Significant Predictor Of Change Research Articles

Longitudinal Analyses of Mental Health in Autistic Individuals: A Systematic Review.

Co-occurring mental health conditions affect autistic individuals at high rates, impacting their well-being and quality of life. Mental health conditions are often appropriate treatment targets that can improve the lives of autistic individuals. Because of this, there is growing interest in predictors of mental health and behavioral outcomes. Given the rapidly evolving evidence base and growing literature using longitudinal cohorts, it is unclear which predictors of symptoms of anxiety and depression are consistent, and which are not. Additionally, it is difficult to deduce which predictors of mental health symptoms at a given time also predict change over time. This can be partially due to the different statistical approaches that are implemented, including trajectory vs. non-trajectory methodologies. We conducted a systematic review to evaluate how non-trajectory and trajectory analyses inform our knowledge of how symptoms of anxiety and depression change over time. Additionally, we aimed to identify important predictors of change and later anxiety and depressive symptoms in autistic individuals. There is variability in symptoms of anxiety and depression in autistic individuals. Adaptive skills arose as significant predictors of change and of later symptoms of both anxiety and depression. Peer relationships in school age seem to be particularly important in predicting later symptoms of depression. This review provides evidence that there are different trajectories and different patterns of mental health symptoms over the lifespan, providing further evidence that autism is a developmental condition that changes over time in different ways for different people. Implications and future directions are further discussed.

Abstract P386: Predictors of Home Blood Pressure Response to Ultrasound Renal Denervation

Background: Out-of-office blood pressure measurements are recommended for hypertension (HTN) management. The RADIANCE clinical trial program showed that ultrasound renal denervation (uRDN) significantly reduces daytime ambulatory systolic blood pressure (SBP) in patients with mild-to-moderate HTN (RADIANCE-HTN SOLO, RADIANCE II) and resistant HTN (RADIANCE-HTN TRIO). Previous analyses have assessed predictors of daytime ambulatory SBP response at 2-months. This analysis assessed predictors of home SBP (HSBP) at 2-months. Method: This analysis included 250 patients who were randomized to and received uRDN and were treated per-protocol. Separate linear regression models were used to assess predictors of the change in HSBP at 2-months. Multivariable regression analysis was conducted including variables with p-value<0.20. Backward selection with a stay criterion of 0.20 was used to select the predictors for the final multivariable analysis. Study was pre-defined as a covariate in the final model. Results: Patients were 69% male and 76% white; average age was 53.9 years and baseline office BP 155.5/101.5 mmHg. The only significant predictor (p< 0.05) resulting from the separate linear regression models adjusting for cohort was baseline HSBP. Other predictors included in the multivariable analyses (p<0.20) were sex, black race, screening medications(Y/N), orthostatic HTN, and right renal artery diameter. In the multivariable analyses, baseline HSBP was the only significant predictor of change in HSBP at 2-months (p=0.009, See Table). Conclusions: In this analysis of response to treatment with uRDN using home BPs, baseline HSBP was the only consistent significant predictor of response. Baseline BP value as a predictor of RDN response is consistent with prior analyses.

A multiphase very-low calorie ketogenic diet improves serum redox balance by reducing oxidative status in obese patients

The very-low calorie ketogenic diet (VLCKD) is recommended as an effective dietary approach for the management of obesity. This study investigated changes in circulating biomarkers of redox homeostasis induced by a multiphase VLCKD in obese individuals.A total of 40 obese subjects were prescribed a multiphasic VLCKD for eleven weeks. Anthropometric measurements, body composition parameters, calorimetric measures, and standard laboratory markers of glucose and lipid metabolism were evaluated at baseline (T0) and at the end of the dietary intervention (T1). Additionally, circulating markers of oxidative damage and antioxidant status were analyzed in serum and erythrocytes.Compared to T0, at T1 the multiphase VLCKD induced significant weight loss and reduction of waist circumference, with beneficial effects on body composition parameters and the glucose/lipid biochemical profile. Moreover, a decrease in serum markers of oxidative damage was reported at T1, while no changes in serum markers of antioxidant status and in erythrocyte redox markers were observed. In addition, a significant association was found between variations in anthropometric measurements, body composition, glucose metabolism parameters, and changes in circulating markers of oxidative damage. Regression models showed that variation in lipofuscin was significant predictor of changes in body mass index, fat mass, visceral adiposity, and insulin sensitivity.In conclusion, this study demonstrated that the multiphase VLCKD improves serum redox balance by reducing markers of oxidative damage in obese individuals, highlighting the interplay between adiposity, glucose metabolism, and redox homeostasis in the pathogenesis of obesity. Furthermore, these data provide a rationale for future investigations aimed at testing serum lipofuscin as a reliable redox marker in obesity.

Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers.

Parenting is a rewarding experience but is not without its challenges. Parents of Autistic children face additional challenges, and as a result can experience lower levels of wellbeing and more mental health problems (i.e., depression, anxiety, stress). Previous studies have identified concurrent correlates of wellbeing and mental health. However, few have investigated predictors of subsequent wellbeing and mental health, or of change over time, among parents of pre-school aged autistic children. We examined child-, parent-, and family/sociodemographic factors associated with change in parents' mental health and wellbeing across three timepoints (spanning approximately one year) among 53 parents of Autistic pre-schoolers (M = 35.48, SD = 6.36months. At each timepoint, parents reported lower wellbeing and greater mental health difficulties compared to normative data. There was no significant group-level change over time in parent outcomes. However, individual variability in short-term (~ 5months) wellbeing and mental health change was predicted by a combination of child- and parent-related factors, while variability in medium-term (~ 10months) change was predicted by parent factors alone. Parents' description of their child and their relationship predicted change in both wellbeing and mental health. Furthermore, participating in a parent-mediated intervention (available to a subgroup) was a significant predictor of change in wellbeing. Our findings highlight potentially modifiable factors (e.g., learning healthier coping strategies) that may positively impact both short- and medium-term change in parental outcomes.

The Prevalence of Bradycardia 12 Years After Roux-en-Y Gastric Bypass for Severe Obesity

PurposeThe aim was to describe the frequency of bradycardia 12 years after Roux-en-Y gastric bypass (RYGB), relations to weight loss, patient characteristics, and the clinical impact.Materials and MethodsThe BAROPS study is a prospective observational study of patients who had follow-up > 10 years after RYGB. Patients with heart rate (HR) ≤ 50 bpm were compared to patients with HR > 50 bpm.ResultsAfter a mean observation period of 12 years, 32 of 546 patients (6%) had a HR ≤ 50 with a mean HR of 47.0 (2.8) bpm. The comparator group (192 patients) had a mean HR of 66.4 (10.2) bpm (p < 0.001). A higher proportion of the bradycardic vs. non-bradycardic patients (18.8% vs. 7.8% at baseline (p = 0.05) and 18.8% vs. 5.2% at end of study (p = 0.006)) used beta-blockers. Both groups had a significant reduction in heart rate from pre-surgery to end of observation. Percent total weight loss from baseline was negatively related to heart rate (p < 0.001), and smoking was positively related to heart rate (p = 0.014). Change in BMI from pre-surgery (p < 0.001) and hypertension at pre-surgery (p = 0.006) were significant predictors of change in heart rate. The only predictor of HR ≤ 50 was the use of beta-blockers (p = 0.010). There were no difference in bradycardia-related symptoms.ConclusionSix percent of patients had HR ≤ 50 bpm 12 years after RYGB, but there was no increased bradycardia-related symptoms in these patients. RYGB induced a significant reduction in HR, and heart rate and changes in heart rate 12 years after RYGB were related to the amount of weight loss.Graphical

Stability assessment of railway trackwork scheduling in Sweden

Ensuring the reliability of railway transportation is heavily dependent on the quality of its infrastructure. In this regard, renewal and maintenance of the railway track infrastructure, referred to as trackwork, play a vital role. However, trackwork execution requires temporary capacity restrictions for train traffic. Therefore, harmonising the train and maintenance schedules is critical but challenging to accomplish when one is frequently changing. This paper explores and models the nature of trackwork schedule instability at the tactical level of the scheduling process. We analyse data from one year of trackwork rolling horizon plans, focusing on weekly changes at eight key trackwork locations across Sweden’s railway network. Our study considers various factors that may affect schedule stability, such as track type, location, time of day, train traffic intensity, and the type of prevailing traffic. We find that schedule instability increases as the rolling horizon plan approaches its end. The regression analysis reveals that the most significant predictors of changes in trackwork schedules include previous changes, track type (single vs. double), work location (at station vs. between stations), and the timing of trackwork (daytime vs. nighttime and month). These provide insights to trackwork planners in making informed and proactive decisions about trackwork timeslot allocation.

Effect of mitomycin C on the corneal endothelial cells of Saudi patients with myopia after transepithelial photorefractive keratectomy: a two-armed cohort study.

To study the effect of mitomycin C (MMC) applied during transepithelial photorefractive keratectomy (TPRK) on the corneal endothelium one week (W1) and three months (M3) after surgery and its determinants. In this two-armed cohort study conducted in 2022, eyes treated with MMC during TPRK (group 1) were compared with eyes not treated with MMC (group 2). The corneal endothelial cell (EC) count, EC density (ECD; cells/mm2), average (µm2), standard deviation (µm2), coefficient of variation (CV%), ECmax, ECmin, and EC percentage of hexagonality were estimated at W1 and M3. The postoperative changes in the EC count in the two groups were compared and correlated with the other independent variables. Group 1 had 26 eyes, and group 2 had 78 eyes. All TPRK indices were significantly higher for the eyes in group 1 than for those in group 2. The MMC usage was not a significant predictor of the change in ECD (P=0.644), change in CV (P=0.374), and change in the percentage of hexagonality of EC (P=0.164) at W1. However, the use of MMC was a significant predictor of changes in CV (P=0.014) and the change in the percentage of hexagonality of EC (P=0.039) at M3. The duration of laser exposure and the size of the optical zone influenced the correlation of MMC use with the changes in EC indices, postoperatively. The use of MMC doesn't affect ECD, CV, and percentage of hexagonality at W1 if other surgical indices are considered. At M3 after operating myopic eyes by TPRK, MMC significantly influence the CV and percentage of hexagonality. The duration of the laser application and the size of the optical zone should be considered when determining the effect of MMC on the EC indices.

Drinking While Stressed and Drinking to Cope Differentially Relate to Mental Health.

Excessive alcohol use, as well as drinking to manage distress, are known to undermine mental health. The current study examined the unique associations of simply consuming alcohol while stressed, versus using alcohol to cope with distress, with mental health during the early stages of COVID-19. Participants (N = 264) reported their alcohol use and use of alcohol/substances to cope with stress daily for 22 days and completed measures of mental health at baseline and every 7 days thereafter. Hierarchical regression models were tested to predict drinking while stressed, drinking to cope, and mental health. At baseline, drinking while stressed was not significantly associated with mental health when coping motives were accounted for. However, drinking to cope was significantly associated with greater stress, anxiety, depression, and loneliness. Drinking while stressed was significantly predicted by baseline stress and loneliness, while drinking to cope was significantly predicted by baseline anxiety. Drinking while stressed was not a significant predictor of change in mental health when coping motives were accounted for. Drinking to cope was a significant predictor of increases in depression but not of change in stress, anxiety, or loneliness. The motivation to manage distress appears to be driving the negative effects of alcohol use on mental health.

Treatment Expectations—You Get What You Expect—and Depression Plays a Role

Positive treatment expectations demonstrably shape treatment outcomes regarding pain and disability in patients with chronic low back pain. However, knowledge about positive and negative treatment expectations as putative predictors of interindividual variability in treatment outcomes is sparse, and the role of other psychological variables of interest, especially of depression as a known predictor of long-term disability, is lacking. We present results of the first prospective study considering expectations in concert with depression in a sample of 200 patients with chronic low back pain undergoing an inpatient interdisciplinary multimodal pain therapy. We analyzed the characteristics of pain and disability, treatment expectation, and depression assessed at the beginning (T0), at the end of (T1), and at 3-month follow-up (T2) of interdisciplinary multimodal pain therapy. Treatment expectations did emerge as a significant predictor of changes in pain intensity and disability, respectively, showing that positive expectations were associated with better treatment outcomes. Mediation analyses revealed a partially mediating effect of treatment expectations on the relation between depression and pain outcomes. PerspectiveThese results expand knowledge regarding the role of treatment expectations in individual treatment outcome trajectories in chronic pain patients, paving the way for much-needed efforts toward optimizing patient expectations and personalized approaches in clinical settings.

Developing an educational “hub”: impact of a distance-learning curriculum in a multinational cohort

PurposeTo address a gap in radiation oncology education in low- and middle-income countries (LMICs), we sought to evaluate the effectiveness and generalizability of a refined curriculum on intensity modulated radiotherapy (IMRT) offered to existing radiation therapy (RT) clinics across Africa and Latin America (LATAM) at no cost.MethodsA curriculum was created based on prior needs assessments and adapted for participating medical physicists, radiation oncologists, radiation therapists, and trainees in LMICs. English-speaking and Spanish-speaking teams of volunteer educators delivered 27 hour-long sessions 1–2 times weekly for 4 months using video conferencing to African and LATAM cohorts, respectively. Pre- and post-course multiple-choice examinations were administered to LATAM participants, and pre- and post-course self-confidence (1–5 Likert-scale) and open-ended feedback were collected from all participants.ResultsTwenty-five centers across Africa (13) and LATAM (12) participated, yielding a total of 332 enrolled participants (128 African, 204 LATAM). Sessions were delivered with a mean of 44 (22.5) and 85 (25.4) participants in the African and LATAM programs, respectively. Paired pre and post-course data demonstrated significant (p < 0.001) improvement in knowledge from 47.9 to 89.6% and self-confidence across four domains including foundations (+ 1.1), commissioning (+ 1.3), contouring (+ 1.7), and treatment planning (+ 1.0). Attendance was a significant predictor of change in self-confidence in “high attendance” participants only, suggesting a threshold effect. Qualitative data demonstrates that participants look forward to applying their knowledge in the clinical setting.ConclusionA specialized radiation oncology curriculum adapted for LMIC audiences was effective for both African and LATAM participants. Participant feedback suggests that the refined IMRT course empowered clinics with knowledge and confidence to help train others. This feasible “Hub and Spokes” approach in which a distance-learning course establishes a hub to be leveraged by spokes (learners) may be generalizable to others aiming to reduce global health care disparities through training efforts.

Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis

Nutritional status is considered a major diagnostic and prognostic indicator of HIV/AIDS in adults. In this aspect, current HIV-treatment guidelines, particularly in low-income countries, recommend the regular monitoring of body mass index (BMI) to determine patients' clinical response to antiretroviral therapy (ART). However, data regarding the change in BMI status of HIV-positive adults on ART following the implementation of the test and treat strategy were limited in Ethiopia. Hence, this study is aimed at investigating the trends of BMI change over time and its associated factors among HIV-positive adults in Northwest Ethiopia. A retrospective longitudinal study was conducted among 404 randomly selected HIV-positive adults receiving ART in Felegehiwot Comprehensive Specialized Hospital (FHCSH), Northern Ethiopia. Data were extracted from the medical record charts of study participants, entered into Epi-data 4.6 software, and exported to Stata 14.2 software for analysis. A generalized estimating equation (GEE) model was fitted to determine the change in BMI status over time and its predictors in HIV-positive adults. The level of significance was declared at a p-value of < 0.05. More than half (201, or 51.73%) of the total 404 participants were female. In the cohort, both the baseline and follow-up mean body mass index levels of the participants fell in the normal range and increased from 20.34 (standard deviation/SD ± 2.8) to 21.41 (SD ± 3.13). The individual profile plots of 50 participants indicated that there is considerable variability in weight change across individuals. Duration of ART follow-up (β = 0.203, 95% confidence interval (CI) 0.16 to 0.24), unemployment (β = − 0.96, 95% CI 1.67 to − 0.25), WHO stage III/IV HIV disease (β = − 0.92, 95% CI − 1.57 to − 0.35),and Tenofovir/Lamivudine/Dolutegravir (TDF/3TC/DTG)ART regimen (β = 0.95, 95% CI 0.32 to 1.57) were identified as significant predictors of change in the BMI status of participants. Likewise, the interaction of TDF/3TC/DTG ART regimen * follow-up duration (β = 2.16, 95% CI 1.84 to 2.84), WHO stage III/IV clinical disease * follow-up duration (β = − 1.43, 95% CI − 1.71 to − 1.15) and TB/HIV co-infection * follow-up duration (β = 1.89, 95% CI 1.57 to 2.87) significantly affects the trend in BMI change status of HIV-positive adults. In this study, the BMI status of HIV-positive adults receiving ART increased with a linear trend. Unemployment, stage III/IV HIV diseases, and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) ART-drug regimen decreases the mean BMI status of HIV-positive adults. Special consideration and strict follow-up need to be given to those individuals with advanced HIV/AIDS diseases and other identified risk group.

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

Surgical treatments such as tendon transfers and muscle lengthening play a significant role in cerebral palsy management,but timing of upper extremity cerebral palsy surgery remains controversial. This study systematically reviews the current literature and investigates the correlation between age at surgery and follow-up time with surgical outcomes in pediatric upper extremity cerebral palsy patients. A comprehensive search of PubMed, Cochrane, Web of Science, and CINAHL databases was performed from inception to July 2020 and articles were screened using PRISMA guidelines to include full-text, English papers. Data analysis was performed using itemized data points for age at surgery, follow-up length, and surgery outcomes, reported as changes in active forearm and wrist motion. A 3D linear model was performed, to analyze the relationship between age, follow-up length, and surgery outcomes. A total of 3,855 papers were identified using the search terms and a total of 8 studies with itemized patient data (n=126) were included in the study. The studies overall possessed moderate bias according to the ROBINS-I scale. Regression analysis showed that age is a significant predictor of change (|t| > 2) in active forearm supination (Estimate = -2.3465, Std. Error = 1.0938, t-value= -2.145) and wrist flexion (Estimate = -2.8474, Std. Error = 1.0771, t-value = -2.643) post-intervention, with older individuals showing lesser improvements. The duration of follow-up is a significant predictor of improvement in forearm supination (Estimate = 0.3664, Std. Error = 0.1797, t-value = 2.039) and wrist extension (Estimate = 0.7747, Std. Error = 0.2750, t-value = 2.817). In contrast, forearm pronation (Estimate = -0.23756, Std. Error = 0.09648, t-value = -2.462) and wrist flexion (Estimate = -0.4243, Std. Error=0.1859, t-value = -2.282) have a significant negative association with follow-up time. These results suggest that there is significant correlation between the age and follow up after surgery with range of motion gains. Most notably, increased age at surgery had a significant negative correlation with select active range of motion postoperative outcomes. Future research should focus on identifying other factors that could affect results of surgical treatment in upper extremity.

What Happens to Sagittal Alignment Following Laminoplasty Versus Laminectomy and Fusion?

ObjectiveLaminectomy and fusion (LF) and laminoplasty (LP) are two sucessful posterior decompression techniques for cervical myelo-radiuclopathy. There is also a growing body of evidence describing the importance of cervical sagittal alignment (CSA) and its importance in outcomes. We investigated the difference between pre- and postoperative CSA parameters in and between LF or LP. Furthermore, studied predictive variables associated with change in cervical mismatch (CM) MethodsThis is retrospective cohort study of adults with cervical myeloradiculopathy in a single healthcare system. The primary outcomes are intra- and inter-cohort comparison of LF vs. LP radiographic parameters at pre- and postoperative time points. A secondary multivariable analysis of predictive factors was performed evaluating factors predicting postoperative CM. Results89 patients were included; 38 (43%) had LF and 51 (57%) underwent LP. Both groups decreased in lordosis (LF 11.4° vs 4.9°, p = 0.01; LP 15.2° vs 9.1°, p < 0.001), increased in cSVA (LF 3.4 vs 4.2cm, p = 0.01; LP 3.2 vs 4.2cm, p < 0.001), and increased in CM (LF 22.0° vs 28.5°, p = 0.02; LP 16.8° vs 22.3°, p = 0.002). There were no significant differences in the post operative CSA between groups. No significant predictors of change in pre- and postoperative CM were found ConslusionsThere were no significant pre-or post-operative differences following the two procedures, suggesting radiographic equipoise in well indicated patients. Across all groups, lordosis decreased, cSVA increased, and cervical mismatch increased. There were no predictive factors that led to change in cervical mismatch.

A Holistic Strategy of Mother and Child Health Care to Improve the Coverage of Routine and Polio Immunization in Pakistan: Results from a Demonstration Project.

The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan's high-risk union councils of polio-endemic districts. We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (β = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (β = -0.38; p = 0.002), knowledge about polio vaccine (β = -0.25; p = 0.011), and knowledge about IPV (β = -0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (β = -0.4; p ≤ 0.0001) and lack of education (β = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (β = 0.26; p = 0.008) and attendance at health camp (β = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (β = -0.13; p = 0.008). This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

Predicting changes in driving performance in individuals who use cannabis following acute use based on self-reported readiness to drive

ObjectiveIt is unclear to what extent individuals who use cannabis can accurately assess their ability to drive safely following cannabis use, and lack of understanding as to what factors influence changes in driving performance following cannabis use. This research explores whether self-reported readiness to drive (RTD) and previous experience (PE) using cannabis within 2 h of driving can predict observed changes in driving performance following acute cannabis use. MethodsIndividuals who used cannabis at least monthly completed a baseline simulated drive, were dosed with cannabis of approximately 6.18% THC, then drove at approximately 30-minutes, 90-minutes, and 180-minutes post-dose. Before each drive, participants were asked if they felt safe to drive (on real roadways, not the simulator), a yes/no question (RTD-yes/RTD-no). Venous blood was drawn at baseline and approximately 15-minutes post-dose. Cannabis use history was obtained and included whether the participant had ever driven within 2 h of use (PE-yes/PE-no) and how many days out of the past 30 they had done so (NPD).Drives were segmented into events delineated by changes in the driving environment. Within events, standard deviation of lateral position (SDLP), average speed, and number of lane departures were calculated, and differences from baseline were modeled using mixed-effects regression. Models considered covariates of time, event, and speed, and used RTD-yes/RTD-no, PE-yes/PE-no, NPD, and their interactions as potential predictors. Conditional R2 was used to compare the predictive ability of RTD versus change in Delta-9-THC. Data SourcesData were collected from 30 individuals who use cannabis and included cannabis use patterns, driving behaviors after use, self-reported RTD, measures of driving performance, and cannabinoid blood levels. ResultsRTD-no predicted a 2.60 cm increase in SDLP relative to baseline (95 % CI: 0.43, 4.73, p = 0.018). Average speeds generally decreased relative to baseline, except for RTD-yes with PE-yes (+1.08 mph, 95 % CI: 0.05, 2.11). NPD predicted increased speed among RTD-yes (+0.11 mph per additional day, 95 % CI: 0.01, 0.22) and decreased speed among RTD-no (-0.06 mph per additional day, 95 % CI: −0.18, 0.32). The difference in these effects was statistically significant (p = 0.038). RTD, PE, and NPD were not significant predictors of changes in number of lane departures. For all outcomes, models using RTD achieved higher conditional R2 than models that replaced this variable with change in Delta-9-THC. Differences were most prominent when modeling change in speed with NPD (R2=0.544 with RTD vs. R2=0.481 with change in Delta-9-THC). Significance of ResultsThese results suggest individuals who use cannabis can somewhat self-identify when they are likely to exhibit greater degraded lateral control, although RTD does not fully explain observed degradation in performance.Past research suggests drivers may reduce speed to compensate for recognized impairment following acute cannabis use. Our findings suggest this to be true for those who reported never having previously driven within 2 h of cannabis use or reported RTD-no, but not for those who had previously driven within 2 h of cannabis use and reported RTD-yes. This indicates compensatory behavior is not uniform and helps focus public health outreach efforts.

A - 30 Risk Factors for Poor Sleep Quality and Subjective Cognitive Decline during the COVID-19 Pandemic in an Ethnoracially Diverse US Sample.

Poor sleep quality is associated with subjective cognitive decline (SCD), a risk factor for developing Alzheimer's disease and Mild Cognitive Impairment. These relationships are understudied in ethnoracially diverse groups. We examined associations between sociodemographic characteristics, sleep changes during the COVID-19 pandemic (i.e., increased problems/poorer quality), and SCD in ethnoracially diverse older individuals in the US. 870 older adults (126 Latino, 74 Black, 33 Asian, and 637 White; Mage = 67.0 [7.6]) completed an online survey including sociodemographic information, the Everyday Cognition scale (ECog), which measures SCD, and a question inquiring about increased sleep problems/worsened sleep quality during the pandemic. Chi-square tests and analyses of variance assessed sociodemographic and SCD differences between groups. Regression and correlation analyses assessed relationships among sociodemographic factors, changes in sleep quality, and SCD. White participants were older (p < 0.001), and White and Asian groups had higher education levels (p = 0.009) than Latinos. There were more female (p = 0.016) and middle-income (p = 0.019) White respondents. There were no group differences in ECog ratings (p = 0.143) or the proportion of respondents endorsing changes in sleep during the pandemic (p = 0.197). Changes in sleep were associated with greater SCD (β= 0.214, p < 0.001). Younger age (p < 0.001), female sex (p = 0.001), and lower income (p = 0.016) were significant predictors of changes in sleep. Poorer sleep quality resulting from the COVID-19 pandemic was associated with SCD concerns. Notably, younger, female, and lower-income adults may have been at greater risk for increased sleep problems. Future work is needed to comprehensively examine sleep quality, SCD, and objective cognitive functioning in more representative samples.

Modeling study of the effect of placebo and medical therapy on storage and voiding symptoms, nocturia, and quality of life in men with prostate enlargement at risk for progression

BackgroundModeling studies using large datasets from men with lower urinary tract symptoms/benign prostate enlargement (LUTS/BPE) can predict changes in International Prostate Symptom Score (IPSS) and risk of acute urinary retention/surgery under different treatment regimens and according to predictors (baseline characteristics) that commonly define risk of progression. We assessed the impact of treatments on different symptom types (storage, voiding, and nocturia), quality of life (QoL; IPSS Q8), and BPH Impact Index [BII]).MethodsGeneralized least squares models were used to predict each outcome. Data from the CombAT study were used to predict outcomes for active treatments (dutasteride, tamsulosin, combination therapy). Predictors included: age; IPSS total, storage, voiding, nocturia and QoL (IPSS Q8) scores; BII; prostate volume; maximum urine flow rate (Qmax), prostate-specific antigen, postvoid residual urine (PVR); alpha-blocker usage within 12 months. Data from phase III dutasteride monotherapy studies were used to predict placebo outcomes. Results were visualized using an interactive web-based tool (www.bphtool.com).ResultsCombination therapy provided greater predicted benefit than either monotherapy for all five outcomes for most patient profiles within the CombAT inclusion criteria. PVR and corresponding subscores were significant predictors of change in both storage and voiding subscores. Alpha-blocker use within 12 months, age (storage subscore), and Qmax (voiding subscore) were also significant predictors. PVR, age, Qmax, and nocturia score were significant predictors of change in nocturia. PVR, Qmax, previous alpha-blocker use, total IPSS, and QoL (IPSS Q8) score were significant predictors of change in QoL (IPSS Q8) score. For BII, significant predictors were PVR, age, total IPSS, and BII score. The multivariable effect of covariates and treatments is best visualized through the interactive web-based tool.ConclusionsThis predictive modeling study informs our understanding of how risk factors for disease progression interact and affect treatment impact on different symptom types and QoL scores.

Menstrual function and mental health of medical students during the COVID-19 pandemic: a continuous cross-sectional study

Aim. To assess the impact of new coronavirus infection (NCI) and COVID-19 vaccination on menstrual function in comparison with the frequency of depressive disorders during the COVID-19 pandemic among female students of a medical university.&#x0D; Materials and methods. Data for a continuous transverse (cross-sectional) study were obtained using an online survey. The questions included demographics, characteristics of menstrual function, the history of COVID-19 and vaccinations against it, and the standard CES-D (Center for Epidemiologic Studies Depression Scale) questionnaire. The survey included 1.879 female medical students. The exclusion criteria were age under 18 and over 25 years, hormonal contraceptives, pregnancy, childbirth during the last year, and vaccination after COVID-19. After applying the exclusion criteria, three study groups were formed. Group 1 included female students with a history of NCI (n=140), group 2 included students with no history of NCI, who were initially vaccinated against COVID-19 (n=647), group 3 (control group) included unvaccinated students with no history of NCI (n=55).&#x0D; Results. There were no differences in the prevalence of changes in menstrual function in female students after the NCI (49.3%) and after COVID-19 vaccination (39.6%) compared to the control group (43.6%); p=0.477. The rate of depression in the overall study cohort was 43.3%, without any significant differences between the study groups. Significant predictors of changes in menstrual function during the pandemic were marriage (odds ratio OR 2.33 [1.513.61]), depression (OR 1.72 [1.282.3]), a history of menstrual dysfunction (OR 1.5 [0.121.99]), and later menarche (OR 1.76 [1.023.04]). Multivariate analysis did not show the significance of the history of NCI and vaccination as factors of menstrual dysfunction (OR 1.61 [0.892.90] and OR 0.91 [0.591.41], respectively).&#x0D; Conclusion. During the COVID-19 pandemic, female medical students reported frequent changes in menstrual function and depressive disorders. During the pandemic, the most significant predictors of menstrual disorders in female students were depression, a history of menstrual dysfunction, and marriage. A multicenter prospective study is necessary to clarify the mechanisms of the pandemic's impact on menstrual function.

Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: Ameta-analytic review of longer-term child and parental outcomes.

Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained. This meta-analytic review investigated longer-term (i.e., more than 2months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD. We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change. Between pre-intervention and follow-up (M=5.3months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.

Impact of the Integrative Oncology Scholars Program on Oncology Providers' Key Knowledge of Dietary Supplements and Antioxidants for Providing Evidence-based Oncology Care.

Dietary supplements are commonly used among cancer survivors. Oncology providers rarely receive training about dietary supplements. We evaluated whether e-learning modules could improve oncology providers' dietary supplement knowledge. Oncology providers participated in the National Cancer Institute funded Integrative Oncology Scholars (IOS) program. We used posttest readiness assurance tests (RAT) to measure knowledge acquisition from modules. One cohort completed a pre and posttest RAT to assess change in knowledge. Multivariate linear regression models adjusted for gender, race, profession, and years in practice were used to determine if these characteristics were associated with posttest RAT performance and change in pre to posttest RAT scores. Scholars (N = 101) included 86% (N = 87) females; age 44 ± 10years; 72% (N = 73) Non-Hispanic White; years in practice mean range 11-15 ± 10. There were 37 physicians, 11 physician assistants, 23 nurses, 21 social workers, 2 psychologists, 4 pharmacists, and 2 physical therapists. The posttest dietary supplement and antioxidant RAT scores for all Scholars were 67 ± 18% and 71 ± 14%. In adjusted models there were no significant associations between dietary supplement and antioxidant posttest RAT scores with Scholar characteristics. Change in RAT scores for dietary supplement and antioxidants were 25% ± 23 and 26% ± 27 (P < 0.0001). In adjusted models, there were no significant predictors of change in dietary supplement RATs. For antioxidant RATs, profession was associated with change in scores (P = 0.021). Improvement in Scholar's test scores demonstrate the IOS program can significantly increase oncology providers' knowledge of dietary supplements and antioxidants.