine and cardiometabolic features. To evaluate the effects of adding topiramate (TPM) to metformin (MTF) on weight control, hormonal and metabolic outcomes in women with PCOS. In a randomized, double-blind, placebo-controlled trial, participants with PCOS and body mass index ≥30 kg/m² or ≥27 kg/m² associated with hypertension, type 2 diabetes, or dyslipidemia followed a 20 kcal/kg diet in addition to 850 mg of MTF or a previous MTF regimen. They were randomized to receive either TPM or placebo (P) alongside MTF. Anthropometric measurements, blood pressure, modified Ferriman-Gallwey score (mFGS), and adverse events were assessed every 4 weeks for 6 months. The primary endpoint was the percent change in body weight from baseline in both groups. Secondary endpoints included changes in clinical, cardiometabolic, and hormonal parameters and psychosocial features. Thirty-one participants were in the MTF+P group and 30 in the MTF+TPM group. The MTF+TPM group showed greater mean weight loss at 3 months (-3.4% vs. -1.6%, p=0.03) and 6 months (-4.5% vs. -1.4%, p=0.03). Both groups improved androgens, lipids, and psychosocial scores. Participants with ≥3% weight loss at 6 months improved mFGS (8.4 to 6.5, p=0.026). Paresthesia was more common in the MTF+TPM group (23.3% vs. 3.2%, p=0.026). Combining TPM with MTF and a low-calorie diet may be an effective, low-cost, easy-to-use, and safe strategy for weight management in women with PCOS, with mild adverse effects.

Relationship Between Sport Specialization and Quality of Life in Young Female Dancers.

To compare quality of life (QoL) between specialized and non-specialized young female dancers. A cross-sectional survey design was used. Young female dancers between the ages of 8-17 years completed the validated pediatric QoL inventory (PedsQL 4.0) and answered the following sport specialization questions: 1) Do you solely perform dance?, 2) Did you quit other sports to focus on dance?, and 3) Do you participate in dance more than 8 months per year? Dancers who responded "yes" to all 3 questions were classified as specialized, while dancers who answered "no" to any of the 3 questions were classified as non-specialized. PedsQL 4.0 subscales (physical, psychosocial, emotional, social, and school) and total scores were compared between specialized and non-specialized dancers using the Mann-Whitney U test with p<0.05 considered statistically significant. As subgroup analyses, the comparisons were repeated with dancers under 12 years (≤12 years) and over 13 years (≥13 years) old. A total of 72 young female dancers were included in the final analysis. The mean age was 12.5 (SD 2.5) years. No QoL differences were found in any subscale or total scores when comparing specialized and non-specialized dancers. However, differences were detected in subgroup analyses. In the dancers ≤12 years, psychosocial and total scores were higher in specialized dancers (57.9%, n=22) compared to non-specialized dancers (42.1%, n=16) (psychosocial p=0.045; total p=0.035). Conversely, in the dancers ≥13 years, psychosocial, emotional, and total scores were lower for specialized dancers (88.2%, n=30) compared to non-specialized dancers (11.8%, n=4) (psychosocial p=0.024; emotional p=0.049; total p=0.024). Our study found that QoL did not differ by sport specialization status when the entire sample was analyzed. However, in subgroup analysis, QoL was higher in specialized dancers in the ≤12 years than non-specialized dancers. Conversely, specialized dancers ≥13 years showed lower QoL than non-specialized dancers. Further studies are necessary to further investigate the difference in QoL when comparing younger to relatively older adolescent female dancers.

Comparative analysis of health-related quality of life between children with bladder and bowel dysfunction versus lower urinary tract dysfunction and healthy controls.

This study aimed to compare health-related quality of life (HRQoL) between children with bladder and bowel dysfunction (BBD) and lower urinary tract dysfunction (LUTD) alone and healthy controls based on self-report forms and parent-proxy report forms. In this retrospective study, clinical records were reviewed. Children with LUTD, with or without bowel dysfunction, and healthy children were included in this study. The dysfunctional voiding scoring system and Rome IV Diagnostic Criteria were used to assess lower urinary tract symptoms. The Rome IV Diagnostic Criteria was also used to evaluate bowel symptoms. The Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaire was administered to investigate pediatric HRQoL. Of the total 252 children (mean age, 7.3±2.1 years) who participated in this study, 78 were classified into the BBD group and 174 into the LUTD group. Compared with the control group, the BBD group had significantly lower total PedsQL scores (p<0.001) and psychosocial healthy summary scores (p<0.001). The BBD group had significantly lower emotional functioning scores than the LUTD group (p=0.023). Children with BBD who presented with fecal incontinence (FI) had a significantly lower social functioning score than those without FI (p=0.023). Children with BBD who present with FI are at higher risk of decreased psychosocial HRQoL, and they require special emotional support. These findings underscore the need for effective treatment and follow-up to improve the HRQoL of children with BBD who presented with FI.

Demonstrating responsiveness of the pediatric cardiac quality of life inventory in children and adolescents undergoing arrhythmia ablation, heart transplantation, and valve surgery.

Pediatric Cardiac Quality of Life Inventory (PCQLI) is a disease-specific pediatric cardiac health-related quality of life (HRQOL) instrument that is reliable, valid, and generalizable. We aim to demonstrate PCQLI responsiveness in children undergoing arrhythmia ablation, heart transplantation, and valve surgery before and after cardiac intervention. Pediatric cardiac patients 8-18 years of age from 11 centers undergoing arrhythmia ablation, heart transplantation, or valve surgery were enrolled. Patient and parent-proxy PCQLI Total, Disease Impact and Psychosocial Impact subscale scores were assessed pre- and 3-12 months follow-up. Patient clinical status was assessed by a clinician post-procedure and dichotomized into markedly improved/improved and no change/worse/much worse. Paired t-tests examined change over time. We included 195 patient/parent-proxies: 12.6 ± 3.0 years of age; median follow-up time 6.7 (IQR = 5.3-8.2) months; procedural groups - 79 (41%) ablation, 28 (14%) heart transplantation, 88 (45%) valve surgery; clinical status - 164 (84%) markedly improved/improved, 31 (16%) no change/worse/much worse. PCQLI patient and parent-proxies Total scores increased (p ≤ 0.013) in each intervention group. All PCQLI scores were higher (p < 0.001) in the markedly improved/improved group and there were no clinically significant differences in the PCQLI scores in the no difference/worse/much worse group. The PCQLI is responsive in the pediatric cardiac population. Patients with improved clinical status and their parent-proxies reported increased HRQOL after the procedure. Patients with no improvement in clinical status and their parent-proxies reported no change in HRQOL. PCQLI may be used as a patient-reported outcome measure for longitudinal follow-up and interventional trials to assess HRQOL impact from patient and parent-proxy perspectives.

Identifying phenotypes in persons with temporomandibular disorders, using latent class analyses: Temporomandibular disorders and phenotypes.

The heterogeneity of persons with temporomandibular disorders (TMD) and the lack of effective treatments have called for a biopsychosocial model and the development of a more personalised treatment approach. Emphasis on phenotypes might be a beneficial approach. Identifying phenotypes among persons with TMD using potential prognostic factors, including personal characteristics and responses to clinical tests. Additionally, examining the distribution of TMD diagnoses within the identified phenotypes. A cross-sectional study including 208 persons (85% females) seeking physiotherapy for problems in the temporomandibular area. All participants were examined clinically and answered questionnaires electronically. The phenotypes were identified using latent class analysis based on seven potential prognostic factors selected within pain, function and psychological domains. Table analysis was used to explore the distribution of TMD diagnoses within the identified phenotypes. Most participants fit into one of three identified phenotypes. Phenotype 1 (32%) was characterised by functional disability, low psychosocial scores and low risk for developing chronicity and future work disability; Phenotype 2 (29%) by parafunctional habits, low psychosocial score and seeking treatment to reduce pain; and Phenotype 3 (39%) by high levels of mental distress, fear avoidance and a large risk of future work disability. Intra-articular disorders dominated Phenotype 1, myalgia and TMD-related headache Phenotype 2, while Phenotype 3 included all the different TMD diagnoses. The knowledge about the three identified phenotypes might be useful for clinicians treating persons with TMD and for the development of preventive strategies and more personalised treatment.

Patient-Reported Preoperative Depression as a Predictor of Psychosocial Outcomes After Gender-Affirming Facial Feminization Surgery.

To understand psychosocial functioning before and after gender-affirming facial feminization surgery (FFS) as well as identify predictors of postoperative psychosocial functioning. Few investigations have rigorously explored the impact of gender-affirming FFS on psychosocial functioning in transgender and gender non-binary (TGNB) individuals. This knowledge gap hinders the identification of methods to optimize mental health quality-of-life outcomes after FFS and carries repercussions for access to care. Adult TGNB participants awaiting gender-affirming FFS were prospectively enrolled and administered Patient-Reported Outcomes Measurement Information System (PROMIS) instruments assessing anxiety, anger, depression, global mental and physical health, positive affect, emotional support, social isolation, companionship, and meaning and purpose before and 3-6 months after FFS. Paired t-tests compared pre- and postoperative scores. Multivariable linear models identified predictors of postoperative psychosocial outcomes. Among the domains, psychosocial scores improved for anxiety, depression, global mental health, social isolation, and positive affect after FFS. When accounting for potential variables contributing to postoperative psychosocial scores including other gender-affirming surgeries, hormone therapy duration, and private versus public insurance type, we found that preoperative depression scores independently predicted the variance in all other postoperative scores with global mental health (β=-0.52, 95%CI -0.58--0.31 P<0.001), anxiety (β=0.40, 95% CI 0.21-0.51, P<0.001), and meaning and purpose (β=-0.52, 95% CI -0.78--0.42 P<0.001) as the strongest models. This study suggests that gender-affirming FFS improves psychosocial functioning; however, such improvements are highly influenced by the baseline psychological functioning of each individual. These findings indicate that preoperative psychological functioning may be a potential avenue for improving outcomes after FFS via perioperative psychological interventions.

Patient reported outcome measures at a large district general hospital post-mastectomy and implant based reconstruction.

11 Background: Breast reconstruction surgery for cancer can be a debilitating and life changing experience for patients, with complex affects on physical and mental health throughout the rehabilitation journey. We conduct a study on a cohort of patients undergoing this procedure, with focus on patient reported outcome measures. Methods: We reviewed all patients who underwent breast reconstruction surgery at our hospital from 2017 to 20223. Demographic, diagnosis, pre- and post-operative adjuvant treatment, and implant characteristics were collected. Psychosocial well being, physical wellbeing, satisfaction with breasts scales of the BREAST-Q were used. Independent t-test was conducted to find differences between PROMs for each group, and linear regression of age and implant size on each score. Results: 69 patients were contacted and 39 PROMS collected. The average age of patients was 57.6 years old. 40% were previous or current smokers and 40.8% had BMI&gt;30. 29 had pre-pectoral placement and 40 sub-pectoral. 17 had smooth implants and 52 textured. The average size of implant was 330mm. Immediate reconstruction was associated with a lower psychosocial score (66.0vs86.9, p=0.02) compared to multi-stage implants. Sub pectoral placement was associated with a higher (75.7vs61.9 p=0.046) psychosocial score than pre pectoral placement. Textured surface was associated with lower physical score than smooth surface (34.7vs50.2 P=0.046). On linear regression, age was positively associated (p=0.007) with psychosocial score. Conclusions: These findings underscore the importance of personalized approaches in surgery, considering implant type, placement technique, and patient age. Surgeons should prioritize patient preferences and needs to optimize post-surgical satisfaction and well-being.