Self-rated Change Research Articles

Simulation requires activation of self-knowledge to change self-concept.

Simulating other people can shift one's self-concept, an effect known as simulation-induced malleability. How does imagining others shift the self? We propose that the activation of self-knowledge is the key factor by which simulation of others alters one's self-concept. We test this possibility across four studies that each manipulate self-knowledge activation indirectly during simulation and measure the impact on subsequent self-ratings. Results demonstrate that increasing activation of self-knowledge during simulation is associated with increased self-concept change. People experienced greater self-concept change when simulating similar others (Studies 1 and 2). People also generalized simulation-induced changes to aspects of the self-concept that were semantically similar to the simulated content (Study 3). Finally, people who are less likely to recruit self-knowledge (i.e., older adults) during simulation were less susceptible to self-concept change (Study 4). These studies highlight self-knowledge activation as an essential component of the effects of simulation on self-rated change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Actual and imagined music-cued gait training for people with multiple sclerosis: a multicentre qualitative study

ObjectivesTo explore the experiences and acceptability of music-cued motor imagery (MCMI), music-cued gait training (MCGT), and combined MCMI and MCGT (MCMI-MCGT) in people with multiple sclerosis (pwMS). We also aimed...

Implementing a research methods curriculum for first year hematology oncology fellows.

9034 Background: The Hematology/Oncology Fellowship Program at the University of Alabama at Birmingham is an ACGME accredited, three-year academic training program. Fellows are expected to participate in at least one mentored research project during their second and third years of training. The program, however, did not provide formal training in research methods. Here, we provide the results of implementing a research methods curriculum for first year fellows to fulfill that educational need and to facilitate engagement in research projects throughout their fellowship training. Methods: We developed a structured curriculum composed of 10 didactic sessions covering the fundamental concepts of epidemiology and biostatistics. Based on the core competencies of research methods, learning objectives integrated concepts of 1) study design; 2) identifying bias and confounding; 3) exploratory data analysis, statistical inference, hypothesis testing; and results interpretation; and 4) critical appraisal of research evidence. The course was designed to promote self-directed learning and build on individual experiences and interests. One-on-one meetings between curriculum faculty and fellows facilitated identification of fellow research interests and pairing with mentors with aligned expertise. The didactic sessions were evaluated using a 21 question pre- and post- knowledge assessment. Fellows also self-rated on a 10-point scale their level of confidence performing research related activities. Following the course, fellows were expected to complete at least i) one research project, present it at a scientific meeting and submit for publication in peer-reviewed journal; and/or ii) one research proposal grant application. Results: To date, 13 first-year fellows across three cohorts have participated in the course, two of which have been completed, and the third will conclude in March 2024. Complete pre- and post- assessment scores were available for 8 fellows. Mean score difference was statistically significant comparing pre- to post- knowledge scores (3.79 points (SD= 4.43), paired t-test p-value=0.02). Self- ratings improved across all components on average from 3.7 pre- to 6.5 post-course (p<0.001). The largest change in self-ratings were in understanding study design concepts, basic principles of research and critical appraisal, followed by interpreting statistical outputs. All fellows are leading at least one mentored research project and 7 out of 8 fellows have presented abstracts at national meetings including the American Society of Clinical Oncology and the American Society of Hematology. Conclusions: Implementing a dedicated research methods curriculum to clinical fellows is feasible, and improved learner knowledge, skills, and engagement in research activities. Research methods principles can be effectively incorporated into the first year of clinical fellowship training.

Initial evaluation of the TALES (technology and literacy engagement after stroke) programme targeting functional literacy and social engagement in people with aphasia after stroke

ABSTRACT Background and aims Literacy skills are typically affected in people with stroke aphasia, leading to reduced engagement in functional everyday reading/writing tasks, such as email/messaging via social media. The aim of this study was to investigate the outcomes of the TALES (Technology And Literacy Engagement after Stroke) programme, a group-based online literacy-focused programme for people with aphasia after stroke. This first evaluation of this programme aimed to examine outcomes related to feasibility, changes in language, literacy and self-ratings of communication skills. Methods Five participants with aphasia were assessed on a range of outcome measures relating to language and self-perception of communication skills. These were: the Western Aphasia Battery-Revised (WAB-R; (Kertesz, 2007)), literacy subtests from the Psycholinguistic Assessment of Language Processing in Aphasia (PALPA; (Kay et al., 1996)) and the Communication Outcomes after Stroke (COAST; (Long et al., 2008)). TALES consisted of a weekly group online session, 1:1 supported telehealth reading/writing practice and regular messaging via email. Results and main contribution From a descriptive statistics perspective, the mean gains across the cohort were 7.94 (from 84.24 to 92.18) on the WAB AQ (aphasia quotient), 8.92 (from 81.18 to 90.10) on the WAB LQ (language quotient). Additionally, there was a change in the mean scores for PALPA subtests (31, 37 and 40) observed between the pre-treatment assessment and post-treatment assessment. Finally, the mean score increased by 8.8 (from 49.40 to 58.20) on the COAST (max score = 80). Results indicated gains in literacy and communication measures as well as changes to self-rating of communication reflecting changes in communication confidence. Conclusions Mindful of the threats to the internal validity inherent in the study design, the reported online therapy can overcome barriers such as distance and mobility limitations and may provide greater accessibility to therapy for individuals with aphasia. TALES was a low-therapist-input yet reasonably intensive treatment approach which embedded language practice immediately in functional use through the social group format and personally-relevant written communication. Implications The TALES programme meets many neuroscience principles of neurorehabilitation including “use it or lose it”, salience and transference. Future research may usefully investigate the contribution of the group format versus the functional literacy components towards these potentially promising early data.

Effects of an educational compact intervention in self-care – a mixed methods study with postgraduate trainees in primary care

BackgroundMultiple studies indicate that residents in family medicine (FM) are exposed to considerable stress and are particularly affected by burnout syndrome. Aim of the study was to specify the effects of a so-called “compact intervention” (i.e., a short intervention) in self-care on FM residents.MethodsThe authors performed a concurrent and independent mixed-methods study with FM residents on the KWBW VerbundweiterbildungPLUS© program. FM residents could voluntarily take part in a two-day seminar including 270 min on self-care, which can be regarded as a compact intervention. Study participants completed a questionnaire before (T1) and ten to twelve weeks after the course (T2), with subsequent recruitment to interview. The main outcomes of the quantitative part were to evaluate (I) self-rated change of cognition and (II) change in behavior. The qualitative outcomes were all possible effects of the compact intervention on participants´ competencies as well as all sorts of induced behavioral changes.ResultsFrom a total of n = 307 residents, n = 287 FM residents (intervention group: n = 212; control group: n = 75) participated in the study. At T2, 111 post-intervention questionnaires were completed. 56% rated the intervention to be helpful for their well-being (n = 63/111). At T2, there was a significant increase in those willing to act in comparison to T1 (p = .01): 36% (n = 40/111) had changed their behavior and half of the study participants had passed on competencies to others (n = 56/111). From the intervention group, n = 17 participants additionally gave an interview. FM residents favored a trustful learning atmosphere, an interactive teaching concept and practical exercises. They described an encouraging stimulus to act and specified behavioral changes.ConclusionsA compact intervention in self-care could increase well-being, foster competencies and induce behavioral changes, if implemented into a training program with sufficient group cohesiveness. Further studies are required to specify long-term-results.

The Effects of Spiritual Wellbeing on Self-Perceived Health Changes Among Members of the Church of England During the COVID-19 Pandemic in England

This paper tests whether changes in spiritual wellbeing were correlated with self-rated changes in mental and physical health after controlling for changes in psychological wellbeing in a sample from the Church of England taken during the third national COVID-19 lockdown in 2021. During the third lockdown in England an online survey, named Covid-19 and Church-21, was delivered through the Qualtrics XM platform from 22 January to 23 July 2021. The responses included 1878 Anglicans living in England. The change in spiritual wellbeing scale was produced using self-reported changes in the frequency of key spiritual practices (prayer and Bible reading), trust in God, the quality of spiritual life, and spiritual health. Changes in mental and physical health were assessed using single self-report items. Changes in psychological wellbeing were assessed using the Index of Balanced Affect Change (TIBACh). After controlling for changes in psychological wellbeing, better change in spiritual wellbeing was positively correlated with better change in both mental and physical health. Negative affect may have mediated the relationship between spiritual wellbeing and both mental and physical health, and positive affect may also have mediated the relationship with mental health. The results suggest changes in spiritual wellbeing, as defined within a Christian religious context, may have had positive effects in promoting better mental and physical health during a sudden crisis such as the COVID-19 pandemic.

Effect of end-of-life care education on perceived self-efficacy of the pediatric respiratory therapist.

End-of-life care (EoLC) is difficult for respiratory therapists (RTs), causing struggles with providing EoLC and grief during and after the death. The objective of the study was to determine if EoLC education can increase RTs' perception of knowledge of EoLC, respiratory therapy as a valuable EoLC service, comfort providing EoLC, and knowledge of ways to deal with grief. One hundred and thirty pediatric RTs completed a 1 h EoLC education session. Afterwards, a single-centre descriptive survey was administered to the 60 volunteers out of the 130 attendees. To determine RTs' self-rated change in knowledge of EoLC, perception of respiratory therapy as a valuable EoLC service, comfort with EoLC, and knowledge of ways to cope with grief. Statistical analysis included percent change. Overall, 96% of surveyed RTs agree they had an increase in knowledge, perception of RT services, comfort with providing care, and coping. Only 4% felt that this course had little benefit overall but still perceived value in RT EoLC and increased knowledge of long- and short-term ways to deal with grief. Education on EoLC practices increased pediatric RTs' perception of knowledge, perceived value of respiratory therapy in EoLC, comfort with EoLC, and knowledge of coping resources.

Age and context effects in personality development: A multimethod perspective.

Observing most pronounced personality trait changes during young adulthood raises the question whether the traits are more stable per se after young adulthood or whether greater stability of daily life contexts also contributes to smaller trait changes in older adults. In this longitudinal multimethod study, we tested the competing explanations of trait stability and context stability by examining (a) whether age differences in Big Five trait changes are less pronounced when younger and older people experience similar context conditions, in this case, college life and (b) whether people of similar age change differently in different contexts. Furthermore, based on dual-process models of personality and because previous research has relied on self-ratings, we examined whether assumed personality changes also occur in implicit measures and other-ratings of traits. The sample of 241 adults consisted of older students (Mage = 67.5 years), older age- and education-matched nonstudents (Mage = 67.7 years), and young students (Mage = 21.1 years). We obtained self-ratings, other-ratings, and implicit measures of Big Five traits at four time points over 2 years. The results replicated increases in self-ratings of emotional stability, open-mindedness, extraversion, and conscientiousness in young first-year students and demonstrated distinct patterns of change among older students and older nonstudents. Changes in other-ratings and implicit measures only partly mirrored changes in self-ratings of Big Five traits. The study highlights the importance of different measures of traits to better understand personality development beyond self-ratings, and that in some groups, substantial trait changes are possible beyond young adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

ASSOCIATION BETWEEN INCREASED CAREGIVER BURDEN AND MENTAL HEALTH DURING THE COVID-19 PANDEMIC IN JAPAN

Abstract During the COVID-19 pandemic, informal caregivers’ mental health was more deteriorated than non-caregivers. The objective of this study was to examine the association between increased caregiver burden and severe psychological distress (SPD) during the pandemic. We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were analyzed (mean age, 52.3 ± 15.9 years; men, 48.8%). SPD was defined as the Kessler 6 Scale (K6) ≥ 13. The self-rated change in caregiver burden was measured with the single question item. A binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted in all variables. Of total caregivers, 56.7% reported the increased caregiver burden and 19.3% were SPD. Increased caregiver burden was significantly associated with SPD, with an adjusted odds ratio 1.90 (95% confidence interval 1.37–2.66). The association between increased caregiver burden and SPD was stronger among married caregivers, with disease treatment, and with their care-receiver’s care need level 1–2 (Japanese long term care service levels). This study demonstrated that increased caregiver burden was associated with SPD during the pandemic. Therefore, measures against mental health for the caregivers with increased caregiver burden need to be implemented immediately.

Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training?

BackgroundPsychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with ADHD might have an effect from a structured skills training group (SSTG) based on dialectical behavioral therapy, by exploring pre-treatment characteristics as potential moderators of long-term treatment outcome.MethodsThis study was based on follow-up data from a randomized controlled trial comparing the SSTG (n = 71) to a psychoeducational control intervention (n = 57) for adolescents with ADHD (15–18 years old). Clinical characteristics (sex, age, medication status, ADHD presentation, severity of ADHD symptom, psychiatric comorbidity, impairment of emotional dysregulation and functional impairment) were explored as potential moderators of pre-treatment to follow-up change in ADHD symptoms and functional impairment. Moderation analyses were performed using the PROCESS macro for SPSS.ResultsThree moderators (severity of hyperactivity/impulsivity, conduct problems and impairment of emotional dysregulation) were identified in regard to the outcome self-rated change in ADHD symptoms. Participants with elevated pre-scores on these variables had a better effect of the SSTG than of the psychoeducational control intervention. No moderators were found in regard to the parental-rated outcomes.ConclusionsThe SSTG seems to be beneficial for adolescents with ADHD who perceive pronounced symptoms of hyperactivity/impulsivity, conduct problems and emotional dysregulation. Our findings need to be confirmed in future trials evaluating dialectical behavioral therapy-based skills training for adolescents with ADHD, where these moderators could be used as criteria for inclusion or stratification.Trial registrationhttps://doi.org/10.1186/ISRCTN17366720, retrospectively registered.

Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction.

Loss of olfactory function is well recognised as a symptom of COVID-19 infection, and the pandemic has resulted in a large number of individuals with abnormalities in their sense of smell. For many, the condition is temporary and resolves within two to four weeks. However, in a significant minority thesymptoms persist. At present, it is not known whether early intervention with any form of treatment (such as medication or olfactory training) can promote recoveryandprevent persisting olfactory disturbance.This is an update of the 2021 review with four studies added. 1) To evaluate the benefits and harms of any intervention versus no treatment for people with acute olfactory dysfunction due to COVID-19 infection. 2) Tokeep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance, which had been present for less than four weeks. We included any intervention compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes werethe presence of normal olfactory function, serious adverse effects and change in sense of smell. Secondary outcomes were the prevalence of parosmia,change in sense of taste, disease-related quality of life and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included five studies with 691 participants. The studies evaluated the following interventions: intranasal corticosteroid sprays, intranasal corticosteroid drops, intranasal hypertonic saline and zinc sulphate. Intranasal corticosteroid spray compared to no intervention/placebo We included three studies with 288 participants who had olfactory dysfunction for less than four weeks following COVID-19. Presence of normal olfactory function The evidence is very uncertain about the effect of intranasal corticosteroid spray on both self-rated recovery of olfactory function and recovery of olfactory function using psychophysical tests at up to four weeks follow-up (self-rated: risk ratio (RR) 1.19, 95% confidence interval (CI) 0.85 to 1.68; 1 study; 100 participants; psychophysical testing: RR 2.3, 95% CI 1.16 to 4.63; 1 study; 77 participants; very low-certaintyevidence). Change insense of smell The evidence is also very uncertain about the effect of intranasal corticosteroid spray on self-rated change in the sense of smell (at less than 4 weeks: mean difference (MD) 0.5 points lower, 95% CI 1.38 lower to 0.38 higher; 1 study; 77 participants; at > 4 weeks to 3 months: MD 2.4 points higher, 95% CI 1.32 higher to 3.48 higher; 1 study; 100 participants; very low-certainty evidence, rated on a scale of 1 to 10, higher scores mean better olfactory function). Intranasal corticosteroids may make little or no difference to the change in sense of smell when assessed with psychophysical testing(MD 0.2 points, 95% CI 2.06 points lower to 2.06 points higher; 1 study; 77 participants; low-certainty evidence, 0- to 24-point scale, higher scores mean better olfactory function). Serious adverse effects The authors of one study reported no adverse effects, but their intention to collect these data was not pre-specified so we are uncertain if these were systematically sought and identified. The remaining two studies did not report on adverse effects. Intranasal corticosteroid drops compared to no intervention/placebo We included one study with 248participants who had olfactory dysfunction for ≤ 15 days following COVID-19. Presence of normal olfactory function Intranasal corticosteroid drops may make little or no difference to self-rated recoveryat > 4 weeks to 3 months (RR 1.00, 95% CI 0.89 to 1.11; 1 study; 248 participants; low-certainty evidence). Noother outcomes were assessed by this study. Data on the use of hypertonic saline nasal irrigation and the use of zinc sulphate to prevent persistent olfactorydysfunction are included in the full text of the review. There is very limited evidence available on the efficacy and harms of treatments for preventing persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.

Improvement in motor symptoms, physical fatigue, and self-rated change perception in functional motor disorders: a prospective cohort study of a 12-week telemedicine program

BackgroundFunctional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need.AimTo compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs.MethodsThe study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2).ResultsImprovement at 3-month follow-up assessment of motor symptoms (p < 0.001), physical fatigue (p = 0.028), and self-rated change perception (p = 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control.ConclusionsLong-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change.

Classical Music Students' Pre-performance Anxiety, Catastrophizing, and Bodily Complaints Vary by Age, Gender, and Instrument and Predict Self-Rated Performance Quality.

Music performance anxiety (MPA) is a multifaceted phenomenon occurring on a continuum of severity. In this survey study, we investigated to what extent the affective (anxiety), cognitive (catastrophizing), and somatic (bodily complaints) components of MPA prior to solo performances vary as a function of age, gender, instrument group, musical experience, and practice as well as how these MPA components relate to self-rated change in performance quality from practice to public performance. The sample comprised 75 male and 111 female classical music university students, aged 15–45 years. Age was positively associated with anxious feelings and bodily complaints. Compared to male students, female students reported significantly more anxious feelings and catastrophizing. Singers reported less anxious feelings and catastrophizing than instrumentalists. Breathing-, mouth- and throat-related complaints were highest among singers and wind players; hand- and arm-related complaints were highest among string players and pianists. The indices of musical experience and practice had marginal effects. An average of four bodily complaints bothered the participants strongly to very strongly. Worsening in performance quality from practice to public performance was reported by almost half of the participants and was best predicted by anxious feelings and breathing-related complaints. We conclude that age, gender and instrument play a significant role in understanding the phenomenology of MPA. Musicians should be examined according to these characteristics rather than as one homogenous population. In particular, it might be valuable to develop assessment tools for MPA that incorporate items related to the bodily complaints that are most relevant to the different instrument groups. Breathing-related complaints could add an important dimension to the investigation of MPA and music performance. Finally, the high percentage of students reporting worsening of their performance quality from practice to public performance highlights the need of professional support to help music students be able to perform at their best and thrive as artists.

Association between increased caregiver burden and severe psychological distress for informal caregivers during the COVID-19 pandemic in Japan: A cross-sectional study

ObjectiveDuring the coronavirus disease 2019 (COVID-19) pandemic, informal caregivers’ mental health deteriorated more than that of non-caregivers. We examined the association between increased caregiver burden during the pandemic and severe psychological distress (SPD). MethodsWe used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were included. SPD was defined as Kessler 6 Scale (K6) score ≥ 13. Self-rated change in caregiver burden was measured retrospectively with a single question item. Binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden during the pandemic, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted for all variables. ResultsParticipants’ mean age was 52.3 years (standard deviation 15.9), 48.8% of participants were male, 56.7% reported increased caregiver burden, and 19.3% exhibited SPD. Increased caregiver burden was significantly associated with SPD (adjusted odds ratio: 1.90; 95% confidence interval: 1.37–2.66). The association between increased caregiver burden and SPD was stronger among caregivers who were married, those undergoing disease treatment, and those with a care-receiver with a care need level of 1–2. ConclusionsThe results revealed that more than half of caregivers reported increased caregiver burden, and increased caregiver burden was associated with SPD during the pandemic. Measures supporting mental health for caregivers with increased caregiver burden should be implemented immediately.

Results of the George Washington University cancer center's comprehensive cancer control cancer communication mentorship program and implications for future practice.

PurposeThe Comprehensive Cancer Control Cancer Communication Mentorship Program (“Mentorship Program”) was created by the George Washington University Cancer Center (GWCC) to provide technical assistance (TA) in implementing evidence-based cancer screening communication interventions and support networking for comprehensive cancer control (CCC) professionals. The Mentorship Program matched entry-to mid-level CCC professionals with health communication and/or CCC experts and offered monthly web-based discussions with academic researchers and practitioners who shared their knowledge and provided applied learning opportunities throughout mentees’ project planning, implementation and evaluation. The program objective was for mentees to improve health communication skills and apply evidence-based knowledge to reduce the burden of cancer.MethodsA mixed methods evaluation was conducted, including a qualitative description of each project and its outcomes as well as quantitative measures of satisfaction with the program and self-rated changes in competence.ResultsMentees represented the following locations: New Jersey, Arkansas, Michigan, West Virginia, and Republic of Palau. Project topics ranged from increasing Human papillomavirus (HPV) vaccinations to increasing screening uptake for colorectal cancer, lung cancer, cervical cancer, and breast cancer. Evaluation results from pre- and post-program communication competency self-assessments and mid- and post-program surveys revealed that the Mentorship Program advanced personal and professional goals and improved public health communication skills.ConclusionThe Mentorship Program achieved its objectives for peer networking and offering expert TA in cancer prevention and control communication, offering a promising model for others involved in supporting implementation of evidence in practice.

Self-rated health changes of individuals in same-sex compared to different-sex relationships: a longitudinal study

BackgroundPrior scholarship on same-sex relationships and health has primarily relied on cross-sectional data, leaving a number of unanswered questions about health changes of same-sex couples over time. This study examined the self-rated health statuses and changes of individuals in same- and different-sex cohabitations and marriages over time (2014–2017).MethodsData were drawn from the 2014 panel of the Survey of Income and Program Participation (SIPP), a nationally representative and longitudinal study (N = 23,297) in the United States. Mixed- and fixed-effects regression models were performed to investigate the self-rated health changes of individuals in same-sex compared to different-sex relationships.ResultsResults show that same-sex married individuals report a faster decline in self-rated health compared to different-sex married counterparts despite similar initial health statuses. Similarly, same-sex cohabitors also exhibit a more rapid health decline as compared to different-sex cohabitors.ConclusionsThe results point to health change disadvantages experienced by same-sex married and cohabiting individuals during the study period. The findings from this study advance scholarly knowledge on the health changes of individuals in marginalized intimate relationships and highlight the importance of studying sexual minorities’ health using longitudinal data.

Temporal changes in medical student perceptions of their clinical skills and needs using a repeated self-assessment instrument

BackgroundMedical student needs in clinical skill training may change over time, but data on this topic are limited. This study uses repeated self-assessments on clinical rotations during medical school to evaluate students’ perceptions of their clinical skill growth.MethodsA self-assessment rating was completed by students during each clinical rotation as they progressed through their core clinical rotation year. The instrument consisted of questions on 5 clinical skill categories where students rated their performance as “below”, “at” or “above” expected, and open-ended questions on strengths and challenges. We evaluated changes in self-ratings between the first (n=136) and third (n=118) quarters by matched-pair analysis of the shift in responses between time points using a Sign Test. We also identified the main themes from the students’ responses to open-ended questions.ResultsWe found 22.4 % and 13.3 % of students increased their self-assessment ratings on “Oral Presentation Skills” and on “Differential Diagnosis”, respectively. In contrast, perceived ability to communicate with patients saw the largest negative shifts. “Patient Interaction” was the most commonly identified area of strength and “Knowledge and Organization” was most frequently cited as a barrier.ConclusionsStudents demonstrated a positive shift in perceived competence in some core clinical skills that are not strongly emphasized in the preclinical curriculum, likely reflecting increased exposure over time. However, their perceived competence in communication skills declined. This may reflect initial over-estimation or true decline due to competing needs/interests. These patterns of change can inform the design of longitudinal curricula that anticipate and address students’ needs during clinical rotations, such as placing increased emphasis on presentation skills and differential diagnosis earlier in the curriculum, and adding more emphasis to communication skills in later phases.

Self-rated Changes of Health Status during Stay-at-home Orders among Older Adults Using the Long-term Care Insurance System of Japan: A Cross-sectional Study.

To reveal self-rated changes of health status during stay-at-home orders among older adults and to verify whether decrease in frequency of going outdoors during these orders was related to self-rated changes in health status. A self-completed questionnaire for older adults was provided in 2 dayservice facilities and a nursing station. We operationally defined health status with 4 domains (motor function, oral and swallowing function, depression, and social networks) and designed the questionnaire to determine self-rated changes in health status using factor analysis. After factor analysis, regression analyses were conducted. Dependent variable was each factor score (self-rated changes of health status), and independent variable was decrease in frequency of going outdoors. Approximately 80% of participants answered that their health status had "worsened" in motor function (75.0%-87.2%). Moreover, more than 70% of participants answered "worsened" in "Feeling energy" and "Getting together and speaking with friends" (72.3% and 75.7%, respectively). Regression analyses demonstrated that, after adjusting for covariates, the decrease in frequency of going outdoors was related to self-rated changes of motor function and friend network. During stay-at-home orders, older adults felt deterioration in their motor function, in feeling energy, and in their friend network, especially people who had decreased their frequency of going outdoors felt more deterioration in their motor function and in their friend network.

Community Health Workers as a Strategy to Tackle Psychosocial Suffering Due to Physical Distancing: A Randomized Controlled Trial.

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Chasing shadows? Transcranial Magnetic Stimulation (TMS) for cognitive enhancement

Introduction: We present a 34 year-old man with childhood hydrocephalus from presumed brain tumor, corrected with a shunt, motivated for TMS for cognitive enhancement of self-perceived difficulties with complex tasks, documented executive dysfunction on psychometric testing, and feeling easily overwhelmed. He was neither depressed nor anxious. Method: Treatment parameters were based on a PubMed search for “transcranial magnetic stimulation” and “cognitive enhancement.” NeuroStar was used to administer 20 sessions of daily left dorsolateral prefrontal cortex (DLPFC) stimulation at 10 Hz, 100% of motor threshold (MT), and 3,000 pulses, followed by 10 sessions of right DLPFC (10 Hz, 120% MT, 3,000 pulses). The 46-item Frontal Systems Behavior Scale (FrSBe), with subscales for Apathy, Disinhibition, and Executive Dysfunction, was completed at baseline and post-treatment by patient and his mother. Normalized T-scores were used to assess for clinically significant change (>10 points). Results: High frequency left DLPFC was the most common target for cognitive enhancement. FrSBe ratings by patient’s mother were significantly low at baseline and within the average range post-treatment. Patient’s self-ratings produced T-scores which ranged from average to significantly elevated at both baseline and completion of treatment. Patient noted a few hours of “clarity” during one of the early sessions but no other subjective improvement. Conclusions: Using TMS for cognitive enhancement has little supporting data. Our patient did not show any clear change in self-ratings of his behavior over the course of treatment, while his mother seemed to discount any behavioral changes at baseline, but seemed to have some limited acknowledgement of challenges after treatment, perhaps reflecting the focus of treatment on these same challenges leading to a more accurate appraisal. When symptoms cannot be clearly defined, observed, and measured, we are “chasing shadows.” Conflicts of interest: None Funding source: NoneTabled 1FrSBe- Patient Rating FormBaseline (12/20/2019)Post-treatment (1/27/2020)Apathy T-score:6769Disinhibition T-score:5658Executive Dysfunction T-score:7061FrSBe- Family Rating FormBaseline (12/21/2019)Post-treatment (1/27/2020)Apathy T-score:3347Disinhibition T-score:3543Executive Dysfunction T-score:3443FrSBe – SubscaleDescriptionApathy (A)Problems with initiation, psychomotor retardation, spontaneity, drive, persistence, loss of energy and interest, lack of concern about self-care and/or blunted affective expression.Disinhibition (D)Problems with inhibitory control such as impulsivity, hyperactivity, socially inappropriate behavior and poor conformity to social conventions.Executive Dysfunction (E)Problems with sustained attention, working memory, organization, planning, future orientation, sequencing, problem solving, insight, mental flexibility, self-monitoring of ongoing behavior and/or the ability to benefit from feedback or modify behavior following errors.FrSBe T-scoreInterpretationLess than 60Normal60-65Borderline impairmentMore than 65Clinically Significant Open table in a new tab