The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs

Does robotic surgical assistant (ROSA) functionally aligned TKA lead to higher satisfaction than conventional mechanically aligned TKA: A propensity-matched pair analysis

Objectives

Total knee arthroplasty (TKA) is the established treatment for severe knee osteoarthritis, with robotic-assisted TKA (rTKA) proposed to enhance surgical precision and potentially improve outcomes. This study investigates whether functionally-aligned rTKA using the ROSA Knee System results in superior functional outcomes and patient satisfaction compared to conventional mechanically aligned TKA (mTKA).

Methods

We conducted a retrospective, propensity-score matched cohort study including 154 patients (46 rTKA, 108 mTKA) who underwent primary TKA by a single surgeon from October 2020 to October 2023. Functionally-aligned (FA) rTKA was performed using the ROSA Knee System. Patients were assessed using the Short-Form 36 (SF36), Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Oxford Knee Score (OKS) preoperatively and at 6 months postoperatively. Immediate postoperative outcomes such as pain at rest and movement, ambulation distance, and range of motion were measured. Statistical analysis evaluated results at a 95 % confidence interval, with significance at P < 0.05.

Results

No significant differences were observed in immediate postoperative pain at rest (P = 0.988), pain during movement (P = 0.634), ambulation distance (P = 0.243), and range of motion (P = 0.752) between the groups. At 6 months, there were no significant differences between rTKA and mTKA in achieving the minimal clinically important difference for SF36 (P = 0.996), KSKS (P = 0.150), KSFS (P = 0.091), and OKS (P = 0.949). No significant differences were noted for satisfaction levels (P = 0.315) and fulfilled expectations (P = 0.557) between both groups.

Conclusions

At 6 months postoperatively, FA rTKA demonstrated equivalent outcomes and satisfaction levels compared to mTKA. Future research should focus on examining longer-term follow-up outcomes, quantifying gap balance in MA mTKA to allow direct comparison with rTKA and studying alternative personalised alignment rTKA strategies to enhance patient outcomes.

Older adults living with Alzheimer's Disease, dementia or mild cognitive impairment with no informal caregiver or care partner: IDEA Café, the first pilot randomized trial intervention for this underserved populations

OBJECTIVES

This study presents findings from IDEA Café, for older adults aged 50 and older living with early dementia, dementia, Alzheimer's Disease or cognitive impairment (ED/CI) with no informal caregiver or care partner. IDEA Café is a group adaptation of Innovations in Dementia Empowerment and Action (IDEA) (built upon the foundation of RDAD). It was tested with sexual and gender minority (SGM) older adults, as an underserved population.

METHOD

Employing a two-group randomized controlled pilot trial, thirty participants were randomly assigned to IDEA Café (n = 15) or routine medical care (RMC; n = 15). Feasibility and acceptability were assessed. We conducted pre- and post-treatment assessments of primary and secondary outcomes.

RESULTS

IDEA Café was feasible (attendance, participation), acceptable (helpfulness of the program), and met enrollment goals, with 85% of participants reporting treatment as helpful. The treatment group showed significant improvement in physical functioning (p = 0.04), depressive symptomology (p = 0.03), quality of life (p = 0.04), and a reduction in microaggressions (p = 0.05) and social exclusion (p = 0.03). The RMC showed no statistical change from pretest to posttest.

CONCLUSION

A future randomized controlled trial is needed to test the efficacy and sustainability of the intervention and to bring the intervention to scale.

Efficacy and safety of lemborexant vs placebo in treating adults with insomnia disorder: a systematic review and meta-analysis of 1976 patients

Insomnia is a typical sleep disorder in which an individual finds it difficult to fall asleep and stay asleep resulting in poor daytime functioning and decreased health and quality of life. The orexin system, which regulates wakefulness and arousal, is often overactive in individuals with insomnia, disrupting normal sleep patterns. Lemborexant, a dual orexin receptor antagonist, works through the inhibition of the orexin system, thus facilitating increased sleep onset and maintenance of sleep. This systematic review and meta-analysis seek to determine the effectiveness and safety of lemborexant in the treatment of insomnia. A comprehensive search was conducted on PubMed, Scopus, Web of Science, and Cochrane Library, from inception to September 2024. Four randomized controlled trials (RCTs) assessing the efficacy and safety of lemborexant for patients with confirmed DSM-5 diagnosis of insomnia as compared to placebo were included. By adopting a random-effect inverse variance model, RevMan was used to pool dichotomous and continuous data. We employed the ROB2 methodology to evaluate the quality of the evidence, so ensuring the reliability of the findings obtained throughout these investigations. Four studies with a total of 1976 patients were included. Lemborexant was superior to placebo in decreasing sleep onset latency and wake after sleep onset: (MD =  - 9.23 min, P = 0.02 and MD =  - 19.9 min, P < 0.0001) with 5 mg and (MD =  - 12.56 min, P = 0.004) and (MD =  - 22.24 min, P < 0.0001) with 10 mg, respectively. In addition, sleep efficiency was statistically significantly higher in the lemborexant group (MD = 6.08%, P < 0.0001) and (MD = 7.46%, P < 0.0001) with 5 mg and 10 mg, respectively. Regarding safety analysis, Treatment emerged adverse events (TEAEs) and somnolence were statistically significantly higher in the lemborexant group (RR = 1.94, P < 0.0001) and (RR = 4.95, P < 0.0001), respectively. In accordance with this systematic review and meta-analysis, lemborexant is an effective pharmacotherapy for the treatment of insomnia as it improves sleep onset latency, wake after sleep onset, and sleep efficiency. Both formulations of 5-mg and 10-mg doses were well tolerated with no significant difference in their effect; however, somnolence was more common relative to placebo. Lemborexant appears to fill a therapeutic gap in the treatment of insomnia but should be used with caution and smaller dose (5 mg) in those who are at risk of developing an excessive daytime somnolence state.

Core characteristics, and effectiveness of mobile health interventions on dyspnoea and quality of life in older persons with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials

AIM

To systematically review the core characteristics, and effectiveness of mobile health interventions (MHIs) on dyspnoea and quality of life (QoL) in older persons with chronic obstructive pulmonary disease (COPD).

METHODS

A comprehensive search was conducted from inception to 21 February 2023 in Chinese and English databases, with an updated search performed on 30 April 2024. Randomised controlled trials (RCTs) involving MHIs with four core functions - customisation, self-monitoring, alerts, and goal-setting - in older persons with COPD were included. Two reviewers independently identified the core characteristics of MHIs using the Template for Intervention Description and Replication (TIDieR) checklist. The Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were used to assess the methodological quality of RCTs and the overall quality of evidence.

RESULTS

28 RCTs were included, with 43% of studies adequately reported core characteristics of MHIs according to the TIDieR checklist. Meta-analysis suggested that MHIs may alleviate dyspnoea and improve disease-specific QoL questionnaires (CRQ and CCQ) and generic-related QoL questionnaires (SF-36 and EQ-5D), but not other disease-specific QoL questionnaires (SGRQ and CAT). Subgroup analyses showed that multi-component MHIs were effective in improving dyspnoea. Dyspnoea showed statistically significant improvement at 3 months, 6 months and 12 months, whereas QoL improved at 4 months (SGRQ), 2 months (CAT) and 6 months (CAT).

CONCLUSION

Reporting on the core characteristics of MHIs is currently incomplete, and it is recommended that healthcare professionals develop and report multi-component MHIs based on the TIDieR checklist to help alleviate dyspnoea and enhance QoL in older persons with COPD.

The role of social problem-solving in emerging adult healthcare transition

Objective

Transitioning to independent self-management is an observed challenge for emerging adults with chronic medical conditions (CMCs). Strong healthcare management skills are linked with better health-related quality of life (HRQoL). Social problem-solving skills also contribute to HRQoL, but limited research exists on the role of these skills among emerging adults with CMCs. Therefore, the current study examines the potential mediating role of problem-solving abilities between healthcare management skills and HRQoL among emerging adults with CMCs.

Methods

Emerging adults (N = 279; Mean Age=19.37, SD=1.33; 84.9 % Female; 79.2 % White; 26.9 % first generation student) with a CMC completed online measures of demographics, transition readiness, social problem-solving, and HRQoL. A path analysis estimated the direct and indirect effects of transition readiness on HRQoL, with demographic and illness-related covariates (e.g., sex, illness controllability, COVID time).

Results

The overall path analysis was significant (p < 0.001) and accounted for 28.0 % of the variance in mental (M=-1.46, SD=1.12) and 20.5 % of the variance in physical HRQoL (M=-0.65, SD=0.96). Transition readiness had a significant indirect effect through dysfunctional problem-solving skills on mental (β=0.07, SE=0.03, p = 0.02) and physical HRQoL (β=0.04 SE=0.02, p = 0.04). Constructive problem-solving did not mediate the relationships (ps>0.05).

Conclusions

Findings indicate that dysfunctional problem-solving may impede emerging adults' ability to effectively apply healthcare management skills, and interventions that reduce dysfunctional problem-solving may be needed to improve HRQoL. College campuses may be a suitable environment for providing problem-solving training, and future research should explore opportunities to engage these communities in healthcare transition support.

Identifying Key Factors Influencing Hospital Stay After Spine Surgery: A Comprehensive Predictive Model

Study DesignRetrospective Cohort Study.ObjectivesTo develop and validate a multivariable predictive model for length of hospital stay (LOS) following spine surgery, incorporating sociodemographic characteristics, medical data, and self-reported patient outcomes.MethodsA retrospective analysis of 4583 patients from a spine surgery registry was conduct-ed. Predictors included age, sex, BMI, ASA score, surgical complexity, and patient-reported outcomes. Binary logistic regression was used to model LOS (<3 days vs ≥3 days).ResultsLower age, active work status, lower ASA scores, and specific surgical procedures were associated with shorter LOS. The model demonstrated good accuracy and dis-criminative ability.ConclusionsSociodemographic, medical, and patient-reported outcomes are valuable predictors of LOS. These findings can help improve preoperative planning and resource allocation in spine surgery.

Five-year outcomes of a randomized controlled trial evaluating a non-adjustable ring in Roux-en-Y gastric bypass

BACKGROUND

Several retrospective studies suggest that adding a non-adjustable silicone ring to a Roux-en-Y gastric bypass (RYGB) results in more weight loss and prevents weight regain in the long term. The aim of this study was to evaluate the effect of a banded Roux-en-Y gastric bypass (B-RYGB) on weight loss outcomes in a randomized controlled trial (RCT).

METHODS

In this single center RCT, 130 patients were divided into two groups: a standard Roux-en-Y gastric bypass (S-RYGB) or a B-RYGB using a Minimizer® ring. Subsequently, weight loss, morbidity, reduction of obesity-associated medical conditions, quality of life (QoL), and complication rates were measured during a follow-up period of five years. A two-sided p < 0.05 (with 95% confidence interval) indicated statistical significance.

RESULTS

After five years, mean percentage total body weight loss (%TBWL) was 30.5% in the S-RYGB versus 31.8% in the B-RYGB group (p > 0.05). The follow-up percentage was 81%. Overall, no significant differences in complication rates, resolution of obesity-associated medical conditions, and QoL were found between the two groups. In the B-RYGB group, 8 (12%) silicone rings were removed due to symptoms of dysphagia.

CONCLUSION

B-RYGB is a safe procedure showing similar comorbidity when compared to a S-RYGB. However, B-RYGB led to a higher rate of postoperative dysphagia which poses a risk of ring removal over time. The results from this RCT do not support the hypothesis that implantation of a non-adjustable silicone ring improves long-term weight loss outcomes.

Health-Related Quality of Life and Health Utility After Metabolic/Bariatric Surgery Versus Medical/Lifestyle Intervention in Individuals With Type 2 Diabetes and Obesity: The ARMMS-T2D Study

OBJECTIVE

Type 2 diabetes and obesity are associated with reduced health-related quality of life (HRQoL) and health utility (HU), but long-term effects of metabolic/bariatric surgery (MBS) compared with those of medical/lifestyle intervention (MLI) on these outcomes are unclear.

RESEARCH DESIGN AND METHODS

We studied 228 individuals with type 2 diabetes and obesity randomly assigned to MBS (Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric band; n = 152) or MLI (n = 76) in the ARMMS-T2D study. HRQoL (36-Item Short-Form Health Survey [SF-36], including Physical Component Score [PCS] and Mental Component Score [MCS]) and HU (Short Form 6 Dimensions [SF-6D]) were measured annually up to 12 years.

RESULTS

At baseline, participants' mean ± SD age was 49.2 ± 8.0 years, 68.4% were female, BMI was 36.3 ± 3.4 kg/m2, and HbA1c was 8.7 ± 1.6%. PCS improved significantly more in the MBS versus MLI group over 12 years (+2.37 ± 0.53 vs. -0.95 ± 0.73; difference 3.32 ± 0.85; P < 0.001). MBS was associated with better general health (P < 0.001), physical functioning (P = 0.001), and vitality (P = 0.003). Reduction in BMI was greater after MBS versus MLI (P < 0.001) and correlated with improved PCS (r = -0.43; P < 0.001). Change in PCS was not associated with change in HbA1c. MCS changed minimally from baseline and was similar between MBS and MLI groups during follow-up (-0.21 ± 0.61 vs. -0.89 ± 0.84; difference 0.68 ± 0.97; P = 0.48). Improvements in HU were greater in the MBS versus MLI group over 12 years (+0.02 ± 0.01 vs. -0.01 ± 0.01; difference 0.03 ± 0.01; P = 0.003).

CONCLUSIONS

Metabolic surgery produces sustained weight loss and improves PCS, general health, physical functioning, vitality, and HU in individuals with type 2 diabetes and obesity compared with medical therapy up to 12 years after intervention.

Clinical features and management of thoracic endometriosis: a 20-year monocentric retrospective study

PURPOSE

Although thoracic endometriosis (TE) represents the most common manifestation of extra-pelvic endometriosis, it is a rare condition and currently there is no established clinical guideline for the management of this condition. The study's primary objective was to assess patient satisfaction with the treatment provided. A secondary objective was to investigate the efficacy of different treatment modalities in terms of symptom and lesion recurrence.

METHODS

A retrospective review of the clinical records of all women with TE who had been referred to our institution, a tertiary referral center, was conducted between January 2000 and September 2021. A frequency analysis was performed for all the variables examined in the study. The Kaplan-Meier method was adopted to analyse the time from thoracic surgery to PNX recurrence. Lastly, an intention-to-treat analysis was performed.

RESULTS

Regarding clinical presentation, 50% of women (30/60; 95% CI 36.8-63.2) experienced at least one episode of pneumothorax (PNX). A total of 61.7% of the women in the study underwent surgical intervention, while 36.6% received pharmacological treatment. The cumulative recurrence rate of the first PNX following surgery was 0.26 (0.13-0.41) and 0.82 (0.44-0.95) at six months and 240 months, respectively. At the follow-up assessment, regardless of the administered treatment modality, over half of the women included in the study reported being satisfied with their treatment (PGIC). Additionally, most of them described their overall condition as having improved since the onset of the treatment (PGIS).

CONCLUSION

Both surgical and pharmacological treatments are valuable options for TE. Rather than being considered mutually exclusive, these approaches should be viewed as complementary.

Food Is Medicine for Human Immunodeficiency Virus: Improved Health and Hospitalizations in the Changing Health Through Food Support (CHEFS-HIV) Pragmatic Randomized Trial

BACKGROUND

Policy support for "food is medicine"-medically tailored meals or groceries to improve health-is rapidly growing. No randomized trials have heretofore investigated the benefits of medically tailored food programs for people with human immunodeficiency virus (PWH).

METHODS

The CHEFS-HIV pragmatic randomized trial included PWH who were clients of Project Open Hand (POH), a San Francisco-based nonprofit food organization. The intervention arm (n = 93) received comprehensive medically tailored meals, groceries, and nutritional education. Control participants (n = 98) received less intensive (POH "standard of care") food services. Health, nutrition, and behavioral outcomes were assessed at baseline and 6 months later. Primary outcomes measured were viral nonsuppression and health-related quality of life. Mixed models estimated treatment effects as differences-in-differences between arms.

RESULTS

The intervention arm had lower odds of hospitalization (odds ratio [OR], 0.11), food insecurity (OR, 0.23), depressive symptoms (OR, 0.32), antiretroviral therapy adherence <90% (OR, 0.18), and unprotected sex (OR, 0.18), as well as less fatty food consumption (β = -.170 servings/day) over 6 months, compared to the control arm. There was no difference between study arms in viral nonsuppression and health-related quality of life over 6 months.

CONCLUSIONS

A "food is medicine" intervention reduced hospitalizations and improved mental and physical health among PWH, despite no impact on viral suppression.

CLINICAL TRIALS REGISTRATION

NCT03191253.

Pelvic floor muscle training with feedback or biofeedback for urinary incontinence in women

BACKGROUND

Pelvic floor muscle training (PFMT), compared to no treatment, is effective for treating urinary incontinence (UI) in women. Feedback and biofeedback are additional resources that give women more information about their pelvic floor muscle contraction. The extra information could improve training performance by increasing capability or motivation for PFMT. The Committee on Conservative Management from the 7th International Consultation on Incontinence states that the benefit of adding biofeedback to PFMT is unclear. This review is an update of a Cochrane review last published in 2011.

OBJECTIVES

The primary objective was to assess the effects of PFMT with feedback or biofeedback, or both, for UI in women. We considered the following research questions. Are there differences in the effects of PFMT with feedback, biofeedback, or both versus PFMT without these adjuncts in the management of stress, urgency or mixed UI in women? Are there differences in the effects of feedback versus biofeedback as adjuncts to PFMT for women with UI? Are there differences in the effects of different types of biofeedback?

SEARCH METHODS

We searched the Cochrane Incontinence Specialised Register (searched 27 September 2023), which includes searches of CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP as well as handsearching of journals and conference proceedings, and the reference lists of relevant articles.

SELECTION CRITERIA

We included only randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs in women with UI. We excluded studies that recruited women with neurological conditions, who were pregnant or less than six months postpartum. Eligible studies made one of the following comparisons: PFMT plus feedback versus PFMT alone, PFMT plus biofeedback versus PFMT alone, PFMT plus feedback or biofeedback versus PFMT alone, PFMT plus feedback versus PFMT plus biofeedback, and one type of biofeedback versus another.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for eligibility, extracted data onto a prepiloted form, and assessed risk of bias using RoB 1. We used the GRADE approach to assess the certainty of evidence in each comparison by outcome. Our primary outcome was lower urinary tract symptom-specific quality of life. We pooled data using a standardised mean difference (SMD). Secondary outcomes were leakage episodes in 24 hours (mean difference (MD)), leakage severity (MD), subjective cure or improvement (odds ratio (OR)), satisfaction (OR), and adverse events (descriptive summary).

MAIN RESULTS

We included 41 completed studies with 3483 women. Most (33 studies, 3031 women) investigated the effect of PFMT with biofeedback versus PFMT alone. Eleven studies were at low risk of bias overall, 27 at unclear risk of bias, and three at high risk. Only one study reported leakage severity, with no usable data. Comparison 1. PFMT with feedback versus PFMT alone: one eligible study reported no outcome of interest. Comparison 2. PFMT with biofeedback versus PFMT alone: there was little or no difference in incontinence quality of life (SMD 0.07 lower, 95% confidence interval (CI) 0.18 lower to 0.05 higher; 11 studies, 1169 women; high-certainty evidence). Women randomised to biofeedback had 0.29 fewer leakage episodes in 24 hours versus PFMT alone (MD 0.29 lower, 95% CI 0.42 lower to 0.16 lower; 12 studies, 932 women; moderate-certainty evidence), but this slight reduction in leakage episodes may not be clinically important. Women in biofeedback arms report that there is probably little to no difference in cure or improvement (OR 1.26, 95% CI 1.00 to 1.58; 14 studies, 1383 women; moderate-certainty evidence) but may report greater satisfaction with treatment outcomes (OR 2.41, 95% CI 1.56 to 3.7; 6 studies, 390 women; low-certainty evidence). None of these outcomes were blinded. Eight studies (711 women) assessed severe adverse events but reported that there were no events. Comparison 3. PFMT with feedback or biofeedback versus PFMT alone: a single study contributed very-low certainty evidence regarding leakage episodes in 24 hours, subjective cure or improvement, and satisfaction. Comparison 4. PFMT with feedback versus PFMT with biofeedback: the evidence is very uncertain about any difference in effect between biofeedback versus feedback for incontinence-related quality of life. Not only is the evidence certainty very low, the confidence interval is very wide and there could be a more than small effect in favour of biofeedack or feedback (SMD 0.14 lower, 95% CI 0.56 lower to 0.28 higher; 2 studies, 91 women; very-low certainty evidence). There may be fewer leakage episodes in 24 hours for women receiving biofeedback verus feedback but the difference may not be clinically important and the evidence certainty is low (MD 0.28 lower, 95% CI 0.62 lower to 0.07 higher; 2 studies, 120 women; low-certainty evidence). There were no data for subjective cure, improvement or satisfaction. One study measured adverse events and none were reported. Comparison 5. PFMT with biofeedback versus PFMT with another type of biofeedback: five studies assessed this comparison, with individual studies contributing data for separate outcomes. There was low- or very-low certainty evidence about the benefits of one type of biofeedback versus another for leakage episodes in 24 hours or subjective cure or improvement, respectively. One study reported adverse events from two of nine women receiving electromyography biofeedback versus six of 10 receiving pressure biofeedback.

AUTHORS' CONCLUSIONS

PFMT with biofeedback results in little to no difference in incontinence quality of life. The addition of biofeedback to PFMT likely results in a small unimportant difference in leakage episodes in 24 hours, and likely little to no difference in patient-reported cure or improvement. Satisfaction may increase slightly for PFMT with biofeedback, based on low-certainty evidence. Five of the 33 studies in this comparison collected information about adverse events, and four reported none in either group. Adverse events reported by women using biofeedback seemed related to using a vaginal or rectal device (e.g. discomfort with device in place, vaginal discharge). The other comparisons had few, small studies, and low- to very low-certainty evidence for all outcomes. None of the studies reported any severe adverse events.

Underemployment and mental health amongst working-age Australians: a gendered analysis using the HILDA survey (2002-2022)

Underemployment is an increasingly persistent and pervasive feature of contemporary labour markets and there is some evidence to suggest that underemployment is an important social determinant of health and well-being. However, the evidence base has tended to focus on hours-based underemployment more than others like skills-based underemployment. Moreover, the gendered dimensions of underemployment remain under-researched despite evidence to suggest that women are more likely to be underemployed. Drawing on 21 annual waves (2002-22) of data from the Household, Income, Labour Dynamics in Australia survey, this longitudinal study employed Mundlak modelling to examine the association between two forms of subjective underemployment and mental health in working-age (25-64 years) Australians (n = 18,285). Underemployment was operationalized in two ways: (1) hours-related underemployment; and (2) skills-based underemployment. Mental health was assessed using the MHI-5 scale. All models were stratified by gender. Results suggest that hours-related underemployment has a more negative effect on women's mental health while skills-related underemployment has a more negative effect on men's. Theoretically, this article highlights how subjective forms of underemployment are like unemployment, acting as a stressor for mental health because they partially deprive workers of the benefits of full employment. This study provides robust longitudinal evidence of the detrimental impact of underemployment on the mental health of working-aged Australians, highlighting how inadequate forms of work have negative health consequences. Thus, greater effort from both governments and employers is needed to implement policies and programs that help workers reach their capacity to mitigate against the negative health effects of underemployment.

Aerobic exercise and aromatase inhibitor-associated musculoskeletal symptoms: results of a randomized clinical trial

PURPOSE

Women receiving aromatase inhibitors (AIs) for breast cancer frequently experience musculoskeletal symptoms (AIMS) including joint pain, stiffness, and muscle weakness. Aerobic exercise may reduce AIMS, but the evidence is inconclusive. This investigation examined whether aerobic exercise reduces pain in women with breast cancer.

METHODS

Pain was a secondary outcome of a randomized controlled trial where postmenopausal women with breast cancer receiving AIs (N = 136) with or without pain were randomized to 6 months of moderate-intensity aerobic exercise (n = 70) or usual care (n = 66). The primary (Brief Pain Inventory severity, interference and worst pain) and secondary (SF-36 Bodily Pain and Breast Cancer Prevention Trial Symptom Checklist Musculoskeletal Pain) pain outcomes were assessed at pre-randomization (T1) and post-intervention (T2). Linear mixed modeling with linear contrasts was used to examine the effect of group assignment on outcomes.

RESULTS

Participants were a median = 4.7 months post-breast cancer diagnosis at T1. Group-by-time interactions were observed for pain severity ( x ¯ = 0.848, 95% confidence interval (CI) = 0.233-1.464), pain interference ( x ¯ = 0.997, 95% CI = 0.448-1.547), and worst pain ( x ¯ = 1.371, 95% CI = 0.273-2.461) with significant increases in pain severity, interference, and worst pain in controls, small effect sizes, and no significant changes in the exercise group. We also found that a greater percentage of women in the control group had a clinically significant increase (≥ 2 points) in worst pain (p = 0.024) and pain severity (p = 0.029).

CONCLUSION

Our results suggest that aerobic exercise prevents pain increase and may reduce pain prevalence when initiated early in AI therapy. The trial was registered at Clinical Trials.gov (NCT02793921) on May 20, 2016.

KEY FINDINGS

Moderate-intensity aerobic exercise may prevent increases in pain and reduce pain when initiated early in AI therapy in postmenopausal women with breast cancer. Lack of exercise may be associated with increased over-the-counter pain medication use.

Analysis of the factors associated with sexual health improvement in patients who underwent surgical management for adult spine deformity

BACKGROUND

Spinal deformity can have a severe impact on the patient's sexual health. Eventually, this can lead to depression and relationship distress. Spinal surgical management is suggested to improve sexual function, however, the literature concerning these aspects is still scarce. This study evaluated which factors predicted improvement in sexual health in patients with adult spinal deformity (ASD) who underwent surgical treatment.

METHODS

Multicentric retrospective study based on a prospectively collected ASD database. Data of patients who underwent surgical correction and had a 2-year follow-up were collected. The association between different patient-reported outcome measures and ODI question 8 (Q8, sexual health) was explored with Pearson correlations and Principal Component Analysis (PCA). Improvement in sexual health was evaluated through a 1-point decrease on Q8. Comparisons between improved and non-improved patients and the non-response to the preoperative Q8 were assessed.

RESULTS

Data from 880 patients were collected. Moderate correlations were revealed between ODI and COMI-back, SRS-22, and SF-36 items and confirmed with PCA. The main factors associated to a non-response to Q8 were being of an older age, having worse sagittal imbalance, and having a specific nationality. Patients with an improvement in sexual health at 2 years were the ones with a worse baseline quality of life, older patients with a greater sagittal correction, and a better improvement of the level of physical activity.

CONCLUSION

Non-response to Q8 was correlated to age and nationality. Long-segment ASD surgery could improve sexual health, which was correlated to physical activity improvement, severe deformity with worse preoperative quality of life, and better postoperative sagittal correction.

Transcultural Adaptation and Evaluation of the Psychometric Properties of the Spanish Version of the FCR7 Questionnaire for Assessing Fear of Recurrence in Cancer Patients: FCR6/7-SP

BACKGROUND/OBJECTIVES

Fear of recurrence is one of the main issues affecting cancer patients after the completion of treatment. Despite the development of various assessment tools at the international level, there is a lack of validated questionnaires in Spanish. For this reason, the aim of this study is to conduct a transcultural adaptation and evaluate the psychometric properties of the Spanish version of the Fear of Cancer Recurrence (FCR7) questionnaire.

METHODS

We carried out translation and transcultural adaptation of the FCR7 scale, content validity through expert review, and face validity with a pilot test in the first phase. In the second phase, construct validity was evaluated through confirmatory factor analysis and Rasch analysis, along with reliability (internal consistency), convergent-divergent validation, and known-groups validation in a sample of 315 individuals with a history of cancer. Descriptive and inferential analysis was performed using JAMOVI© v.2.3.24., confirmatory factor analysis with FACTOR© v.12.02.01x64 bits, and Rasch analysis with JMetrik© v.2.0.

RESULTS

Aiken's coefficient exceeded 0.75 for all items, indicating acceptable face validity for the instrument. Two unidimensional models were obtained for the instrument, FCR7-SP and FCR6-SP, both showing acceptable fit values and adequate reliability (omega coefficient = 0.933 [95% CI: 0.922-0.944] and 0.942 [95% CI: 0.931-0.951], respectively).

CONCLUSIONS

The Spanish version of the FCR7 is valid and reliable for assessing fear of cancer recurrence in the Spanish population, with two models available for its application (FCR7-SP and FCR6-SP). The availability of this tool will enable the evaluation of this phenomenon in clinical practice and a more effective approach to addressing its consequences.

Pain revolution in the public health system: Active coping strategies for chronic pain unit

BACKGROUND

Chronic pain represents a global health challenge demanding a transition from traditional biomedical to patient-centered biopsychosocial models. This masterclass explores active coping strategies for effective chronic pain management within healthcare systems. It describes the Unit of Active Coping Strategies for Chronic Pain (UAAD - Unidad de Afrontamiento Activo para el Dolor) in Primary Care in Valladolid, Spain, as a successful example of implementing a biopsychosocial care model for treating chronic pain.

OBJECTIVE

To provide tools that allow the application of active coping strategies in the treatment of patients with chronic pain and how to implement the UAAD units in other healthcare systems.

METHODS

This masterclass describes the UAAD's innovative approach, starting with its comprehensive and personalized methodology. This includes a referral system, a thorough assessment encompassing biological, psychological, and social factors, and a functional categorization system. These elements guide personalized treatment plans delivered through group and individual programs grounded in therapeutic exercise and pain science education. Four key pillars are highlighted: clinical care, teaching, resource management, research and dissemination.

CONCLUSION

Embracing this model empowers healthcare providers to address the growing burden of chronic pain. It also enables patients to take an active role in their recovery and self-management.

Tools for assessing the quality of life of hysterectomized women: A systematic review

AIMS AND OBJECTIVES

Since hysterectomy surgery is a major and invasive procedure, it can affect the quality of life of women in many ways. This study aimed to review and critique the psychometric properties of tools used to measure the quality of life of hysterectomized women.

METHOD

An advanced search was conducted in international (PubMed, Web of Science, Scopus, PsycINFO, Embase) as well as national databases (SID and Magiran) to retrieve articles published from 2000 to 2024, using keywords related to hysterectomy and quality of life. Then, the psychometric properties of the tools found in these articles were evaluated by COSMIN checklist.

RESULTS

The psychometric properties of tools were analyzed using the COSMIN checklist. Among the 20 general and specific tools examined, content validity had not been evaluated in 15 tools, construct validity had not been evaluated in four tools, criterion validity had not been evaluated in eight tools, internal consistency had not been evaluated in five tools, responsiveness had not been evaluated in 16 tools, and interpretability had not been assessed in 18 tools, and measurement error had not been evaluated in any of the tools.

CONCLUSION

The results showed that none of the evaluated tools have all the criteria of Cosmin's checklist. Of course, construct validity and reliability had been assessed in most of the tools. Meanwhile, there was no tool to measure the quality of life of hysterectomized women specifically. Therefore, it seems that developing a tool with acceptable psychometric properties is necessary to measure the quality of life of hysterectomized women specifically.

Efficacy of psychotherapy versus pharmacotherapy, or their combination, in chronic depression: study protocol for a systematic review and network meta-analysis using aggregated and individual patient data

INTRODUCTION

Chronic depression represents a common and highly disabling disorder. Several randomised controlled trials (RCTs) investigated the effectiveness of psychological, pharmacological and combined treatments for chronic depression. This is the first overarching systematic review and network meta-analysis (NMA) based on aggregated and individual patient data comparing the efficacy and acceptability of various treatment options for all subtypes of chronic depression. Furthermore, individual demographic and clinical characteristics that predict or moderate therapy outcomes will be investigated.

METHODS AND ANALYSIS

A systematic literature search of the Cochrane Library, MEDLINE via Ovid, PsycINFO, Web of Science and metapsy databases will be conducted from database inception without language restrictions to include all available samples from RCTs that investigated the efficacy of psychotherapy versus pharmacotherapy, or their combination in adult inpatients or outpatients with a primary diagnosis of chronic depression. Exclusively internet-based treatment studies will be excluded. The main outcome is depression severity measured on a continuous observer-rated scale for depression at 6 months post-treatment (range 3-12 months). Two reviewers will independently screen and select eligible studies based on the predefined inclusion and exclusion criteria. Risk of bias will be assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Individual patient data (IPD) will be requested and incorporated in the network when provided, as it is the gold standard of evidence. For studies which do not provide IPD, aggregate data (AD) will be extracted and incorporated in lieu of IPD for the NMA, strengthening the evidence base and leveraging all existing evidence regardless of data availability restrictions. An NMA comparing psychotherapies and a network meta-regression estimating individualised treatment effects of psychotherapy will be implemented assuming a Bayesian framework. All models will be fitted in R with calls to JAGS. Empirical informative prior distributions will be used for model parameters where available, and non-informative priors will be used in cases where empirical priors are not available.

ETHICS AND DISSEMINATION

This IPD-NMA requires no ethical approval. All results will be disseminated as peer-reviewed publication in a leading journal in this field and presented at (inter)national scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42024526755.

Health-Related Quality of Life in Long-Term Survivors of Non-Hodgkin Lymphoma: A French Population-Based Study

Background/Objectives: Non-Hodgkin lymphoma (NHL) represents 63% of all hematological malignancies in France, with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) being the two most frequent forms. With the improvement of therapeutics, the issue of health-related quality of life (HRQoL) is becoming increasingly crucial for these patients. The aim was to compare HRQoL of NHL survivors with that of the general French population and to identify factors associated with HRQoL in NHL survivors. Methods: We conducted a population-based study among living patients from three registries of hematological malignancies, using standardized questionnaires, including the SF-12, in September 2023. The data collected were compared to those of a normative general French cohort. Results: In total, 493 patients completed the study questionnaires, yielding a response rate of 36%. The median time since diagnosis was 8 years (IQR 6-10) These NHL survivors reported lower HRQoL compared to the general French population, except in terms of bodily pain (p < 0.01). Each one-year increase in the time since diagnosis was associated with an increase in social functioning (p = 0.009). Men had better general health (p = 0.01) and less bodily pain (p = 0.007) than women. Higher income was associated with better HRQoL (p < 0.01). Underweight or obesity were associated with poorer physical functioning (p = 0.008). The presence of comorbidities, socioeconomic deprivation, anxiety, and depression were associated with poorer HRQoL (p < 0.01). Conclusions: This study provides valuable information of HRQoL values for comparison in further follow-up studies and proposes measures that could be implemented to improve the HRQoL of NHL survivors.

Evaluating a digital prehabilitation tool in patients with colorectal surgery: protocol for a multisite randomised controlled trial

INTRODUCTION

Colorectal cancer is a leading cause of cancer mortality in the USA and occurs most frequently in older adults. These patients are at increased risk of adverse outcomes following major cancer surgery. While prehabilitation has been shown to mitigate this risk, multiple barriers to implementation remain. Our team created a digital tool co-designed with older adults that employs an algorithm to assess patient-specific geriatric vulnerabilities and generate personalised prehabilitation programmes before surgery.

METHODS AND ANALYSIS

We have designed a multisite, unblinded randomised trial to be completed at three high-volume academic cancer centres located in California or Texas. Our study population is individuals aged 65 and older with planned colorectal cancer resection who are proficient in English and have home internet access. We aim to enroll 132 patients who will be randomised in a 2:1 ratio to receive the intervention (assistance from a home health coach and access to the web application (web app)) or control (usual care with written prehabilitation materials). Our primary outcome is patient engagement with prehabilitation activities.

ETHICS AND DISSEMINATION

A properly executed, written, informed consent will be obtained from each subject prior to entering the subject into the trial. Information will be given in both oral and written form, and subjects may withdraw at any time from the study without effect on their medical care. The protocol and consent form have been approved by the Institutional Review Board (IRB) of each participating centre. We anticipate publication of results in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05520866.

Associations between flavonoid-rich food and flavonoid intakes and incident unhealthy aging outcomes in older United States males and females

BACKGROUND

Our knowledge of the importance of flavonoid-rich foods in preventing unhealthy aging across its different domains is limited.

OBJECTIVES

This study aimed to examine prospective associations between flavonoid-rich food and flavonoid intakes and indicators of unhealthy aging, namely frailty, impaired physical function, and poor mental health.

METHODS

We followed up 62,743 females and 23,687 males, all aged ≥60 y, from the Nurses' Health Study (1990-2014) and Health Professionals Follow-up Study (2006-2018), respectively. Both time-updated and change in intakes of a flavodiet score (an aggregate of intakes of major flavonoid-rich foods and beverages) and individual flavonoid-rich foods and beverages and time-updated intakes of total flavonoids and flavonoid subclasses were calculated from food frequency questionnaires collected at baseline and every subsequent 4 y. Associations with incident frailty, impaired physical function, and poor mental health, assessed from self-reported questionnaire responses, were examined with multivariable-adjusted Cox proportional hazards models.

RESULTS

In the Nurses' Health Study, participants with the highest flavodiet scores, compared with the lowest, had a 15% lower risk of frailty (HRQ5vsQ1: 0.85; 95%CI: 0.80, 0.90), a 12% lower risk of impaired physical function (HRQ5vsQ1: 0.88; 95% CI: 0.84, 0.91), and a 12% lower risk of poor mental health (HRQ5vsQ1: 0.88; 95% CI: 0.82, 0.94). Increases in flavodiet scores and both higher intakes and increases in intakes of tea, red wine, apples, blueberries, and oranges tended to be associated with lower risks of all outcomes. Higher intakes of total flavonoids and all flavonoid subclasses tended to be associated with a lower risk of each outcome. Although fewer associations were observed among males in the Health Professionals Follow-up Study, those with the highest flavodiet scores had a lower risk of poor mental health.

CONCLUSIONS

High intakes of flavonoid-rich foods may support healthy aging. Further research is needed, including examining sex-specific associations, as incorporating flavonoid-rich foods in the diet may be a simple strategy to support healthy aging.

Developing a utility value set for the Gambling Quality of Life Scale-Brief (GQoLS-Brief) using a discrete choice experiment

OBJECTIVES

The Gambling Quality of Life Scale -brief (GQoLS-Brief) assesses the impact of gambling disorder (GD) on quality of life (QoL). Preference-based measures are essential for obtaining the quality adjustment weight (i.e. utility score) needed to calculate quality-adjusted life years (QALYs) in economic evaluations. We aimed to derive a value set for the GQoLS-Brief.

METHODS

We employed a discrete choice experiment for preference elicitation. An online survey was administered (n = 928). Respondents completed 10 choice tasks, each presenting two GQoLS-Brief health states alongside life expectancy. Conditional logit regression, parameterized to fit the QALY framework, was used for data analysis. QALY weights for each health state defined by the GQoLS-Brief were calculated.

RESULTS

The estimated coefficients from the conditional logit models aligned with expectations: utility increased with survival time and decreased with QoL impairment. Utility values for health states ranged from - 1.48 (worse than death) to 1.0. "Financial difficulties" exhibited the highest utility decrement, followed by "Sleep disturbance related to financial difficulties."

CONCLUSIONS

This reference set facilitates the calculation of QALYs for economic evaluations of GD interventions. The weight of subjective financial difficulties underscores the need for therapeutic interventions to target this aspect.

Sexuality and bleeding in von Willebrand disease

Background

Sexuality is a fundamental aspect of quality of life, often impacted by chronic or inherited diseases like von Willebrand disease (VWD), an inherited bleeding disorder characterized by mucosal bleeding, including heavy menstrual bleeding (HMB). To date, no studies have investigated the impact of VWD on sexuality.

Objectives

This study aimed to identify sexual restrictions and symptoms in VWD patients, differentiating between men and women and between premenopausal and nonmenstruating women.

Methods

We performed a nationwide, multicenter, prospective cohort study, the Willebrand in the Netherlands-Prospective study, including adult VWD patients (>18 years) who completed questionnaires on sexuality and health-related quality of life (SF-36). Additional data were collected via blood tests and a self-reported bleeding assessment tool (International Society on Thrombosis and Haemostasis Bleeding Assessment Tool).

Results

We included 549 VWD patients with a median age of 51 years (IQR, 37-66 years), of whom the majority were women (n = 347; 63.2%). Patients were diagnosed with type 1 (57.2%), type 2 (39.2%), or type 3 VWD (3.6%). Sexual restrictions due to VWD were reported by 3.5% of men (n = 7) and 9.8% of women (n = 34; P < .01). Bleeding during sexual activity was reported by 33.1% (n = 115) of women. Premenopausal patients more often reported sexual restrictions than nonmenstruating patients (15.5% vs 5.2%, P = .01), with HMB as the most important determinant (odds ratio, 1.60; 95% CI, 1.12-2.46). Most patients (n = 455; 82.9%) reported that sexuality was not discussed during routine clinic visits.

Conclusion

Women with VWD experience more sexual restrictions than men and report more postcoital bleeding than the general population. Premenopausal women are particularly affected, mostly due to HMB. This highlights the need for health care providers to address sexual health during consultations and treat HMB to improve overall care for VWD patients.

Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS).

METHODS

We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373).

RESULTS

Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group.

CONCLUSIONS

This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Effectiveness of peer-delivered sleep health education and social support in increasing OSA evaluation among at-risk blacks

To assess the effectiveness of culturally and linguistically tailored, peer-delivered obstructive sleep apnea education and of social support to increase adherence to physician-recommended obstructive sleep apnea evaluation among blacks. In a two-arm randomised controlled trial, we ascertained the effectiveness of peer-delivered obstructive sleep apnea education in increasing obstructive sleep apnea evaluation among 319 blacks at risk of obstructive sleep apnea (intervention = 159 and control = 160); their average age was 47 ± 12.9 years, and 41% were male. Obstructive sleep apnea risk was assessed with the Apnea Risk Evaluation System questionnaire, administered in community venues. Participants in the intervention arm received tailored obstructive sleep apnea education during a 6 month period; those in the control arm received standard sleep and healthy lifestyle information. Analysis focussed on the effectiveness of peer-delivered obstructive sleep apnea education on adherence to obstructive sleep apnea evaluation, but also considered the role of psychosocial factors. The results showed no significant differences in baseline demographic and clinical measures when contrasting participants in the study arms. The adherence rates for home-based obstructive sleep apnea evaluation in the intervention and control arms were 45.9% and 45.6%, respectively. Overall, participants in both study arms (adherers) who underwent obstructive sleep apnea evaluations were likely to experience a greater level of social support (8.2 ± 2.4 vs. 7.3 ± 2.4; p = 0.06). Moreover, adherers showed greater psychosocial scores (i.e., Dysfunctional Beliefs and Attitudes about Sleep scale, Apnea Beliefs Scale (ABS) (and Apnea Knowledge) compared with non-adherers (6.0 ± 1.8 vs. 4.9 ± 2.2; p = 0.02; 77.0 ± 7.1 vs. 73.2 ± 7.4; p = 0.04, and 6.4 ± 3.1 vs. 7.6 ± 2.4; p = 0.06, respectively). The results of the present randomised controlled trial favoured a potential role of peer-based social support and psychosocial factors, associated with obstructive sleep apnea adherence behaviour.

Osteoarthritis and Degree of Fatigue are Associated with Pain Levels in Patients with Fibromyalgia Syndrome: A Cross-Sectional Study of 394 Patients

Objective

To observe how osteoarthritis (OA) and degree of fatigue affect are associated with pain levels in patients with fibromyalgia syndrome (FMS).

Methods

A cross-sectional study was conducted involving FMS patients. Data regarding the clinical features of the patients, including scores for pain-Visual Analogue Scale (VAS), Fatigue Scale-14 (FS-14) and other patient information, was collected. A multivariable logistic regression model was constructed to determine whether there is a true association between OA, degree of fatigue, and pain level in FMS patients. Restricted cubic spline (RCS) analysis was used to explore a potential non-linear relationship between degree of fatigue scores and pain levels in FMS patients. An interaction analysis based on the main regression model was performed to examine the interaction between OA and degree of fatigue.

Results

Among the FMS patients, the presence of OA was identified as a risk factor associated with higher pain-VAS scores (OR=2.777, 95% CI=1.377-5.601, P=0.004); furthermore, higher degree of fatigue scores on the FS-14 were found to be significantly associated with high pain level (OR=1.145, 95% CI=1.054-1.243, P=0.001). The RCS analysis demonstrated a linear relationship between increasing FS-14 scores and an elevated risk of high pain levels among FMS patients (P-non-linear=0.119, P-overall=0.008). The interaction analyses revealed a significant association between OA and degree of fatigue, which were related to the pain level of patients with FMS synergistically.

Conclusion

Patients with FMS experience coexisting OA and a high degree of fatigue, which interact synergistically, being correlated with increased pain levels.

Trial Registration

The study was approved by the Clinical Research Ethics Committee of the China-Japan Friendship Hospital (2022-KY-079) and registered on ClinicalTrials.gov (NCT05508516) on August 17th, 2022.

Exploring booster session attendance, prescription, and outcomes in adults with chronic low back pain: Secondary analysis of a randomized clinical trial

Introduction

Booster sessions are a potential method for maintaining self-management behaviors and treatment effects in people with chronic low back pain (LBP). However, few studies have examined booster prescription or outcomes in people with LBP.

Objective

(1) Compare booster prescription for two exercise-based treatments for low back pain (LBP) in a randomized clinical trial (RCT) where the number of boosters prescribed was based on self-management program independence, (2) Determine if there are variables that predict who will require >1 booster, (3) Explore the effects of boosters on pain and function in people who required >1 booster.

Design

Secondary analysis of a RCT in which participants were randomized to motor skill training (MST), MST+Boosters (MST+B), strength and flexibility exercise (SFE), or SFE+B.

Setting

Academic research setting.

Participants

76 participants with chronic LBP assigned to receive boosters.

Interventions

This secondary analysis focuses only on the MST+B and SFE+B groups. Both groups received 6 visits of MST or SFE and six months later received up to 3 boosters. The number of boosters was based on self-management program independence at the first booster. Those who required >1 booster were not able to independently perform their program at the first booster.

Main Outcome Measures

Booster attendance and prescription, pain (Numeric Pain Rating Scale), function (modified Oswestry Disability Questionnaire).

Results

There was not a significant difference between MST+B and SFE+B in returning for the initial booster, χ 2 (1)=1.76, p=0.185. SFE+B were more likely to require >1 booster than MST+B; β =2.39, p <0.001. No participant-specific factors we examined were statistically related to needing >1 booster.

Conclusion

MST+B participants were less likely to require additional boosters. No additional participant-specific factors we examined were associated with needing additional boosters. Qualitatively, attending additional booster sessions did not appear to change pain or function in the current sample.

Clinical Utility of Zuranolone for Postpartum Depression: A Narrative Review

Peripartum depression (PPD) affects approximately one in every eight birthing individuals. Despite a high prevalence, PPD is underdiagnosed and undertreated. Several PPD treatment options exist including psychotherapies, conventional serotonergic-based antidepressants and alternative and integrative medicine approaches. Rapid-acting neuroactive steroid-based antidepressants have been studied and approved in the United States (US) for the treatment of adult females with PPD. Zuranolone is the first US Food and Drug Administration approved oral antidepressant for adult females with PPD. This narrative review reports on the evidence for the clinical utility of zuranolone in PPD treatment. In double-blind, randomized, placebo-controlled, clinical trials, zuranolone demonstrated rapid, statistically significant and clinically meaningful improvements in depressive symptoms. Most common adverse events reported with zuranolone use were somnolence, dizziness, sedation, and headache. No clinically significant changes in vital signs, electrocardiogram or clinical lab parameters were observed. No loss of consciousness and no increase in suicidal ideation from baseline or deaths were seen in the studies. Secondary analyses demonstrated that zuranolone improves comorbid symptoms of anxiety and insomnia and some measures of health-related quality of life. Zuranolone relevant infant dose lactation data suggest that its use is compatible with breastfeeding, though future research is needed to measure potential adverse effects on the breastfed infant. Key aspects of clinical decision-making in patients with PPD are discussed.

Changes in health related quality of life in mothers with inflammatory joint disease from year 2000 to 2020 - a comparative cross-sectional study

Objectives

More knowledge about health related quality of life (HRQoL) among mothers with inflammatory joint disease (IJD) is needed to understand the complex challenges for this group of patients. The overall aim of this study was to investigate changes in HRQoL among mothers with IJD from year 2000 to year 2020.

Methods

This study had a comparative cross-sectional design with two study groups 20 years apart, year 2000 (n = 77) and year 2020 (n = 197). Patients were identified from RevNatus, a Norwegian nationwide medical quality register (2020 cohort) and from a national centre for pregnancy and rheumatic disease (2000 cohort). Mothers with the diagnoses of rheumatoid arthritis, juvenile idiopathic arthritis, axial spondyloarthritis and psoriatic arthritis with children aged 0-6 were included. Data on HRQoL were self-reported and assessed by the RAND-36 (SF-36) questionnaire, along with data on educational status, number of children, months since last childbirth and eight questions on experienced motherhood limitations and experienced anxiety and distress for the children. Descriptive statistics were performed using the Mann-Whitney U-test, the Pearson chi-squared test and independent samples t-test. Multivariable linear regression were used to investigate changes and association between the RAND36 (SF-36) scores and the two study groups and possible confouders.

Results

The 2020 cohort had significantly higher scores on bodily pain (p < 0.001), physical function (p < 0.001), and role physical (p = 0.01) scales compared to the 2000 cohort, indicating better health. There were no significant differences between the two cohorts in the mental health (MH) (p = 0.81), vitality (p = 0.09), general health (p = 0.06), social function (p = 0.83), and role emotional (p = 0.93) scales. Compared to the calculated norm scores, the 2020 cohort had significantly lower scores on all scales (p < 0.01) except on the MH scale (p = 0.37).

Conclusion

Mothers with IJD were affected in most dimensions of RAND-36 (SF-36) both in year 2000 and year 2020. The findings emphasize the importance of understanding the intrusiveness of being a mother with IJD despite the improved medical treatment options over the last 20 years.

Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation

BACKGROUND

Currently, there is no clear standard for the surgical options for Evans-Jensen Type IV intertrochanteric femur fractures in elderly patients over 65 years old. This study aims to retrospectively analyze and compare the early postoperative limb function and quality of life of patients treated with total hip arthroplasty (THA) and proximal femoral nail antirotation (PFNA) for this type of fracture. We hypothesize that there is no significant difference in complications and postoperative recovery between the two surgical methods.

METHODS

A retrospective analysis was conducted on patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures who were treated between 2020 and 2023. The patients were divided into two groups based on the treatment method: the PFNA group (20 cases) and the THA group (20 cases). General patient information, operative time, intraoperative blood loss, time to postoperative mobilization, time to weight-bearing on the affected limb, Harris hip scores at 1, 3, and 6 months postoperatively, excellent and good rates, SF-36 scores, and postoperative complications were recorded.

RESULTS

Compared to the PFNA group, the THA group had a longer operative time (86.7 ± 9.6 vs. 51.5 ± 5.3 min, p < 0.001) and more intraoperative blood loss (212.0 ± 35.5 vs. 76.5 ± 16.1 ml, p < 0.001). However, the THA group had an earlier time to first postoperative mobilization (3.1 ± 1.4 vs. 43.3 ± 13.09 days, p < 0.001) and earlier time to full weight-bearing on the affected limb (33.5 ± 3.1 vs. 77.9 ± 12.0 days, p < 0.001). The Harris hip scores and SF-36 scores at 1, 3, and 6 months postoperatively were higher in the THA group (p < 0.05 for all). There was no significant difference in the overall incidence of postoperative complications between the two groups (p = 0.41).

CONCLUSION

For elderly patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures, especially those with underlying diseases who cannot tolerate prolonged bed rest, hip replacement surgery (THA) may be preferred. Postoperative patients can begin rehabilitation exercises earlier, preventing the exacerbation of internal medical conditions. Early recovery of hip function on the affected side is faster, and the quality of life of patients is higher.

Associations between stages of diabetic polyneuropathy and quality of life, neuropathic pain, and well-being: A multicenter, cross-sectional analysis based on electroneuromyographic findings

AIM

This study aimed to investigate the relationship between electrophysiological findings of diabetic neuropathy (DN) and patients' quality of life, neuropathic pain levels, and well-being.

MATERIALS AND METHODS

A cross-sectional study was conducted in 12 centers in Turkey. DN patients were categorized into four stages based on electrophysiological findings using the Baba classification. Scales such as Short Form-36 (SF-36), Douleur Neuropathique 4-Questions (DN4), Brief Pain Inventory (BPI), and WHO-5 Well-Being (WHO-5 WB) were used to assess quality of life, pain, and well-being. Additional factors like HbA1c levels and diabetes duration were analyzed.

RESULTS

Among 323 DN patients, 90 were in stage 1, 84 in stage 2, 72 in stage 3, and 77 in stage 4. There were no significant differences in age or gender between the stages. Diabetes duration and HbA1c levels were significantly lower in stage 1 compared to later stages. SF-36 and WHO-5 WB scores declined, while DN4 and BPI pain interference scores increased in the later stages. These findings persisted after adjusting for confounders such as age, BMI, comorbidities, and diabetes duration.

CONCLUSION

Patients with advanced-stage DN experienced a poorer quality of life, greater pain, and more frequent comorbidities compared to early-stage patients. Electrophysiological findings should be considered in the clinical management of DN.

Psychobiological Stress Response Profiles in Current and Remitted Depression: A Person-Centered, Multisystem Approach

Background

A dysregulated stress response, including exaggerated affective reactivity and abnormal hypothalamic-pituitary-adrenal axis responsivity, has been implicated in the etiology, maintenance, and relapse of major depressive disorder (MDD). Among adolescents, discordant affective and physiological stress response profiles have been linked to negative affective outcomes and increased risk for psychopathology. Whether these findings extend to adults with varying degree of MDD risk is unclear, as are possible links to various risk factors.

Methods

We used a person-centered, multisystem approach in a sample of 119 unmedicated adults with current or remitted MDD and individuals without past MDD to evaluate psychobiological stress response profiles. Multitrajectory modeling was applied to positive affect, negative affect, and salivary cortisol (CORT) levels in response to the Maastricht Acute Stress Test.

Results

Analyses identified 4 within-person profiles, 1 typical, termed normative (n = 32, 26.9%) and 3 atypical: CORT hyperreactivity affective stability (n = 17, 14.3%), CORT hyporeactivity affective reactivity 1 (n = 45, 37.8%), and CORT hyporeactivity affective reactivity 2 (n = 25, 21.0%). While validating the assumption of a normative profile and increased risk for psychopathology in non-normative stress response profiles, coherent associations emerged between stress response profiles and clinical status, depression severity, anhedonia, perceived stress, childhood adversity, and reports of well-being, suggesting increased risk for psychopathology for individuals with a hyperreactive or discordant hyporeactive stress response profile.

Conclusions

This work advances our understanding of stress response mechanisms in MDD and underscores the potential of targeted interventions to enhance resilience and reduce psychopathology based on individual stress response profiles.

A machine learning approach to stratify patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders according to disorders of gut brain interaction, comorbidities and quality of life

BACKGROUND

A high prevalence of disorders of gut-brain interaction (DGBI) exist in patients with hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorders (HSD). However, it is unknown if clusters of hEDS/HSD patients exist which overlap with different DGBIs and whether this overlap influences presence of comorbidities and quality of life. We aimed to study these knowledge gaps.

METHODS

A prospectively collected hEDS/HSD cohort of 1044 individuals were studied. We undertook Uniform Manifold Approximation and Projection-enabled (UMAP) dimension reduction to create a representation of nonlinear interactions between hEDS/HSD and DGBIs, from which individuals were stratified into clusters. Somatization, Postural Tachycardia Syndrome (PoTS), autonomic symptoms, psychological factors and quality of life were statistically compared between clusters.

KEY RESULTS

The mean age of patients was 40 ± 13.2 years; 87.8% were female. Patients segregated into three clusters: Cluster 0 (n = 466): hEDS/HSD+ functional foregut disorders (FFD) + irritable bowel syndrome (IBS); Cluster 1 (n = 180): hEDS/HSD+ IBS and Cluster 2 (n = 337): hEDS/HSD alone. In cluster 0, we demonstrated increased somatization (p <0.0001), anxiety (p <0.0001), depression (p <0.0001), PoTS prevalence (p = 0.003), autonomic symptoms (p <0.0001) and reduced quality of life (p <0.0001) compared to cluster 2. Cluster 0 had greater comorbidity burden than cluster 1.

CONCLUSIONS

Within hEDS/HSD, subgroups exist with a high prevalence of FFD and IBS. These subgroups have a higher prevalence of psychological disorders, dysautonomia and poorer quality of life compared with hEDS/HSD alone. Further research should focus on healthcare utilization, management and prognosis in hEDS/HSD and DGBI overlap.

Changes in spatial bodily pain distribution one year after benign hysterectomy with emphasis on prevalence and risk factors for de novo and persistent pelvic pain- a prospective longitudinal multicenter study

BACKGROUND

The objectives were to determine the prevalence of de novo and persistent pelvic pain after benign hysterectomy and to assess risk factors.

METHODS

A Swedish prospective multicenter study of 440 women undergoing benign hysterectomy was conducted between October 2011 and March 2017. Measures of pain, the spatial extent of bodily pain, and pain sensitivity were assessed using a self-reporting questionnaire, Margolis's patient pain drawing, and quantitative sensory testing of pain thresholds for pressure, heat, and cold, respectively. Quality of life was evaluated by EQ-5D-3L and SF-36. Psychological distress was assessed by the Hospital Anxiety and Depression Scaleand the Stress-Coping Inventory. Logistic regression models were used to assess risk factors, and the outcome was presented as an adjusted odds ratio (aOR) and 95% confidence interval (CI).

RESULTS

Preoperatively, 18.0% of the women reported no bodily pain, 41.5% had pelvic pain, either as the only location (7.0%) or along with pain in other locations (34.5%), and 40.5% had non-pelvic pain only. Postoperatively, 6.2% developed de novo pelvic pain and 16.4% had persistent pelvic pain. De novo pelvic pain developed exclusively in women who preoperatively had non-pelvic pain only. Risk factors for de novo pelvic pain were a long hospital stay (aOR 1.50 (95%CI) 1.02-2.21)), high preoperative pain intensity (aOR 1.25 (95%CI 1.01-1.62)) and a high number of pain areas (aOR 1.15 (95%CI 1.05-1.27)), along with anxiety (aOR 10.61 (95%CI 1.84-61.03)) and low EQ-5D-3L health index (aOR 0.02 (95%CI 0.00-0.31)). Risk factors for persistent pelvic pain were lower age (aOR 0.89 (95%CI 0.81-0.97)), higher number of pain areas (aOR 1.08 (95%CI 1.02-1.14)), and a higher frequency of preoperative pain (aOR 12.75 (95%CI 2.24-72.66)).

CONCLUSION

Although hysterectomy appeared to be reasonably effective in curing pelvic pain, a non-negligible proportion of women developed de novo pelvic pain or had persistent pelvic pain. De novo pelvic pain seemed to affect only those who preoperatively had widespread bodily pain. Women at risk for de novo and persistent pelvic pain after hysterectomy could be identified preoperatively.

TRIAL REGISTRATIONS

The study was retrospectively registered in ClinicalTrial.gov (NCT01526668) on 01/27//2012.

Investigation of caregiver burden, quality of life, and occupational performance of primary caregivers of individuals having experienced a stroke with and without aphasia

BACKGROUND

Individuals having experienced a stroke need the help of an individual to perform their activities of daily living. Therefore, the disease affects not only patients but also their caregivers.

OBJECTIVES

This study aimed to investigate how aphasia affects caregivers' burden of care, quality of life, and occupational performance.

METHODS

This cross-sectional study involved Group 1, (n=51) the caregivers of individuals having experienced a stroke with aphasia, and Group 2 (n = 51), the caregivers of individuals having experienced a stroke without aphasia. The caregivers were evaluated using the sociodemographic information form, the Zarit Caregiver Burden Scale, the SF-36 Short Form, and Canadian Occupational Performance Measure tests.

RESULTS

Our study found that the caregiver burden in Group 1 was higher than in Group 2 (t = 3.8, p = 0.01). Caregivers in Group 1 also had higher pain levels (t = -2.21, p = 0.029) and lower social functions than those in Group 2 (t = -2.54, p = 0.013). There was no statistically significant difference between the other sub-parameters of quality of life (p > 0.05). It was observed that the occupational performance (t = -3.31, p = 0.001) and satisfaction levels (t = -3.57, p = 0.001) of the caregivers in Group 1 were lower than those of the caregivers in Group 2.

CONCLUSIONS

Occupational therapy evaluation and intervention programs for caregivers should consider the occupational performance of caregivers of individuals with aphasia and include approaches to problem areas.

A longitudinal analysis of the impact of multidimensional precarious employment on the mental health of men and women

This study aimed to investigate the effect of precarious employment (PE) on the mental health of Australians. Building on previous research, we conceptualised PE as a multidimensional construct, accounted for gender differences in the associations, and our modelling strategy addressed the possibility of reverse causality bias. Data was pooled panel data from 15 waves (2005-2019) of the HILDA survey (n = 14,237). Using PCA, we created two multidimensional measures of PE: objective and subjective. Fixed effects (FE) regression models (attending to unmeasured time-invariant confounders) estimated the change in mental health associated with a change in PE, and instrumental variable (IV) analyses (addressing endogeneity bias) obtained an unbiased estimate of effect of subjective PE on mental health (with ordinary least squares (OLS) models as baseline). For both genders, FE models showed that objective and subjective multidimensional PE both had a strong negative association with mental health (stronger for subjective PE). IV analysis indicated OLS models overestimate the relationship between subjective PE and mental health for men but underestimate it for women, providing causal evidence that subjective PE is important for women's mental health. Overall, findings suggest that targeted PE policies have the potential to provide significant population mental health gains, particularly for working women.

Comparison of Anorectal Function and Quality of Life Measures in Patients Following Intersphincteric Resection and Lower Anterior Resection

This study explored postoperative outcomes for patients with lower rectal cancer who underwent low anterior resection (LAR) or intersphincteric resection (ISR). A total of 49 patients (33 LAR, 16 ISR) were followed using anorectal manometry and quality of life (QOL) questionnaires over a year, pre- and post surgery. The primary aim of this study is to clarify differences in anal manometry, sphincter function, fecal incontinence, and QOL between the two surgical arms. The secondary aim was to identify indicators suitable for assessing relationships between anorectal manometry measurements, fecal incontinence, and QOL. Anorectal manometry elements (AMEs), such as atmospheric maximum mean squeeze pressure (aMSP), maximum tolerable volume (MTV), and incremental maximum mean squeeze pressure (iMSP), showed no significant differences during the observation period. However, maximum resting pressure (MRP), high-pressure zone length (HPZ), and threshold volume (TV) were significantly worse in the ISR group. Fecal incontinence, measured by Wexner and Kirwan scores, was significantly better in the LAR group. We observed no differences in SF36 between the two groups. Multi-correlation analysis revealed positive and negative correlations among these factors, with inverse correlations between anorectal manometry measurements and incontinence assessments decreasing post-surgery. We found no correlation between SF36 and anorectal manometry at any time. The findings indicate that surgical technique affects postoperative anal function, fecal incontinence, and SF36. However, combined assessment methods should be used with caution when deriving relationships between anal function and SF36.

Body dysmorphic disorder

Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder-related psychiatric condition characterized by an intense preoccupation with perceived physical flaws that are not observable by others. BDD affects ~2% of the adult population but is underdiagnosed, partly owing to limited clinician awareness, and undertreated, partly due to limited access to treatment. Research on the aetiology of BDD is scarce but likely involves an interplay between genetic and environmental factors. A few studies suggest functional and structural brain differences (compared with controls) in the regions involved in visual and emotional processing, although firm conclusions about the pathophysiology of the disorder cannot be made at this stage. Diagnosis requires the presence of repetitive behaviours or mental acts typically aimed at checking, correcting or concealing perceived flaws. The disorder typically has its onset before 18 years of age, with a female preponderance in youth but no major gender disparity in adults. Quality of life is markedly impaired across multiple domains and suicide risk is considerable. Evidence-based treatments include cognitive behavioural therapy and selective serotonin reuptake inhibitors. Future research should focus on understanding the biological and environmental factors that increase the risk of BDD, and on improving access to effective treatments, thereby addressing a critical gap in care for this often misunderstood and overlooked disorder.

Handgrip strength is independently associated with physical quality of life in patients undergoing maintenance hemodialysis: a cross-sectional study

Objective

We aimed to identify the association between Health-related quality of life (HRQoL) and muscle strength in patients undergoing maintenance hemodialysis (MHD).

Methods

In this cross-sectional study from March 2021 to December 2021, 110 MHD patients with a mean age of 63.9 ± 13.0 years and a median dialysis vintage of 25.5 (12.0-52.3) months, were enrolled at a hemodialysis center in Guangzhou city, China. HRQoL was assessed using the Short Form 36 Health Survey (SF-36) and converted into the Physical Component Summary (PCS) and the Mental Component Summary (MCS). The groups were assigned according to the mean score of PCS and MCS, and those with higher PCS/MCS scores (high-PCS/MCS) were compared with those with lower PCS/MCS scores (low-PCS/MCS). Independent factors were evaluated using multivariate analysis. Muscle strength was estimated by handgrip strength (HGS).

Results

The mean HGS was 23.7 ± 9.60 kg in men and 14.3 ± 5.30 kg in women. Compared to the high-PCS group, the low-PCS group had older age, higher levels of creatinine, total cholesterol, high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6), and had lower HGS (all p < 0.05). After adjusting for confounding factors in different models, the five-model multivariate binary logistic regression analyses revealed that HGS was the only independent factor in PCS domain, but not in MCS.

Conclusion

HGS may be an independent factor of poor HRQoL in MHD patients, particularly in relation to physical health. The management of muscle strength may improve the HRQoL in MHD patients.

Clinical trial registration

The study was registered at https://www.chictr.org.cn/ as ChiCTR2100053790.

Predictors of treatment response trajectories to cognitive behavioral therapy for chronic fatigue syndrome: A cohort study

BACKGROUND

The response to cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) varies greatly between patients, but predictors of treatment success remain to be elucidated. We aimed to identify patient subgroups based on fatigue trajectory during CBT, identify pre-treatment predictors of subgroup membership, and disentangle the direction of predictor - outcome relationships over time.

METHODS

297 individuals with CFS were enrolled in a standardized CBT program consisting of 17 sessions, with session timing variable between participants. Self-reported levels of fatigue, depressive, anxiety, and somatic symptoms, perceived stress, and positive affect were collected pre-treatment, and after 3, 10, and 15 sessions. Latent Class Growth Analysis (LCGA) was used to identify subgroups based on fatigue trajectories and baseline predictors of group membership. Cross-lagged structural equation models were used to disentangle predictor-outcome relationships.

RESULTS

LCGA identified four fatigue trajectory subgroups, which were labelled as "no improvement" (23 %), "weak improvement" (45 %), "moderate improvement" (23 %), and "strong improvement" (9 %) classes. Higher pre-treatment levels of depressive, anxiety, and somatic symptoms, stress, and lower levels of positive affect predicted membership of the "no improvement" subgroup. Reductions in anxiety preceded reductions in fatigue, while the depressive symptoms - fatigue relationship was bidirectional.

CONCLUSIONS

On a group level, there were statistically significant reductions in fatigue after 15 sessions of CBT, with important individual differences in treatment response. Higher pre-treatment levels of anxious, depressive, and somatic symptoms and perceived stress are predictors of lack of response, with reductions in anxiety and stress preceding improvements in fatigue.

Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma

Background  There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation. Materials and Methods  The outcomes of 61 patients that underwent lower extremity local flap reconstruction ( n  = 33) or amputation ( n  = 28) between 2014 and 2020 were recorded. Chart reviews were performed to collect perioperative data. Patients were contacted via telephone for participation in the survey portion of our study. PROs were recorded utilizing both the Lower Extremity Functional Scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36). Results  Surveys were completed by 61 patients (response rate 59.2%). The mean time of survey after flap reconstruction or amputation was 2.7 ± 1.4 years. Recent trauma (within 90 days) was the most common indication for local flap coverage ( n  = 23). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared with fasciocutaneous flaps ( p  = 0.021 and p  = 0.022). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS ( p  = 0.01), SF-36 physical functioning ( p  = 0.031), physical role functioning ( p  = 0.031), and emotional role functioning ( p  = 0.047) scores than amputation patients. Conclusion  Patients who underwent local fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. These data suggest that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient-perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.

Symptom flares in women with chronic pelvic pain: Questionnaire study within a cohort study (translational research in pelvic pain (TRiPP))

OBJECTIVE

To quantify the variation, triggers and impact on quality of life of symptom flares in women with chronic pelvic pain (CPP).

DESIGN

Cross-sectional questionnaire within the Translational Research in Pelvic Pain clinical cohort study.

SETTING

Women with CPP, with subgroups of women with endometriosis (EAP), interstitial cystitis/bladder pain syndrome (BPS), comorbid endometriosis and interstitial cystitis/bladder pain syndrome (EABP), and those with pelvic pain without endometriosis or interstitial cystitis/bladder pain syndrome (PP).

POPULATION OR SAMPLE

A total of 100 participants.

METHODS

Descriptive and comparative analysis from flares questionnaire.

MAIN OUTCOME MEASURES

The prevalence, characteristics and triggers of short, medium and long symptom flares in CPP.

RESULTS

We received 100 responses of 104 questionnaires sent. Seventy-six per cent of women with CPP have ever experienced symptom flares of at least one length (short, medium and/or long). Flares are associated with painful and non-painful symptoms. There is large variation for the frequency, duration, symptoms and triggers for flares. Over 60% of participants reported flares as stopping them from doing things they would usually do, >80% reported thinking about symptoms of flares and >80% reported flares being bothersome.

CONCLUSIONS

Flares are prevalent and clinically very important in CPP. More research is needed to elucidate the mechanisms and characteristics underlying flares. Clinical practice should include an enquiry into flares with the aim of finding strategies to lessen their burden.

Evaluation of akathisia in patients receiving selective serotonin reuptake inhibitors/serotonin and noradrenaline reuptake inhibitors

Akathisia is an underestimated but disturbing extrapyramidal side effect of antidepressants, which could reduce treatment compliance in mood disorders. This study aimed to investigate the frequency and risk factors in patients treated with selective serotonin reuptake inhibitors/serotonin and noradrenaline reuptake inhibitors (SSRI/SNRI). In addition, we assessed the impact of akathisia on the quality of life (QoL). Patients were aged between 18 and 75 years, receiving an SSRI/SNRI for 4-8 weeks, and were diagnosed with anxiety, depression, or obsessive-compulsive disorder. The Barnes Akathisia Rating Scale was used to assess the severity of the akathisia. QoL was evaluated using the Short Form 36 (SF-36) questionnaire. Akathisia was observed in 25% (50/198) of patients. Smokers and younger patients were more frequent among patients with akathisia. Physical functioning, physical role, vitality, and mental health domains of the SF-36 were reduced in the presence of akathisia. In conclusion, our results suggest that akathisia is not a rare side effect of SSRI/SNRI in patients with mood disorders, especially in smokers and younger patients. In addition, akathisia may reduce treatment compliance owing to a reduction in QoL. Further investigations are needed to confirm the risk factors, frequency, and consequences of treatment compliance for SSRI/SNRI-induced akathisia in patients with mood disorders.

Relationship Between Quality of Life, Perceived Stress, and Disease Characteristics in Patients With Ulcerative Colitis in Al-Madinah

Background Ulcerative colitis (UC) is a common chronic disease. Perceived stress is one of the risk factors that stimulate UC activity. Long-term clinical suffering negatively alters the health-related quality of life (HRQOL). Aim This study aimed to investigate the relationship between HRQOL, perceived stress, and disease characteristics in patients with UC in Al-Madinah. Methodology Between June 2024 and September 2024, a cross-sectional study was conducted on 122 participants. The test group included 61 UC patients who visited the gastroenterology department of King Fahd Hospital, Al Madinah, Kingdom of Saudi Arabia (KSA). Sixty-one healthy volunteers served as controls. Data were collected from the participants through an anonymous questionnaire after their consent. The questionnaire included demographic data, a 10-item Perceived Stress Scale (PSS), a 36-item Short Form (SF-36) Survey, and UC clinical status data from the UC patients. Results The mean score of PSS was significantly greater in UC patients (19.23±5.28) than in the control group (11.21±6.644), p < 0.001. Patients with UC suffer significantly (p < 0.05) lower health-related quality of life than the control group. Ulcerative colitis patients experienced the lowest scores in the energy/fatigue (56.15±29.15) and emotional well-being domains (66.69±29.26). Sex standardized (β) (-0.308) and time since diagnosis β (0.336) were good predictors (p < 0.05) of physical functioning. Time since diagnosis β (0.401) and partial Mayo score (p Mayo) score β (-0.353) were good predictors (p < 0.05) of role limitations due to physical health. Time since diagnosis β (0.349) was a good predictor (p < 0.05) of role limitations due to emotional health. For social functioning, sex β (-0.348), smoking β (-0.314), time since diagnosis β (0.421), and extraintestinal manifestations β (-0.260) were good predictors (p < 0.05). Extraintestinal manifestations β (-0.386) were good predictors (p < 0.05) of pain. Time since diagnosis β (0.325) and p Mayo score β (-0.278) were good predictors (p < 0.05) of general health. Conclusion Patients with US had lower PSS and HRQOL domains than healthy individuals. Patients with UC experienced the lowest scores in the energy/fatigue and emotional well-being domains. Time since diagnosis, p Mayo score, extraintestinal manifestations, sex, and smoking were good predictors of many domains. This confirms the solidarity of psychological care with medical treatment in those patients.

Reliability and validity of the Turkish version of the patellofemoral pain and osteoarthritis subscale of the KOOS

BACKGROUND

Patellofemoral pain and patellofemoral osteoarthritis are highly prevalent knee disorders associated with pain and functional limitations. The subscale of the Knee Injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF) was developed to evaluate patients with patellofemoral pain and osteoarthritis.

PURPOSE

This study aims to translate the KOOS-PF into Turkish and assess its measurement properties.

METHODS

The Turkish version of the KOOS-PF was tested for reliability and validity in a convenience sample of 55 patients with patellofemoral pain and/or osteoarthritis. Reliability analyses were conducted through a retest 7-14 days later with a subgroup of 35 patients. The KOOS-PF was compared with Kujala's Anterior Pain Scale (AKPS) and the Short Form-36 health survey (SF-36) to assess construct validity. Additionally, responsiveness analyses were performed on 29 patients who were followed up with a home-based exercise program three months later.

RESULTS

The Turkish version of KOOS-PF has high test-retest reliability (ICC2,1 = 0.96) and internal consistency (Cronbach's α = 0.91). It has a very good correlation with the AKPS (r = 0.77) and the SF-36 physical component summary (r = 0.64) with no floor or ceiling effects. Responsiveness is confirmed by a good correlation with the global rating of change score (r = 0.51). The minimal clinically important change is 16.5 points, and the minimal important difference is 10.2.

CONCLUSION

The Turkish version of the KOOS-PF is valid, reliable, and responsive for evaluating patients with patellofemoral pain and/or osteoarthritis.

The relationship of race, ethnicity, gender identity, sex assigned at birth, sexual orientation, parental education, financial hardship and comorbid mental disorders with quality of life in college students with anxiety, depression or eating disorders

BACKGROUND

Previous studies showed that comorbidity and demographic factors added to burden on health-related quality of life (HRQoL). Only one study explored the relationship between HRQoL and comorbidity in college students with mental disorders, leaving generalizability of findings uncertain. Less is known about the association of demographics on HRQoL. This study investigated HRQoL based on demographics and comorbidity among college students with mental disorders.

METHODS

Participants were students (N = 5535) across 26 U.S. colleges and universities who met criteria for depression, generalized anxiety, panic, social anxiety, post-traumatic stress, or eating disorders based on self-report measures. ANOVA and linear regressions were conducted.

RESULTS

Overall, female, minoritized (gender, sexual orientation, race, or ethnicity), and lower socioeconomic status students reported lower HRQoL than male, heterosexual, White, non-Hispanic, and higher socioeconomic status peers. After accounting for comorbidity, differences in physical HRQoL based on sex assigned at birth and gender were no longer significant. For mental HRQoL, only gender and sexual orientation remained significant. A greater number of comorbidities was associated with lower HRQoL regardless of demographic group.

LIMITATIONS

The non-experimental design limits causal inference. The study focused on univariable associations without examining potential interactions between demographic factors. Future research should explore structural factors like discrimination.

CONCLUSION

Results suggested that increased comorbidities placed an additional burden on HRQoL and that certain demographic groups were more vulnerable to HRQoL impairment among students with mental disorders. Findings suggest the need for prevention of disorders and their comorbidity and implementing tailored interventions for specific student subgroups with increased vulnerability.

Rural-urban differences in the association between home-based community care services satisfaction and mental health status among older adults in Zhejiang Province, China: a cross-sectional study

Objective

This study aims to examine the association between home-based community care services (HBCCS) and mental health in older adults and specifically analyzes rural-urban differences in the association.

Methods

This cross-sectional study enrolled 852 older adults from Zhejiang Province, China. The Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), University of California Los Angeles 3-item Loneliness Scale (UCLA-3), and the Mental Health (MH) component score of the 36-item Short Form (SF-36) were used to measure self-reported mental health status. Four categories of community care services were examined: daily, medical, social and recreational, and spiritual comfort. Satisfaction with community care services was assessed using self-reported measures. We used a multiple linear regression model.

Results

Satisfaction with daily care services, social and recreational services, and spiritual comfort services in rural older adults was significantly higher than in urban older adults (p = 0.016, p < 0.001, p < 0.001, respectively). Rural older adults reported lower scores on the PHQ-9, GAD-7, and UCLA-3 than urban older adults (p < 0.001, p = 0.003, p = 0.001, respectively) and had significantly higher scores on the SF-36 MH than urban older adults (p < 0.001). Among urban older adults, medical care services satisfaction was negatively related to the PHQ-9 and UCLA-3 scores (β = -0.296, p = 0.004; β = -0.447, p = 0.009, respectively). A lower UCLA-3 score was associated with higher levels of satisfaction with social and recreational services and with spiritual comfort services (β = -0.426, p = 0.010; β = -0.523, p = 0.002, respectively). A higher level of spiritual comfort services satisfaction was associated with a lower SF-36 MH score (β = 0.646, p < 0.001). Among rural older adults, medical care services satisfaction was negatively related to the GAD-7 score (β = -0.327, p = 0.028).

Conclusion

Home-based community care services satisfaction was positively associated with older adults' mental health status in Zhejiang Province. More attention should be paid to maintaining relevant satisfaction with HBCCS to ensure positive mental health among rural and urban older adults.

Assessment of patient expectations toward health professionals and quality of life among Płock (Poland) residents aged 55 and over: a cohort study

Background

The right attitude of health professionals (mainly doctors) towards patients-particularly older ones-determines patients' level of illness acceptance and quality of life. The aim of the study was to assess patient expectations of health professionals and quality of life among residents of Płock (Poland) aged 55 and over in relation to sociodemographic variables and to examine correlations between these patients' expectations and their quality of life.

Methods

The study included 2040 adults aged 55 and over, with 68.9% being women. A diagnostic survey was used, incorporating sociodemographic questions and two standardized scales: the Patient Request Form (PRF) and the 36-Item Short Form Health Survey (SF-36). This cohort study utilized a multi-stage sampling method, with data collected through a diagnostic survey. Data analysis incorporated ANOVA, post-hoc Fisher's LSD tests, and Pearson's correlation to assess relationships between variables.

Results

Statistically significant differences were observed between male and female respondents in their expectations of health professionals. Women reported higher scores than men across all three PRF scales, including emotional support (4.85 vs. 4.35, p < 0.05), test- and treatment-related information (7.41 vs. 6.81, p < 0.05), and explanation of the illness (6.89 vs. 6.47). A low but statistically significant correlation was found between age and expectations for emotional support (r = 0.162, p < 0.001), as well as test- and treatment-related information (r = 0.122, p < 0.001). Respondents with secondary/post-secondary education reported the highest expectations for explanation of the illness (mean = 7.06) and test- and treatment-related information (mean = 7.64). Meanwhile, respondents with lower education levels, especially those with primary or vocational education, reported the highest expectations for emotional support (mean = 4.93). The average QoL score measured by the SF-36 was 63.45 (SD = 17.68), indicating moderate-to-high overall QoL. The mental component summary score (mean = 65.07, SD = 19.69) was slightly higher than the physical component summary score (mean = 62.70, SD = 18.06). Age was negatively correlated with QoL scores, particularly in the physical component (r = -0.407, p < 0.001). Education level positively influenced QoL, with respondents holding tertiary education reporting the highest QoL scores.

Conclusion

What the older adults included in our study expect most from health professionals is full and ac-curate medical information, particularly information about their health. Overall, the respondents reported moderate, bordering on high, quality of life. The quality of life of the respondents and their expectations of health professionals were influenced by sociodemographic characteristics, and in particular sex, age and education level.

Development and Implementation of an Online Patient Education Program for Children and Adolescents With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Their Parents, Siblings, and School Personnel: Protocol for the Prospective BAYNET FOR ME/CFS Study

BACKGROUND

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) presents significant challenges for affected children and adolescents, their social environment, and treating physicians, due to its profound impact on quality of life and the lack of causal therapeutic approaches. One crucial aspect of care that has been missing for these patients is comprehensive education for both them and their social circles.

OBJECTIVE

This study protocol aims to outline the goals, study design, execution, and evaluation of the subproject within the BAYNET FOR ME/CFS project. The focus is on developing online education programs for children and adolescents with ME/CFS, as well as for their parents, siblings, and school staff. These programs are designed to improve independent disease management, increase knowledge, and promote interaction with other affected individuals.

METHODS

In phase I, the group-based online education programs were developed by a multidisciplinary team based on the ModuS concept created by the Competence Network for Patient Education (KomPaS). These programs were then piloted and finalized. Phase II involved recruiting participants and implementing the finalized programs. Given the restricted physical and cognitive capacities of the affected individuals, the patient education programs were exclusively designed in a digital format to facilitate participation. In phase III, the programs will be evaluated for acceptance, completeness, and participant satisfaction. The qualitative assessment will focus on individual expectations and benefits derived from the training. Phase IV will further assess the programs in terms of improvements in disease knowledge, health-related quality of life, life satisfaction, and family burden.

RESULTS

The programs were developed, piloted, and finalized during phase I, which ran from December 2022 to May 2023. The pilot phase, from March to May 2023, led to adaptations in the program concept. In total, 8 patients and their parents, 5 siblings, and 59 school staff participated in the piloting. Adjustments were made to the format, content, duration, and schedule to better meet the needs of the affected individuals and their social circles. In phase II, participant recruitment for the patient education program took place from January to July 2023. The study successfully recruited 24 young patients with ME/CFS and their parents, along with 8 siblings and 51 school staff. Two program blocks for patients and parents and 2-3 blocks for siblings and school staff commenced in May 2023 and were completed within the same year. Phase III began after phase II and involves the evaluation of the programs, with the process expected to conclude by the end of 2024. Phase IV, planned for 2025-2026, will involve the rollout of the program to 150 children and their caretakers. This phase will focus on evaluating disease knowledge, health-related quality of life, life satisfaction, and family burden, as well as include longitudinal assessments.

CONCLUSIONS

The data aim to support the development of a comprehensive, interprofessional care model for children and adolescents with ME/CFS.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54679.

Collaborative Care to Improve Quality of Life for Anxiety and Depression in Posttraumatic Epilepsy (CoCarePTE): Protocol for a Randomized Hybrid Effectiveness-Implementation Trial

BACKGROUND

Anxiety and depression in people with epilepsy are common and associated with poor outcomes; yet, they often go untreated due to poor mental health specialist access. Collaborative care is an integrated care model with a strong evidence base in primary care and medical settings, but it has not been evaluated in neurology clinics. Evaluating implementation outcomes when translating evidence-based interventions to new clinical settings to inform future scaling and incorporation into real-world practice is important.

OBJECTIVE

The Collaborative Care for Posttraumatic Epilepsy (CoCarePTE) trial aims to evaluate the effectiveness (improvement in emotional quality of life) and implementation of a collaborative care intervention for people with anxiety or depressive symptoms and posttraumatic epilepsy.

METHODS

CoCarePTE is a 2-site, randomized, single-blind, hybrid type 1 effectiveness-implementation trial that will randomize 60 adults to receive either neurology-based collaborative care or usual care. Adults receiving neurological care at participating centers with anxiety or depressive symptoms and a history of at least mild traumatic brain injury before epilepsy onset will be enrolled. The collaborative care intervention is a 24-week stepped-care model with video or telephone calls every 2 weeks by a care manager for measurement-based anxiety and depression care, seizure care monitoring, and brief therapy intervention delivery. This is supplemented by antidepressant prescribing recommendations by psychiatrists for neurologists via case conferences and care manager-facilitated team communication. In step 2 of the intervention, individuals with <50% symptom reduction by 10 weeks will receive an added 8-session remote cognitive behavioral therapy program. The study is powered to detect a moderate improvement in emotional quality of life. As a hybrid type 1 trial, effectiveness is the primary focus, with the primary outcome being a change in emotional quality of life at 6 months in the intervention group compared to control. Secondary effectiveness outcomes are 6-month changes in depression, anxiety, and overall quality of life. Implementation outcomes, including fidelity, acceptability, feasibility, and appropriateness, are evaluated before implementation and at 3 months. The primary effectiveness analysis will compare changes in emotional quality of life scores from baseline to 6 months between the intervention and control arms using multiple linear regression modeling, adjusting for study site and using an intent-to-treat approach.

RESULTS

Enrollment commenced in 2023, with modifications in the inclusion and exclusion made after the first 6 enrollees due to slow recruitment. Enrollment is expected to continue at least into early 2025.

CONCLUSIONS

The CoCarePTE trial is novel in its use of a hybrid effectiveness-implementation design to evaluate an evidence-based mental health intervention in epilepsy, and by incorporating seizure care into a collaborative care model. If a significant improvement in emotional quality of life is found in the intervention group compared to usual care, this would support next step scaling or clinical implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05353452; https://www.clinicaltrials.gov/study/NCT05353452.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59329.