Subscale Scores Research Articles

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

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

Mental health literacy in patients with acute myocardial infarction: a cross-sectional registry-based study

IntroductionThis study aimed to explore mental health literacy (MHL) and its related factors in a cross-sectional, registry-based sample of patients after acute myocardial infarction (AMI).MethodsAll survivors of AMI between 2017 and 2019 from the Myocardial Infarction Registry Augsburg (n=1.712) received a postal questionnaire on MHL (Mental Health Literacy Scale (MHLS-GER)) and single questions on experiences with and information on mental disorders in 2023. The response rate was 49.9%. Logistic and linear regression models were used to investigate the associations between these variables and sociodemographic factors.ResultsIn the sample of 855 patients (77.5% male, mean age 71.4 ± 10.9 years), 30.0% had experienced mental problems about 5 years after AMI. Among these, 17.4% received psychotherapy and 26.1% psychotropic drugs. Information about possible mental problems after their AMI was obtained from a physician by 30.8% of the patients and in a rehabilitation setting by 46.4%, respectively. Of the patients, 26.2% wished to receive more information on mental problems after AMI. MHLS-GER subscale scores ranged between and 54 (“Social distance”) and 76 (“Information seeking”) (best score 100). Age was the most important factor that was significantly associated with the report of mental health problems, a perceived lack of information, help seeking behavior and treatment, and MHL.DiscussionElderly and poorly educated patients were at risk of poor MHL. Further studies are required to specify the role of MHL in post-AMI life and health care.

Abstract 4116708: Variations in Patients’ Perceptions of Continuity of Care After Hospitalization Due to Cardiac Condition

Background: Continuity of care is crucial to enabling a seamless chain of care after hospitalization due to cardiac conditions. Most measurements (e.g., continuity indexes) neglect the patient's perception of continuity. Inequality in medication and treatment is well known within cardiac care, but there is a lack of knowledge about whether there are inequalities in how patients perceive continuity of care after hospital discharge. Aims: Describe perceptions of continuity of care after hospitalization in patients with cardiac conditions and variations in age, gender, and diagnosis. Methods: This cross-sectional study included patients hospitalized at 4 hospitals in Sweden due to cardiac conditions. Data were collected using the Patient Continuity of Care Questionnaire, a 27-item questionnaire with 6-subscales. A sub-scale score <4 indicates an area of concern. Factorial ANOVA was used to analyze interactions or main effects of sex, age (<65 or ≥65), and diagnosis (angina, atrial fibrillation, heart failure, myocardial infarction) on perceived continuity of care. Independent t-tests or post-hoc analysis with LSD correction compared group differences. Results: A total of 1,000 patients were included, with a mean age of 72 (SD 10) years, 661 (66%) males. For the sub-scales, no significant 3- or 2-way effects were found. In the sub-scale: Information to patient (mean 4.1), significant differences were found in sex, age, and diagnosis. For the sub-scales Relations in hospital (mean 4.3) and Relations in community (mean 4.1), significant differences were found in sex and diagnosis. There were significant differences between the diagnosis groups in the sub-scale: Management of follow-up (mean 3.9). In the sub-scale: Management of communication (mean 3.7), significant differences were found in sex and age. For the sub-scale: Management of forms (mean 3.8), significant differences were found based on age. See Figure 1a-1c for details. Conclusion: Overall, patients hospitalized due to cardiac conditions reported a quite high level of continuity of care. However, statistically significant differences were found, and men, younger patients and those hospitalized due to myocardial infarction perceived higher levels of continuity or care. This indicates that patients who are more dependent on continuity of care, who might be more fragile and have a diagnosis with a complex clinical pathway, are experiencing lower levels of continuity of care

Abstract 4125581: Association Between Life’s Essential 8 and Premature Atherosclerotic Cardiovascular Disease: A Cross-sectional Study Among Young Adults in the United States

Background: Among patients presenting with atherosclerotic cardiovascular disease (ASCVD), the proportion of young individuals has increased in recent years. Life’s Essential 8 (LE8), containing two domains of health behaviors and health factors, is an updated monitoring measurement of cardiovascular health by assessing 8 modifiable risk factors. Objective: The objective of this study is to investigate the potential relationship between the LE8 score and a history of premature ASCVD among young adults residing in the United States. Methods: This population-based cross-sectional study utilized data from the National Health and Nutrition Examination Survey spanning 2005 to 2018, focusing specifically on adults aged 20 to 45. LE8 score was measured and categorized into low (0-49), moderate (50-79), and high (80-100) levels (Figure 1). Premature ASCVD status was determined by interviews conducted at enrollment, encompassing a self-reported composite disease history of coronary heart disease, angina pectoris, heart attack, and stroke. Following descriptive statistics, weighted multivariable logistic regression and restricted cubic spline models were employed to evaluate the associations between the LE8 score and premature ASCVD. Additionally, subscale and subgroup analysis were developed. Results: Among 17,499 participants, 9846 were eligible for analysis (weighted mean age, 32.7 years; male, 50.3%), and 167 had premature ASCVD history (weighted percentage, 1.46%). The weighted mean LE8 score of the study population was 71.99 (0.3). Following the adjustment for potential confounders, individuals with higher LE8 scores exhibited a reduced risk of developing premature ASCVD (Table 1). A nonlinear relationship was observed and similar patterns were also identified in the association of health behaviors and health factors scores with premature ASCVD (Figure 2). This inverse association was consistently observed across various subgroups, including sex, age strata, ethnicity, education, and income levels, with no significant interactions identified. Conclusions: The LE8 score and its subscale scores exhibited a negative, nonlinear association with premature ASCVD. Maintaining a healthy lifestyle and controlling modifiable risk factors are crucial in preventing premature ASCVD in the younger demographic. Further studies, encompassing prospective cohorts, are needed to confirm this finding.

Comparing two transitioning strategies to paliperidone palmitate once-every-6-months.

A double-blind, randomized, active-controlled, parallel-group, noninferiority trial (NCT03345342) demonstrated that paliperidone palmitate once-every-6-months (PP6M) was noninferior to paliperidone palmitate once-every-3-months (PP3M) in preventing relapse in clinically stable adults with schizophrenia. This post hoc analysis assessed efficacy and safety following transition to PP6M from paliperidone once-monthly (PP1M) versus PP3M. Adults with schizophrenia who were clinically stable on moderate/high doses of PP1M or PP3M were randomly assigned 1:2 to dorsogluteal PP3M or PP6M treatment for 12months. The primary efficacy measure was time to relapse during the 12-month DB phase. Secondary endpoints included change from DB baseline to endpoint in Positive and Negative Syndrome Scale (PANSS) total and subscale scores, Clinical Global Impression-Severity (CGI-S) scale score, and Personal and Social Performance (PSP) scale score. Safety was assessed by treatment-emergent adverse events (TEAEs), vital signs, and clinical laboratory tests. Of 702 patients in the study, 231 transitioned from PP1M to PP6M and 247 transitioned from PP3M to PP6M. Low relapse rates for PP6M were observed regardless of transition pathway (PP1M/PP6M: 7.8%; PP3M/PP6M: 7.3%). Changes from DB baseline to endpoint in PANSS total, PSP, and CGI-S scores were similar between transition groups. In the DB phase, ≥1 TEAE was observed in 61.0% and 63.2% of patients in the PP1M/PP6M and PP3M/PP6M, groups, respectively. Adults with schizophrenia who transitioned to PP6M from either PP1M or PP3M experienced similarly low relapse rates. Additionally, symptom and functionality scores supported the primary analysis and, along with TEAE incidences, were comparable between transition groups.

Psychometric Evaluation of the Dutch version of the Substance Use Recovery Evaluator (SURE-NL)

Introduction Patient-Reported Outcome Measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The Substance Use Recovery Evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking patients with SUD. Methods The original SURE questionnaire was translated from English to Dutch using forward-backward translation. A total of N=171 participants were recruited as part of a naturalistic multicenter study in inpatient (N=149) and outpatient (N=22) SUD treatment centers. We examined the factorial structure, reliability, and concurrent and discriminant validity of the SURE-NL. Results The original 5-factor structure of the SURE showed acceptable fit for the SURE-NL, and internal consistencies of the subscales ranged from .61 to .76 and internal consistency of the total score was .83. Concurrent validity was confirmed through positive correlations of the SURE-NL total and subscale scores with the WHOQoL-BREF subscales, but correlations varied depending on subscale and treatment setting, with higher correlations for the outpatient compared to the inpatient subgroup. Discriminant validity was confirmed through low, mostly non-significant correlations between the SURE-NL and the DASS-21. Conclusions Although the SURE was originally designed for outpatient settings, our findings in a predominantly inpatient sample indicate that the SURE-NL is suitable for assessing personal recovery and recovery capital in Dutch-speaking Belgian patients with SUD. However, subscales should be used and interpreted with caution. Further research is needed with larger Dutch-speaking outpatient samples and the development of a tailored SURE for inpatient settings should be considered.

The efficacy of training based on the family-centered empowerment model on the mental health of aged women: a stratified randomized controlled trial

BackgroundMental health among older women is substantial due to their longer life expectancy. They are more susceptible to mental disorders like depression and anxiety compared to older men. Additionally, older women fulfill essential family roles and depend on social support for age-related health issues. Family-centered education provides a platform to assist families and foster a collaborative relationship between the patient, family members, and health care providers in end-of-life care. The study aimed to explore how education based on family‑centered empowerment model affects mental health in aged women.MethodsThis randomized controlled trial involved a group of 60 elderly women aged 60 years and older, specifically selected from elderly-friendly health centers in Tabriz-East Azerbaijan, who were randomly assigned to either an intervention or control group with an equal ratio. The intervention group received a family-centered healthy lifestyle intervention weekly for 10 sessions, while the control group received standard care from elderly-friendly centers. The mean score of mental health using a three-part questionnaire of demographic-anthropometric characteristics and a mental health questionnaire (GHQ) were assessed before the intervention, 4 and 8 weeks after the intervention through SPSS/version 13 using, ANCOVA, independent t‑test, and repeated measure analysis at a significant level of p < 0.05.ResultsThe average age (standard deviation: SD) was 64.0 (3.8) years. The literacy level of the more than half of the participants was primary school. Regarding occupation and marital status, the majority of them were married and housekeeper. Two months after the intervention (end of the intervention), a significant decrease was detected in terms of overall mental health score in the intervention group compared to the control (the adjusted difference was − 5.7 with a 95% CI from − 10.3 to -1.1, and the p-value was 0.015). In the intragroup analysis, two months after the intervention, there was a significant decrease in overall mental health score compared to baseline in the intervention group (the mean change was − 5.4, with a 95% CI from − 9.9 to -0.9, and a p-value of 0.015). Moreover, a significant decrease was indicated in the physical subscale score in the intervention group compared to the control group (the adjusted difference was − 5.7, with a 95% CI from − 10.2 to -1.2, and a p-value of 0.015). There was no significant difference between the two groups in other subscales (p > 0.05). In the intragroup analysis, there was a significant decrease in the physical subscale score (the mean change was − 1.7, with a 95% CI from − 2.9 to -0.2, and a p-value of 0.038) and anxiety symptoms (the mean change was − 1.8, with a 95% CI from − 3.4 to -1.0, and a p-value of 0.033) compared to the baseline in the intervention group.ConclusionAn education based on family-centered empowerment model could improve the overall mental health score in elderly women. Hence, it may be recommended to regard this approach as a practicable educational strategy for improving the well-being of the elderly.Trial registrationIranian Registry of Clinical Trials; https://irct.behdasht.gov.ir/trial/30535 (IRCT20161126031087N2), registered (03/08/2018).

Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial.

Young people in low- and middle-income countries encounter significant barriers to accessing mental health support due to various factors, including a substantial treatment gap and limited health care budgets allocated to mental health. Using innovative strategies, such as scalable digital self-help psychological interventions, offers a potential solution for improving access to mental health support. However, digital mental health interventions come with their own set of challenges, including issues related to low user engagement. Chatbots, with their interactive and engaging nature, may present a promising avenue for the delivery of these interventions. This study aims to explore the effectiveness of a newly developed World Health Organization (WHO) digital mental health intervention, titled Scalable Technology for Adolescents and Youth to Reduce Stress (STARS). A single-blind, 2-arm randomized controlled trial will be conducted nationally across Jordan. Participants will include 344 young adults, aged 18-21 years, currently residing in Jordan. Inclusion criteria are heightened levels of psychological distress as determined through the 10-item Kessler Psychological Distress Scale (≥20). Assessment measures will be conducted at baseline, 1-week post intervention, and 3-month follow-up. Following baseline assessments, eligible participants will be randomized to receive STARS or enhanced usual care. The primary outcomes are the reduction of symptoms of depression and anxiety (Hopkins Symptom Checklist, 25 subscales) at 3-month follow-up. Secondary outcomes include general functioning (WHO Disability Assessment Schedule 2.0), well-being (WHO-5 Well-Being Index), personal problems (Psychological Outcomes Profile), and agency (State Hope Scale subscale). The study was funded in January 2020 by the Research for Health in Humanitarian Crises Programme (Elhra) and recruitment for the trial started on July 16, 2023. As of November 15, 2023, we randomized 228 participants. This trial intends to contribute to the growing digital mental health evidence base by exploring technological solutions to address global public health challenges. Given the widespread use of technology globally, even in resource-constrained settings, and the high adoption rates among adolescents and young individuals, digital initiatives such as STARS present promising opportunities for the future of mental health care in low- and middle-income countries. ISRCTN Registry ISRCTN10152961; https://www.isrctn.com/ISRCTN10152961. DERR1-10.2196/54585.

Gender features of clinical manifestations and quality of life indicators in generalized myasthenia

Objective. To study the influence of clinical indicators of myasthenia gravis severity to the quality of life of men and women with generalized myasthenia gravis.Materials and methods. The study included 41 patients aged 60.4±16.4 years with generalized myasthenia gravis: 31 (76 %) women and 10 (24 %) men. Clinical manifestations of myasthenia gravis were assessed with quantitative myasthenia gravis score, myasthenia gravis-specific activities of daily living scale and short form of specialized quality of life questionnaire. Forced vital respiratory capacity was measured in all patients with subsequent additional data calculation.Results. We revealed significant improvement of examined data during hospitalization in both males and females, but in females, significant improvement was established in all quantitative myasthenia gravis score subscales. In men worse affection of swallowing muscles and severe pain phenomena were revealed. Correlations of physical functioning parameter with total quantitative myasthenia gravis score and with score characterizing the strength of limb muscles were revealed in studying group.Conclusion. Clinical manifestations and course of myasthenia gravis have the peculiarities n men and women. Quality of life disorder in studying patients correlated with severity of clinical manifestations, mainly with limb weakness.

Reliability and Validity of the Turkish Version of the Deglutition Handicap Index.

The Deglutition Handicap Index (DHI) is a self-reported questionnaire focus on dysphagia related quality of life of patients. The present study was aimed to translate the DHI into Turkish, and investigate the reliability and validity of the Turkish version of the DHI (T-DHI). A total of 100 patients with different diagnoses participated. The study was carried out in 3 phases including translation, reliability and validation phases. The translation phase was performed by the forward-backward-forward translation methodology. The internal consistency and test-retest reliability were used for reliability phase. The criterion validity of the T-DHI was investigated for validation phase. The Cronbach's alpha value of the T-DHI was 0.93 of which indicates excellent internal consistency. The Intraclass Correlation Coefficient ranged from 0.96 to 0.99 for test-retest reliability. There was negative and weak correlation between functional subscale score from the T-DHI and the Functional Oral Intake Scale (r=-0.29, p = 0.004), and positive and moderate to strong correlations between total and subscale scores from the T-DHI and the Turkish version of the Eating Assessment Tool (r = 0.67-0.78, p < 0.001) indicating sufficient criterion validity. The T-DHI is a reliable and valid questionnaire to define dysphagia related quality of life of patients. Clinicians could be used the T-DHI during swallowing evaluation part during the management process of deglutition disorders to plan patient centered rehabilitation, improve care and follow up.

Sense of coherence in students while studying abroad

Background: In the 1970s, medical sociologist Aaron Antonovsky developed the concept of salutogenesis, which is the study of health and development focusing on sense of coherence (SOC). Although salutogenesis has been well researched in higher education contexts, the concept has not been studied in depth in intercultural and cross-cultural settings, such as the one provided by semester at sea (SAS), which is a United States (US) study-abroad programme.Aim: The aim was to investigate and compare levels of SOC in students in the SAS study-abroad programme.Setting: The research was conducted during a selected voyage at sea over a period of 106 days.Methods: The authors used a quantitative cross-sectional correlational design and investigated mean score differences in three SOC sub-scale scores measuring meaningfulness, comprehensibility, and manageability. The authors compared US students’ SOC scores to those of students from other countries and compared the scores of women to men. Measurement invariance was firstly established before investigating mean score differences. Data were collected in the form of a survey, using Antonovsky’s 29-item Life Orientation Questionnaire.Results: The study shows that overall scores in meaningfulness were the highest, followed by manageability and comprehensibility, which potentially supports the idea that the motivational component in life of these students is the most important. Finally, women scored higher in meaningfulness than men.Conclusion: The study can provide insights in SOC in students and might provide implications for interventions regarding SOC results across diverse student populations in SAS.Contribution: This article contributes to SOC research in study-abroad programmes.

Rates of socio-emotional difficulties among deaf and hard of hearing children in Ireland

ABSTRACT Higher rates of socio-emotional difficulties for deaf and hard of hearing (DHH) children have been reported compared with their typical hearing (TH) peers. Nonetheless, there has to date been limited examination on this issue internationally and no such examination in the Republic of Ireland. In this study, data was collected from parents using an online survey which included the Strengths and Difficulties Questionnaire to examine the socio-emotional development of 113 DHH children aged 5–16 in the Republic of Ireland. The results were compared with data from typically hearing (TH) children obtained from a large longitudinal study of childhood in Ireland – the Growing Up in Ireland study. The findings demonstrate that the prevalence of socio-emotional difficulties among this cohort of children is over three times that of the general population of children in Ireland, with 42% of the sample demonstrating clinically significant problem scores. Furthermore, DHH children had elevated subscale scores for the four problem scales in the SDQ when compared against the TH sample. These differences were statistically significant and had a range of effect sizes from small to large. The subscale of most concern was the peer problems subscale where the DHH sample had mean scores that were roughly double those of the TH sample, with a large effect size found. Finally, bivariate analysis revealed that several background variables were associated with elevated difficulty scores for DHH children, namely male gender, poorer communicative competency, and presence of an additional educational need.

Prophylactic Swallowing Exercises in Patients with Laryngeal Cancer Who Underwent Total Laryngectomy—A Randomized Trial

Objectives: This study aims to determine the efficacy of prophylactic swallowing exercises on swallowing function in patients undergoing total laryngectomy for laryngeal cancer. Methods: The design was a randomized controlled trial set in one tertiary care academic medical center. A total of 92 patients undergoing total laryngectomy for stages III and IV laryngeal cancer performed five targeted swallowing exercises for a period of three months after their surgery, starting two weeks after the surgery. Weekly swallowing therapy sessions were held with the patients in order to encourage adherence and proper technique. The controls received no preventive exercise and were referred for swallowing treatment following the surgery, as well as radiation therapy if necessary. The Functional Oral Intake Scale (FOIS) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-H&amp;N) were used to measure swallowing function at the baseline, one week following the surgery, and three, six, nine, and twelve months following the surgery. Results: Right after the surgery, there were no statistically significant variations between the intervention and control groups in the FOIS scores (p value = 0.64), the Eating in Public subscale scores (p value = 1) and Normalcy of Diet subscale scores (p = 0.33) of the PSS-H&amp;N. The scores were significantly better among the intervention patients at months 3, 6, 9, and 12 for all the scores, with p values smaller than 0.000. Conclusions: Although not immediately following the surgery, the patients who engaged in prophylactic swallowing exercises showed improvements in their ability to swallow at 3, 6, 9, and 12 months following their procedure.

Gender Differences in Self-Advocacy Among Cancer Survivors: How Women and Men Vary in How They Learn to Engage in Decision-Making and Social Support.

Understanding gender variations in self-advocacy can help oncology clinicians support the educational needs of cancer survivors. This study aims to examine the role of gender along with additional other sociodemographic variables in how cancer survivors self-advocate including their engagement in decision-making, communication with healthcare providers, and use of social support. Data from two cross-sectional descriptive studies were combined for analyses. Each study used convenience sampling methods to recruit adults (≥ 18 years old) with a history of invasive cancer who had English literacy from cancer clinics and community advocacy groups. The first study recruited women (n = 317), and the second study recruited men (n = 179). In both studies, participants completed two assessments of self-advocacy: Self-Advocacy in Cancer Survivorship (SACS) Scale and the Patient Self-Advocacy Scale. We built a linear regression model to test the association between gender and self-advocacy total and subscale scores controlling for covariates. N = 496 participants completed study procedures between 2014 and 2022. On both self-advocacy scales, women reported higher self-advocacy scores compared to men, with women's higher scores on the SACS subscales of connected strength and informed decision-making driving the gender difference in cancer-specific self-advocacy. Self-advocacy behaviors are associated with gender, most notably by way of individuals' ability to derive strength through social connection. Women tend to have greater engagement in care with larger and more meaningful social networks, while men report less engagement. Educational materials for cancer survivors should leverage gender-associated self-advocacy skills and bolster skills that require support.

Persistence of ADHD into adulthood and associated factors: a prospective study.

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in child and adolescent psychiatry. The aims of this study are to describe the persistence of ADHD into adulthood and to explore factors associated with persistence.Methods: This is a prospective study conducted in a clinical sample of Spanish children and adolescents diagnosed with ADHD. After a baseline interview in which a battery of standardized scales was administered (e.g., Strengths and Difficulties Questionnaire (SDQ). A review of the digital medical history was carried out ten years after recruitment. The persistence of the ADHD diagnosis into adulthood and the end-point diagnoses were described. We carried out logistic regression to explore the factors associated with ADHD persistence.Results: Most of the patients (87.5%) kept the ADHD diagnosis into adulthood. Factors associated with ADHD persistence was high SDQ hyperactivity/inattention subscale scores at baseline (OR = 1.197), high scores on the SDQ peer relationship problems subscale (OR = 0.823), number of diagnoses at baseline (OR = 0.490).Conclusions: Our findings show that ADHD diagnosed in children often persists into adulthood. An appropriate transition between child and adolescent mental health services and adult services needs to be mapped out, as a large proportion of children with ADHD will continue to need mental health care during their adulthood.

Diet quality is positively associated with nature Relatedness in a U.S. Population: A pilot study

BackgroundSustainable dietary practices can help reduce greenhouse gas emissions and promote planetary health. The importance of investigating how to promote sustainable dietary practices is therefore crucial. Nature Relatedness measures an individual’s connection to nature and can predict environmental concern and stewardship. While emerging research has suggested those with a higher degree of Nature Relatedness report the intention to follow more sustainable dietary practices, the relationship between actual dietary intake and Nature Relatedness has yet to be fully explored. Therefore, the purpose of this pilot study was to assess the relationship between diet quality and Nature Relatedness. MethodsIn this cross-sectional study, participants across the United States completed the online survey from September to November 2023. Diet History Questionnaire II and Nature Relatedness scale were completed by the participants. Diet quality was assessed using the Healthy Eating Index (HEI)-2020 total and component scores. Nature Relatedness total and subscale scores were computed. Pearson and Spearman Rho correlation coefficients assessed associations between HEI-2020 and Nature Relatedness. Simple linear regression models examined the relationships between HEI-2020 total and component scores and Nature Relatedness (controlling for age, gender, race, and education). ResultsThree hundred adults completed the study. HEI-2020 total score was positively associated with Nature Relatedness (p < 0.001). Total fruit, total vegetable, green and beans, and refined grains component scores were positively associated with Nature Relatedness (p < 0.001). Nature Relatedness significantly predicted diet quality and total fruit, total vegetable, greens and beans, and moderation of refined grains consumption. ConclusionsThere are positive and significant relationships between diet quality, components of dietary intake that may promote planetary health, and Nature Relatedness. Our findings may be used to inform future research and nutrition intervention programs promoting personal and planetary health through nature-based interventions.

Pretreatment Quality of Life and Substance Use Among Patients Diagnosed With Head and Neck Cancer.

There is a paucity of research on the effects of commonly used substances, such as cannabis and other drugs, on quality of life as a contributor to head and neck cancer (HNC) prognosis. We examined associations between non-alcohol or tobacco substance use (cannabis and other illicit drug) and self-reported quality of life in patients with HNC prior to starting treatment. This was a cross-sectional study of patients who presented for routine psych-oncologevaluation prior to treatment between 11/2015 and 9/2022. Primary exposures were cannabis use (never, past, or current users) and current illicit drug use (yes/no). The primary outcome measure was the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) subscales (physical, social/family, functional and emotional). Linear regression models examined associations between pretreatment substance use and FACT-HN subscales adjusting for demographic, socioeconomic, and clinical factors. Of 570 patients, 13.9% endorsed current cannabis and 13.9% current illicit drug use. The mean (SD) scores for FACT-HN subscales were physical well-being = 22.8 (5.0), social well-being = 22.7 (5.5), emotional well-being = 17.5 (4.5), and functional well-being = 18.7 (6.9). In the adjusted models, cannabis use was not independently associated with any FACT-HN subscales. However, patients who currently used illicit drugs reported worse emotional well-being (β = -1.32; 95% CI -2.45 to -0.20). No independent association was found between current illicit drug use and other subscales (physical, social, and functional). Illicit drug use, but not cannabis use, is negatively associated with pretreatment emotional well-being in patients with HNC. Further research exploring the relationships between longitudinal cannabis and illicit drug use and methods of consumption on QoL and cancer outcomes in patients with head and neck cancer is warranted.

Attitudes and Willingness of Patients Toward Organ Donation and Distrust in the Health Care System: Insights from Turkish Family Physicians

ObjectivesOrgan transplant recipients express trust in their physicians with the phrase, "I entrust my life first to Allah and then to you." However, trust is not reflected in organ donor rates in Türkiye despite the rising incidence of end-stage organ failures.The aim of this study was to map individuals' attitudes, willingness, and behaviour towards organ donation, relationships with distrust in the health care system, religious aspects, and demographic variables. Material and MethodsIn a descriptive cross-sectional approach, a face-to-face questionnaire was issued to randomly selected 557 patients in family medicine clinics of two tertiary hospitals in Istanbul city. Positive and negative attitudes subscales of the organ donation attitude scale and distrust in the health care system scale were used. ResultsThe organ donation rate was 12.4%, and 37.9% of participants were willing to donate. A higher education level revealed higher rates of willingness but did not supply a higher donation rate (p=0.001, p=0.048).The liver was the organ with the most potential to donate (90.3%).The average positive and negative attitude scores towards organ donation were 48.10 ± 21.41and 72.11 ± 26.47, highlighting negative tendency. The rate of refusals donated for religious reasons was 30.1%. It was observed that individuals who religiously refused organ donation were less willing to donate and showed higher distrust in the healthcare system (p<0.001; p<0.001),but they exhibited more positive and less negative donation attitude scores versus others (p<0.001; p<0.001). Approximately half of the participants reported awareness of organ donation law and brain death principles supporting a significantly higher donation rate(p<0.001; p<0.001). ConclusionsOur findings highlight a crucial mismatch between willingness, attitudes, distrust, religious aspects, and actual behaviour regarding organ donation. Strategically, educational materials and interventions on relevant laws, brain death principles, and reasons for becoming donors may be more effective than focusing solely on increasing donation rates.

A validation of the Flemish School Burnout Assessment Tool for students between 17 and 21 years old (FS-BAT)

IntroductionThe present study assessed the factor structure, reliability, and convergent validity of the Flemish school burnout assessment tool (FS-BAT) for students between 17 and 21 years old. MethodThe sample consisted of 570 secondary and higher education students between 17 and 21 years old (Mage = 19.14, SDage = 1.11, 81% female). Confirmatory factor analysis (CFA), reliability scores, and the convergent validity were assessed. ResultsCFA revealed four distinguishable but strongly related school burnout core symptoms (i.e., exhaustion, mental distance, cognitive impairment and emotion impairment), referring to one underlying construct ‘school burnout’. The psychological stress complaints and psychosomatic complaints are two separate but positively correlated aspects of the secondary symptoms. The internal consistency of the scales ranged between excellent (.94; total core symptoms scale) and acceptable (.77; psychosomatic complaints scale). The test-retest reliability after five months varied between excellent (the total core scale and secondary symptoms subscales) and good (core symptoms subscales), indicating good stability over time. The convergent validity showed moderate positive correlations with the Perceived Stress Scale and the Perceptions of Academic Stress scale. ConclusionThe current findings illustrate that the FS-BAT can be used as a reliable and valid instrument to assess school burnout symptoms in secondary and higher education students between 17 and 21 years old. Further research to assess the discriminant validity and the relation to other school burnout measures is needed.

Effect of virtual-reality-based education program for managing behavioral and psychological symptoms of dementia: A randomized controlled trial

This study aims to evaluate the effect of the virtual-reality-based education program (VR-EduBPSD) for managing behavioral and psychological symptoms of dementia (BPSD). Sixty-six family caregivers of people with dementia were randomly assigned to either the experimental or control group following a 1:1 ratio. The experimental group received VR-EduBPSD while the control group received analogous paper-based educational materials. The outcome measures were competence in managing BPSD, dyadic relationship, caring self-efficacy, attitudes toward dementia, and behavior management skill. Only the ‘awareness of symptoms’ sub-scale score for competence in managing BPSD showed a significant group-by-time interaction. Significant time effects were also observed on the total and sub-scale scores for competence in managing BPSD, as well as on the dyadic relationship. This program, which utilizes high-immersion VR technology, offers a valuable learning experience for those new to the care of people with dementia. This study was registered at cris.nih.go.kr with number of KCT0006788.