Total Distress Score Research Articles

The Association between Nurses’ Quality of Work Life and Moral Distress: A Cross-Sectional Study in Rasht, Iran

Nurses play a crucial role in delivering healthcare services, emphasising the need for healthcare managers to prioritise their well-being. The quality of work life (QWL) is a significant factor influencing the recruitment and retention of nurses. This study aimed to investigate the relationship between the QWL and moral distress among nurses working in educational-remedial hospitals in Rasht, Iran. This cross-sectional analytical study utilised multi-stage sampling to survey all nurses in educational-remedial hospitals in Rasht, excluding those in ICUs, and in administrative, educational and research roles. A structured questionnaire was employed as the primary data collection tool, with data analysis conducted using SPSS version 16. The study found that over 50% of nurses reported a QWL below the mean. Significant correlations were observed between the QWL and variables, such as age (r = 0.349, p < 0.001); work experience (r = 0.319, p < 0.001); marital status (p = 0.036); level of education (p = 0.023); work shifts (p < 0.001); employment status (p < 0.001); and work position (p = 0.014). Additionally, the nurses’ moral distress levels were generally low, with a notable negative correlation between the nurses’ total QWL score and total moral distress scores (rS = –0.305, p < 0.001). The findings suggest that nurses experiencing moral distress due to executing unnecessary physician orders; ineffective team communication; and providing futile patient care are likely to face diminished QWL. Moreover, heightened moral distress levels can contribute to a decline in overall job satisfaction and well-being among nurses.

Moral resilience and intention to leave: Mediating effect of moral distress.

This study aims to examine the mediating effect of moral distress on the relationship between moral resilience and the intention to leave. Moral distress is a phenomenon that negatively impacts healthcare workers, healthcare institutions, and recipients. To eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience is important in protecting against the negative effects of moral distress, such as burnout and turnover intention. In this direction, it is necessary to increase the moral resilience of nurses to reduce negative situations such as turnover intention in nurses. It is a descriptive-predictive study. Sociodemographic Information Form, Measure of Moral Distress - Healthcare Professionals, and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 220 clinical nurses were recruited. Approval was obtained from the university's non-interventional ethics committee, and informed consent was obtained from the participants. The study found a total moral distress score of 6.39 ± 0.3.12 and moral resilience score of 2.69 ± 0.48. A moderate and weak negative correlation was found between moral distress and moral resilience. Moral distress has a moderating effect on the intention to leave nursing (β = -0.158, p = .010) and the intention to leave the current position (β = -0.174, p = .000). Individual's moral resilience directly affects the intention to leave. The presence of moral distress eliminates the direct effect of moral resilience and affects the intention to leave together with moral resilience. Moral resilience leads to decreased intention to leave, and moral distress mediates this situation. An increase in moral distress decreases moral resilience and increases intention to leave. It can be assumed that if moral distress is not controlled, increasing moral resilience will not affect the intention to leave the job.

Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial

Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. For the Urdu translation of the abstract see Supplementary Materials section.

Unveiling long COVID symptomatology, co-occurrence trends, and symptom distress post SARS-CoV-2 infection

BackgroundLong COVID, an emerging public health issue, is characterized by persistent symptoms following SARS-CoV-2 infection. This study aims to explore the relationship between post-COVID-19 symptomatology and patient distress employing Latent Class Analysis to uncover symptom co-occurrence patterns and their association with distress. MethodsA cross-sectional study was conducted using an online survey among 240 participants from a university and affiliated hospital of southern Taiwan. The survey quantified distress due to persistent symptoms and assessed the prevalence of Long COVID, symptom co-occurrence, and latent symptom classes. Latent Class Analysis (LCA) identified distinct symptom patterns, and multiple regression models evaluated associations between symptom patterns, distress, and demographic factors. ResultsThe study found that 80 % of participants experienced Long COVID, with symptoms persisting for over three months. Individuals with multiple COVID-19 infections showed a significant increase in general (β = 1.79), cardiovascular (β = 0.61), and neuropsychological symptoms (β = 2.18), and higher total distress scores (β = 6.35). Three distinct symptomatology classes were identified: "Diverse", "Mild", and "Severe" symptomatology. The "Mild Symptomatology" class was associated with lower distress (−10.61), while the "Severe Symptomatology" class showed a significantly higher distress due to symptoms (13.32). ConclusionThe study highlights the significant impact of Long COVID on individuals, with distinct patterns of symptomatology and associated distress. It emphasizes the cumulative effect of multiple COVID-19 infections on symptom severity and the importance of tailored care strategies.

Self-Care of Diabetes and Diabetes Distress in Non-Hispanic Black Adults With Type 2 Diabetes.

The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes. This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress. Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management. In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.

Psychotic experiences in university students: prevalence, correlates and association with non-specific psychological distress

Introduction Subclinical psychotic experiences (PEs) are far more prevalent than psychotic disorders, with an estimated prevalence of 7.2% (Linscott &amp; Van Os. Psychol Med 2013;43(6) 1133-1149). PEs are particularly prevalent in late adolescence and young adulthood, when obtaining academic education is one of the main developmental tasks. University students are at the peak age of onset of mental disorders, and often experience high levels of social and academic stress that may contribute to the onset of psychopathology. Hence, estimating the prevalence and correlates of PEs among university students is particularly important.ObjectivesTo estimate the prevalence of PEs in a sample of Israeli students; assess whether rates of PEs differ by selected sociodemographic characteristics; and examine the association between PEs and non-specific psychological distress.Methods150 students from universities and colleges in Israel participated in a cross-sectional online survey. All students were over the age of 18 and were not diagnosed with psychotic disorders. Participants completed self-report questionnaires, including the Prodromal Questionnaire - Brief Version (PQ-B), Kessler Psychological Distress Scale (K10) and sociodemographic details. The PQ-B yields a score for the total number of items endorsed (range 0–21), and a total distress score (range 0–105). A cutoff of ≥8 distressing symptoms was used to identify participants at high-risk for psychosis.Results 21 participants (14.0%) reported 8 or more distressing PEs. PEs were more common in males and among those with a psychiatric illness (Table 1). PEs were not associated with marital status, religiosity, or immigrant status. While a greater number of PEs was positively associated with non-specific psychological distress (r=0.589, p&lt;.001), there was no association between distress caused by PEs and non-specific psychological distress (r=0.145, NS). Table 1.Sociodemographic characteristics by groupPEs-PEs+X2, pSexM29.5%52.4%4.32, .038F70.5%47.6%Marital StatusMarried17.1%23.8%0.56, NSUnmarried82.9%76.2%ImmigrantNo89.9%85.7%0.34, NSYes10.1%14.3%ReligiositySecular74.4%57.1%2.67, NSOther25.6%42.9% PsychiatricillnessNo87.6%61.9%8.87, .003Yes12.4%38.1%ConclusionsThe findings confirm that self-reported PEs are much more prevalent than clinically diagnosed psychotic disorders, particularly among young adults. As PEs were found to be associated with non-specific psychological distress, and as they are known forerunners for severe mental disorders, it is important to address mental health issues in school settings and promote prevention and early intervention programs.Disclosure of InterestNone Declared

Efficacy and mechanisms of cannabis oil for alleviating side effects of breast cancer chemotherapy (CBC2): protocol for randomized controlled trial

BackgroundIn a pilot study using both cannabidiol (CBD) and tetrahydrocannabinol (THC) as single agents in advanced cancer patients undergoing palliative care in Thailand, the doses were generally well tolerated, and the outcome measure of total symptom distress scores showed overall symptom benefit. The current study aims to determine the intensity of the symptoms experienced by breast cancer patients, to explore the microbiome profile, cytokines, and bacterial metabolites before and after the treatment with cannabis oil or no cannabis oil, and to study the pharmacokinetics parameters and pharmacogenetics profile of the doses.MethodsA randomized, double-blinded, placebo-controlled trial will be conducted on the breast cancer cases who were diagnosed with breast cancer and currently receiving chemotherapy at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. Block randomization will be used to allocate the patients into three groups: Ganja Oil (THC 2 mg/ml; THC 0.08 mg/drop, and CBD 0.02 mg/drop), Metta Osot (THC 81 mg/ml; THC 3 mg/drop), and placebo oil. The Edmonton Symptom Assessment System (ESAS), Food Frequency Questionnaires (FFQ), microbiome profile, cytokines, and bacterial metabolites will be assessed before and after the interventions, along with pharmacokinetic and pharmacogenetic profile of the treatment during the intervention.Trial registrationTCTR20220809001.

Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study

BackgroundMoral distress is a multifactorial and complex phenomenon influenced by various individual, cultural, and systemic factors. This study aimed to investigate the frequency and intensity of nurses’ moral distress, explore their experiences, and develop the conceptual model of risk factors of moral distress in surgical units and operating rooms.MethodThis is a sequential mixed-method study conducted at four teaching hospitals affiliated with the Qom University of Medical Sciences. In the first step, the moral distress of nurses in surgical units and operating rooms was investigated by a survey. The participants included nurses who worked in the operating room and surgical units. (n = 180). The data was collected by a Moral Distress Scale-Revised (MDS-R) questionnaire. In the second step, the experiences of nurses regarding risk factors of moral distress were explored using semi-structured interviews and analyzed using the conventional content analysis by Graneheim and Lundman’s approach.ResultsOne hundred eighty nurses participated in this study. The mean total moral distress scores ranged from 12 to 221, with a mean (SD) of 116.8 (42.73). The causes of moral distress cited with the highest frequency and intensity related to the ‘role of healthcare providers’. The experiences of the participants in the theme ‘Inductive process of moral distress development’ were categorized into three categories: ‘Melting into the faulty system’, ‘Power and the system as distress promotors’, and ‘Perceived unpleasant consequences’.ConclusionThe results indicated that the frequency of moral distress in operating rooms and surgical units was at a moderate level and the distress intensity of nurses was at a moderately high level. The results indicated that in the investigated system, the “inductive moral process of distress development” was continuously understood by the participants. This process was influenced by systemic and individual factors. Weak assertiveness, conservative compromise, and desensitization to unprofessionalism as individual factors were effective in causing distress. Risk factors at the systemic level led nurses to melt into the faulty system and created adverse outcomes at the individual level. The lack of systemic support and the stabilization of mobbing by powerful system members had a negative impact on the individual factors of distress development. Also, these factors directly cause negative consequences.

Comparison of male and female non-refugee immigrants with psychosis: clinical, sociodemographic, and migration-related differences and impact on stress.

To compare social, clinical, and migration-related factors between male and female immigrants with psychotic disorders and to determine the association between these variables and stress in the last year. We administered the Holmes and Rahe Social Readjustment Scale to evaluate psychological stress in 99 non-refugee immigrants (26 women, 73 men) who presented ≥ one psychotic episode (ICD-10 criteria). We compared the two groups in terms of sociodemographic, clinical, cultural, and migration-related variables. A multivariable analysis using a linear regression model (stepwise method) was performed to evaluate potential associations between these variables and stress. Women were more likely to be married and divorced, had less access to welfare payments, and lower unemployment and homeless rates than men. The most common psychiatric diagnosis was psychosis not otherwise specified with more women being affected (61.5% in women vs. 45.2% in men), but the diagnosis of schizophrenia was more common in men (38.4% vs 15.4%). Both groups exhibited very high levels of stress in the past year (mean total distress score > 300). In women, stress was significantly associated with age at first migration and be a racialized person. By contrast, among men stress was significantly associated with language barrier and comorbidity with a physical disorder. The results of this study reveal important differences between men and women immigrants. These findings underscore the importance of understanding how gender-specific roles and social expectations intersect with the timing and nature of migration to influence stress levels differently in immigrant women and men with psychotic disorders.

Moral distress and intention to leave work among nurses: a prospective survey study in Oman

Background/Aims Moral distress can have a substantial impact on nurses, contributing to burnout and staff turnover. This study aimed to assess the level of moral distress, identify the situations considered to cause the most moral distress and measure the relationship between moral distress, demographic factors and intention to leave one's role or the nursing profession in a hospital in Oman. Methods A descriptive correlational design was used. The study sample comprised 167 nurses working in intensive care, oncology, medical or surgical units in a referral hospital in Muscat, Oman. A survey was distributed to participants in their place of work. Data were collected using the Measure of Moral Distress – Healthcare Professionals tool, measuring frequency of morally distressing events and the level of distress caused. The survey also collected demographic details and information on whether participants were currently considering (or had ever considered) leaving their role because of moral distress. Results were summarised using descriptive statistics, with relationships between variables analysed using Mann–Whitney and Kruskal–Wallace tests, Spearman's rho and logistic regression. Results The mean total moral distress score was 81.0 (±59.4) out of a possible score range of 0–432. The situations that participants found the most morally distressing were excessive documentation requirements that compromise patient care and feeling pressured to provide what they considered to be unnecessary or inappropriate tests and treatments. Area of work was not significantly associated with level of moral distress, but moral distress was significantly higher in participants with less nursing experience and those considering leaving their role. Conclusions Practical solutions are required to support nurses who may be at high risk of experiencing moral distress. This could include mentoring schemes and strategies to reduce or streamline clinical documentation requirements.

Presence and Characteristics of Behavioral and Psychological Symptoms in Subacute Stroke Patients with Cognitive Impairment.

This retrospective cross-sectional study is aimed at investigating the prevalence and characteristics of behavioral and psychological symptoms (BPS) in subacute stroke patients with cognitive impairment. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was used to assess BPS. A total of 358 consecutive patients with first-ever stroke admitted to rehabilitation wards and with Mini-Mental State Examination (MMSE) scores < 24 on admission were included. BPS was defined as a total NPI-Q Severity or Distress score ≥ 1. Differences between the severity and presence of BPS among patients with severe cognitive impairment (MMSE scores 0-17) and those with mild cognitive impairment (MMSE scores 18-23) were analyzed using the Mann-Whitney U test and chi-squared test, respectively. Eighty-one patients (mean (standard deviation) age, 73.5 (13.1) years) were enrolled for analysis. BPS were observed in 69.1% and 74.1% of patients when assessed with NPI-Q Severity and NPI-Q Distress, respectively. The most frequently observed BPS was apathy, followed by depression (approximately 44% and 40%, respectively). The severity and frequency of delusions, euphoria, apathy, and disinhibition were significantly higher in the severe cognitive impairment group than in the mild cognitive impairment group. However, the severity, distress, and frequency of depression were not dependent on the severity of cognitive impairment. The presence of BPS, especially apathy and depression, in subacute stroke patients with cognitive impairment is high. The severity and frequency of some BPS are higher in patients with severe cognitive impairment than in those with mild cognitive impairment. However, depression is highly prevalent among the patients regardless of the severity of cognitive impairment.

The relationship between healthy lifestyle behaviors and pregnancy distress situations in pregnant women during the COVID-19 epidemic

Background: The COVID-19 pandemic is causing significant changes in pregnant women’s healthy lifestyles such as nutrition, physical activity, sleep, and weight gain. This study was conducted to determine the relationship between pregnant women’s healthy lifestyle behaviors and distress during the COVID-19 pandemic. Materials and Methods: The data were collected between April and October 2021 through face-to-face interviews with pregnant women over 18. The sample of the study consisted of 209 pregnant women. The Tilburg pregnancy distress scale and the healthy living behaviors scale were used to collect data. Descriptive statistics, parametric tests, and regression analysis methods were used to analyze the data in the study. Results: As a result of the study, the mean Tilburg Distress Scale score of pregnant women was 19.91±9.15. The total psychological distress score of 26.8% of the pregnant women was observed to be higher than the cutoff point. The mean score of the healthy living behaviors scale of pregnant women was 120.71±17.04. It was observed that the Tilburg Distress Scale total score and the spousal participation sub-dimension score affected pregnant women’s healthy living behaviors scale total score (values p&lt;0.001 and p&lt;0.005, respectively). It was determined that the total score of the Tilburg Distress Scale was 0.34 times effective on the quality of life during pregnancy, and the spousal participation sub-dimension was −2.16 times effective. Conclusion: This study concluded that pregnant women experienced psychological distress during the COVID-19 period and that this situation affected the quality of life of pregnant women.

Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers

BackgroundPaternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints. MethodWe employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups. ResultsAt 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing “crying”. LimitationsWhile the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time. ConclusionsInterpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.

Moral Distress and Its Relating Factors Among Pediatric Emergency Department Nurses: A Cross-Sectional Study.

Emergency services are patient circulation units that require chaos, trauma, and high tension. It was aimed to determine the moral distress levels of pediatric nurses in pediatric emergency and emergency departments and relevant factors. This study is a descriptive and cross-sectional study. It consists of 255 nurses with their data. The Participant Information Form and the Moral Distress Scale-Revised for Pediatric Nurses (MDS-R) were used to collect data. In the study, the mean score of MDS-R frequency was found to be 27.36 ± 13.16, the mean score of MDS-R intensity to be 37.65 ± 17.53, and the mean total score of MDS-R to be 58.96 ± 39.40. It was determined that 93.7% of the nurses received training on moral distress, and education level was effective on moral distress levels of the nurses. The nurses working in the pediatric emergency service had higher moral distress levels than the nurses serving pediatric patients in the emergency department ( P(total MDS-R) = 0.02, P(frequency of MDS-R) = 0.008). Job satisfaction ( P(total MDS-R) = 0.003, P(frequency of MDS-R) < 0.001, P(intensity of MDS-R) < 0.001) and frequency of thinking about changing working unit ( P(frequency of MDS-R) = 0.02, P(intensity of MDS-R) = 0.01) were found to be effective on the level of moral distress. It was determined that the type of emergency service, the working time in the emergency service, and the level of job satisfaction significantly affected the total moral distress scores of the nurses ( P < 0.001, R2 = 0.09). It was found in the study that nurses had low levels of moral distress; however, many factors relevant to working conditions were associated with moral distress. The pediatric emergency service nurses were determined to experience a higher moral distress compared with the emergency department nurses serving pediatric patients.

Implementation strategies for monitoring adherence in real time (iSMART): A pilot randomized trial.

9115 Background: Helping patients to manage symptoms and adhere to oral anticancer agents (OACAs) is a major challenge in oncology. OACAs cause side effects that can lead to suboptimal adherence if not optimally managed, contributing to decreased effectiveness. Low-cost, text messaging approaches have shown promise, but have not been robustly studied in oncology. Guided by principles from implementation and behavioral science, we developed and tested the effect of an augmented intelligence chatbot on OACA adherence and symptom burden in patients with advanced lung cancer. Methods: We conducted a two-arm pilot randomized trial (NCT04347161) to evaluate the effect of the chatbot on OACA adherence and symptom burden compared to usual care. The chatbot engages patients via text messaging and applies natural language processing and machine learning to learn from interactions. Core functionalities include: 1) motivational daily adherence reminders, 2) longitudinal symptom monitoring with self-management support, and 3) bidirectional communication with clinical teams. Participants included English-speaking patients with advanced lung cancer treated with any of 9 OACAs targeting EGFR, ALK, or ROS-1. The primary outcome was 12-week adherence, measured using the microelectronic monitoring system (MEMS) and defined dichotomously if the patient achieved ≥95% adherent days or not. Secondary outcomes were assessed at baseline and 12 weeks using validated survey instruments, including symptom burden using the Edmonton Symptom Assessment System Total Distress Score (range 0-90), health-related quality of life (HRQOL) using EQ-5D-3L (range 0-100), and usability using Health-ITUES (range 1-5). We used multivariable logistic regression adjusting for stratification variables to test the chatbot’s effect on adherence (intent-to-treat analysis) and evaluated mean differences (by arm) in secondary outcomes using Fisher’s exact test. Results: From February 2021 to August 2022, 75 patients across 4 sites enrolled (median age 65 years, 64% female, 88% White, 21.3% high school education or lower); 50.7% (n=38) were randomized to intervention. Compared to usual care, we observed no significant differences in adherence in the intervention arm (78.8% vs 81.8%; aOR=1.7 95% CI: 0.3-9.4). However, in contrast to those in usual care, participants in the intervention arm had significantly greater decreases in symptom burden (mean difference: -2.7 vs 2.6; p&lt;0.05) and increases in HRQOL (mean difference: 4.1 vs -4.8; p&lt;0.05) from baseline to 12 weeks. Overall chatbot usability was high (mean score=3.9). Conclusions: In this pilot randomized trial, an augmented intelligence chatbot successfully reduced symptom burden and improved HRQOL but did not significantly alter OACA adherence. Chatbots are a potentially scalable strategy for improving symptom management that warrant study in larger randomized trials. Clinical trial information: NCT04347161 .

Emotional Distress in a Patients Following Polytrauma.

Emotional affectivity can be described under two general dimensions: positive affectivity and negative affectivity. It is often assessed by means of questionnaires completed retrospectively by the subjects. The most common scales used are PANAS, DES, and PANA-X. All these scales are based on the concept of two dimensions, negative and positive affective emotions, respectively. Both dimensions mentioned, positive and negative affectivity, can be associated with a bipolar dimensional entity called pleasant-unpleasant. Specifically, a high level of positive emotions and a low level of negative emotions are associated with pleasant/positive feelings (happiness, well-being, satisfaction, cheerfulness, etc.), while a low level of positive emotions and a high level of negative emotions are associated with negative feelings (sadness, anger, nervousness, depression, anxiety, etc.). This study is an observational and cross-sectional study. The elements that led to the production of the final database were collected by means of a questionnaire, which included 43 items, 39 of which were specific questions found in the affective distress profile. The questionnaire was administered to 145 patients who had suffered polytrauma and were admitted to the Emergency Hospital of Galati in October 2022. The final centralizing tables included the characteristics of 145 patients, aged between 14 and 64 years. The aim of this study is to identify the level of emotional distress in patients who have suffered polytrauma, so the following scores were evaluated, obtained after the application of PDA: STD, ENF, END. The total distress score was obtained by summing all the negative items found in the PDA questionnaire. Men show a high level of emotional distress compared to women. Polytrauma has a negative effect on patients' emotional status, with a worrying prevalence of negative functional and dysfunctional emotions. The level of distress in polytrauma patients is high.

Behavioral and Psychological Symptoms of Dementia: Prevalence, Symptom Severity, and Caregiver Distress in South-Western Uganda-A Quantitative Cross-Sectional Study.

The purpose of the study was to investigate behavioral and psychological symptoms (BPSD) prevalence, severity, and distress experienced by caregivers of people living with dementia (PLWD). A cross-sectional, population-based study was conducted in a rural area in southwestern Uganda. A Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to determine the presence of BPSD as perceived by caregivers of PLWD. We carried out both descriptive and inferential data analysis. A total of 175 caregivers of PLWD were enrolled in this study. Among PLWD, 99% had presented BPSD in the past month. Hallucinations (75%) and dysphoria/depression (81%) were the two BPSD that occurred most frequently. Most participants (70%) stated that PLWD experienced hallucinations of significant severity. Aberrant motor activity was reported by 60% of the participants as the type of BPSD that caused severe distress. There was a high positive correlation (0.82) between the total severity score and total distress scores. Interventions aimed at addressing dysphoria and hallucinations may be essential for the reduction of caregiver distress. These findings point to the need for promoting early screening for BPSDs and the provision of support to caregivers.

Diabetes Distress Among Type 1 Diabetic Adolescents in a Tertiary Care Hospital in Pakistan.

Diabetes distress, a term used to describe negative emotions associated with diabetes, is the key factor responsible for the elevated risk of psychological burden and compromised self-management. The aim of this study is to determine the prevalence of diabetes-related distress among adolescent patients with type 1 diabetes (T1D) and to ascertain various factors associated with it. In this cross-sectional study, 117 T1D patients with age 12-20 years visiting a diabetic clinic in the Department of Endocrinology and Metabolism,Services Hospital Lahorefrom February 2022 to August 2022 were enrolled. The patient's demographic and clinical details were noted in a pre-designed proforma. T1D distress scale (T1DDS) was utilized as the tool for measuring diabetes distress and distress was classified as severe, moderate, and no/little distress. Of the total 117 T1D patients, 34.2% (n=40) had diabetes-related distress, out of which 31.6% had moderate and 2.6% had severe distress. The average total distress score was 1.73 ± 0.52 and higher mean scores were of powerlessness, negative social perception, and eating distress. Distress was higher among females, in those with the onset of diabetes in teens rather than in childhood. There is a significant impact of glycated hemoglobin (HbA1c) on the severity of diabetes distress as demonstrated by Pearson's correlation (r=.570, n= 117, p = <.001) Conclusion:The present study highlights the association of diabetes distress in adolescents with various factors, most significantly poor glycemic control, and therefore emphasizes the need for developing psychological interventional strategies in routine diabetes care to improve the mental well-being and self-management of diabetic patients.

Abstract CT512: A technology-based intervention using computers and mobile devices: To improve symptom experience of Asian American breast cancer survivors

Abstract Purpose: Especially with the COVID19 pandemic, the necessity of technology-based interventions using computers and mobile devices has increased in cancer survivorship management including symptom management. However, little is known about the effectiveness of a technology-based intervention in improving symptom experience of racial/ethnic minorities including Asian American breast cancer survivors. The purpose of this study was to examine the efficacy of a technology-based intervention in improving symptom experience of Asian American breast cancer survivors. Methods: This study was conducted as a part of an ongoing randomized clinical trial among 199 Asian American breast cancer survivors. The technology-based intervention included three sub-ethnic specific social media sites, interactive online educational sessions, and online resources. Both groups (intervention and control groups) used the American Cancer Society’s website on breast cancer, and only the intervention group used the technology-based intervention. Only the data collected using the questionnaire on background characteristics and health/disease status and the Memorial Symptom Assessment Scale-Short Form (MSAS) were analyzed for this study. The data were analyzed using separate intent-to-treat growth curve models. Results: While both groups reported decreases in symptom scores from the pre-test to post 3-months (p&amp;lt;.01), the intervention group had larger decreases in symptom scores compared with the control group (p&amp;lt;.01). There existed significant group * time interactive effects on the Global Distress Index (β = - 0.234), the Physical Symptom Distress scores (β = -0.266), the psychological symptom distress scores (β = - 0.212c), the total number of symptoms (β = -0.261), and the total symptom distress scores ( β = -0.261). Conclusions: The findings of this study clearly indicated symptom improvement among Asian American breast cancer survivors by a technology-based intervention using computers and mobile devices. Further studies with diverse racial/ethnic minorities are warranted to confirm the effectiveness of technology-based interventions in improving symptom experience of cancer survivors across different types of cancer. Citation Format: Eun-Ok Im, Gayeong Kim, Ruiqi Jin, Mi-Yong Choi, Sudeshna Paul, Wonshik Chee. A technology-based intervention using computers and mobile devices: To improve symptom experience of Asian American breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT512.

Clinico-demographics of people with younger-onset dementia and neuropsychiatric symptoms referred to an Australian dementia support service: A comparison study with older-onset dementia.

Younger-onset dementia accounts for about 5-10% of all dementias in Australia. Little data is available on neuropsychiatric symptoms in people with younger-onset dementia compared to those with older-onset dementia. This study aims to compare the types of neuropsychiatric symptoms and their clinico-demographic characteristics of people with younger-onset dementia and older-onset dementia who are referred to a specific dementia support service. A 2-year retrospective observational cross-sectional analysis was undertaken on referrals with neuropsychiatric symptoms from Dementia Support Australia programmes. Neuropsychiatric symptoms were measured using the Neuropsychiatric Inventory total severity scores and distress scores. Contributing factors to neuropsychiatric symptoms for dementia groups were examined. Logistic regression was used to examine the relationship between individual neuropsychiatric symptoms and having older-onset dementia vs younger-onset dementia. Of the 15,952 referrals, about 5% (n = 729, mean age: 60.7 years, standard deviation = 5.4) were individuals with younger-onset dementia. Referrals with older-onset dementia were more likely to be female (56%), whereas referrals with younger-onset dementia were more likely to be male (54%). There was a four times greater rate of frontotemporal dementia for those with younger-onset dementia (16.0%, n = 117) compared to those with older-onset dementia (2.8%, n = 427), χ2 (1) = 366.2, p < 0.001. Referrals with younger-onset dementia were more likely to be referred from community settings and those with older-onset dementia were more likely to be from residential aged care. Overall, there was no difference in the severity and distress of neuropsychiatric symptoms between the two groups. Contributing factors to neuropsychiatric symptoms were different between the groups, with pain being more frequently endorsed for individuals with older-onset dementia whereas communication difficulties were more commonly identified for those with younger-onset dementia. Clinico-demographics of referrals with younger-onset dementia differ from those with older-onset dementia. There were some differences in the characteristics of neuropsychiatric symptoms between younger-onset dementia and older-onset dementia. Our findings have implications for service provision and support for people with dementia at different ages.