The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483. [PMID: 1593914 DOI: 10.1097/00005650-199206000-00002]

Workplace sexual harassment is associated with poor mental well-being among employees at a large Swedish university

BACKGROUND

Sexual harassment (SH) is a persistent problem at workplaces around the world, including academia.

OBJECTIVE

This study examines the association between SH and mental well-being among employees at Lund University (LU) in Sweden.

METHODS

Data was obtained from a cross-sectional survey targeting all LU employees in 2019. SH exposure was measured using a ten-item scale capturing SH experiences and enabling the differentiation between soliciting and non-soliciting types of SH. Validated instruments were used to measure two aspects of mental well-being; mental health (GHQ-12) and vitality (SF-36 vitality scale). Association between SH exposure and outcome variables was investigated through multivariable logistic regression analysis adjusting for confounders. Modifying effects of gender, age, background and academic position, respectively, on the relation between SH and outcomes were studied.

RESULTS

Workplace SH was associated with poor mental health (PMH) (OR 1.5 (95% CI 1.1-2.0)) and low vitality (LV) (OR 1.8 (95% CI 1.3-2.5)) among women and with LV (OR 2.0 (95% CI 1.1-3.9)) among men, after adjusting for confounders. Among women, experiences of non-soliciting and soliciting SH combined were associated with PMH and LV. Among men, experiences of non-soliciting SH behaviours exclusively were associated with LV. Indications of synergistic interaction affecting the association between SH and LV were found related to age, background and academic position, but not gender.

CONCLUSIONS

Workplace SH is a significant risk factor for poor mental well-being, primarily among female, but also among male university employees. These findings can inform local policies for prevention of SH.

Effects of exercise-cognitive dual-task training on elderly patients with cognitive frailty and depression

BACKGROUND

Cognitive frailty and depression are prevalent among the elderly, significantly impairing physical and cognitive functions, psychological well-being, and quality of life. Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.

AIM

To evaluate the effects of exercise-cognitive dual-task training on frailty, cognitive function, psychological status, and quality of life in elderly patients with cognitive frailty and depression.

METHODS

A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023. Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care. Frailty, cognitive function, balance and gait, psychological status, and quality of life were assessed before and after the intervention.

RESULTS

After the intervention, the frailty score of the observation group was (5.32 ± 0.69), lower than that of the control group (5.71 ± 0.55). The Montreal cognitive assessment basic scale score in the observation group was (24.06 ± 0.99), higher than the control group (23.43 ± 1.40). The performance oriented mobility assessment score in the observation group was (21.81 ± 1.24), higher than the control group (21.15 ± 1.26). The self-efficacy in the observation group was (28.27 ± 2.66), higher than the control group (30.05 ± 2.66). The anxiety score in the hospital anxiety and depression scale (HADS) for the observation group was (5.86 ± 0.68), lower than the control group (6.21 ± 0.64). The depression score in the HADS for the observation group was (5.67 ± 0.75), lower than the control group (6.27 ± 0.92). Additionally, the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group, with statistically significant differences (P < 0.05).

CONCLUSION

Exercise-cognitive dual-task training is beneficial for improving frailty, enhancing cognitive function, and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.

Understanding the Impact of Diabetic Peripheral Neuropathy and Neuropathic Pain on Quality of Life and Mental Health in 6,960 People With Diabetes

OBJECTIVE

Diabetic peripheral neuropathy (DPN) and neuropathic pain impacts quality of life (QoL) and mental health negatively. This cross-sectional survey study aimed to 1) elucidate the associations between painful and painless DPN and QoL, mental health, and socioeconomic factors, 2) assess the prevalence of sensory pain descriptors, and 3) evaluate the association between descriptors and the above factors.

RESEARCH DESIGN AND METHODS

Participants were grouped into people with (n = 1,601) and without (n = 5,359) DPN based on the Michigan Neuropathy Screening Instrument questionnaire. Participants with DPN were subsequently divided into people with (n = 1,085) and without (n = 516) concomitant neuropathic pain based on the modified Douleur Neuropathique en 4 Questions-interview.

RESULTS

The study showed diminished QoL (36-item Short Form Health Survey [SF-36]: 55.1 [interquartile range 36.7, 73.6], 82.2 [63.6, 90.9]) and poorer mental health (Hospital Anxiety and Depression Scale, subscale for anxiety [HADS-A]: 5.00 [2, 9], 2.00 [1, 5]; HADS-subscale for depression [HADS-D]: 4.00 [1, 8], 1.00 [0, 3]) in participants with DPN compared with participants without DPN. The addition of pain diminished QoL (SF-36: 50.7 [34.8, 69.8]) and mental health (HADS-A: 6 [3, 10], HADS-D: 4 [1, 8]) further. The most prevalent pain descriptor in participants with painful DPN were burning pain (73%), while the most prevalent sensory descriptor was pins-and-needles (93%). An interesting finding is the high prevalence of itch (44%). Weak associations with mental health and QoL were present for cold pain, electric pain, and itch.

CONCLUSIONS

An increased focus on differences in QoL, mental health, and pain phenotypes is of importance to move the field forward toward more interdisciplinary, personalized treatment.

Improved Items for Estimating SF-36 Profile and Summary Component Scores: Construction and Validation of an 8-Item QOL General (QGEN) Survey

BACKGROUND

Comprehensive health-related quality of life (QOL) assessment under severe respondent burden constraints requires improved single-item scales for frequently surveyed domains. This article documents how new single-item-per-domain (SIPD) QOL General (QGEN-8) measures were constructed for domains common to SF-36 and results from the first psychometric tests comparing scores for the new measure in relation to those for the SF-36 profile and summary components.

RESEARCH DESIGN

Online NORC surveys of adults, ages 19-93 (mean=52 y) representing the US population in 2020 (N=1648) included QGEN-8 and SF-36 items measuring physical (PF), social (SF), role physical (RP) and role emotional (RE) functioning and feelings of bodily pain (BP), vitality (VT), and mental health (MH). QGEN-8 items were constructed with response categories increasing score ranges for functioning (PF, SF, RP, RE) and directly measuring first-order factors for feelings (BP, VT, and MH). Analyses compared ceiling effects, convergent-discriminant correlations, classic and confirmatory factor analysis (CFA) testing for higher-order physical and mental components, and validity in discriminating across groups differing in comorbid condition severity.

RESULTS

QGEN-8 reduced response times by 75% and lowered ceiling effect percentages (-2.2% to -27.8%, median=-14%) in comparison with SF-36. Their common measurement model was supported by: (1) substantial convergent correlations (r=0.576-0.778, median r=0.721) between methods for all domains; (2) lower discriminant correlations between different domains; (3) patterns of factor loadings equivalent to previous studies and adequate CFA model fit; (4) high correlations between methods for physical (r=0.813) and mental (r=0.761) component scores; and (5) equivalent average declines across groups reporting worse comorbid conditions.

CONCLUSIONS

Overall, results support the use of QGEN-8 to reduce respondent burden and ceiling effects while maintaining convergent and discriminant validity sufficient to estimate group-level SF-36 physical (PCS) and mental (MCS) summary scores. To facilitate its use, QGEN-8 has been made available in multiple languages from the non-profit Mapi Research Trust at https://eprovide.mapi-trust.org .

Favorable change in patient-reported outcomes following peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction

BACKGROUND

A peroneus longus to brevis tendon transfer is recommended for a severely torn peroneus tendon, but there is little research on the outcome. We conducted a prospective cohort study to examine patient-reported outcomes after this procedure.

METHODS

Thirty-two patients underwent a peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction, 11 had an additional calcaneal osteotomy. The Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) were assessed preoperatively, six and 12 months after surgery.

RESULTS

Preoperative mean FAOS was 51.7 (SD 17.8) compared with 72.7 (SD 21.2) at 12 months, an improvement of 21 (95 % CI 12.7-28.0) (p < 0.0001). SF-36 improved significantly in the three domains involving physical function and bodily pain (p < 0.007).

CONCLUSION

Patient-reported outcomes improved significantly through peroneus longus to brevis tendon transfer. This procedure is worth considering for patients with a severely damaged peroneus tendon.

LEVEL OF EVIDENCE

Level II: Prospective cohort study.

Immediate Versus Delayed Exercise on Health-related Quality of Life in Patients Initiating Androgen Deprivation Therapy: Results from a Year-long Randomised Trial

BACKGROUND AND OBJECTIVE

An array of treatment-related toxicities result from androgen deprivation therapy (ADT) in patients with prostate cancer (PCa), compromising function and health-related quality of life (HRQoL). Exercise has been demonstrated to counter a number of these adverse effects including decreased HRQoL; however, when exercise should be initiated is less clear. This study aims to examine whether commencing exercise when ADT is initiated rather than later during treatment is more effective in countering adverse effects on HRQoL.

METHODS

Men with PCa (48-84 yr) initiating ADT were randomised to immediate exercise (IMEX; n = 54) or delayed exercise (DEL; n = 48) for 12 mo. IMEX consisted of 6 mo of supervised resistance/aerobic/impact exercise commenced at the initiation of ADT with 6 mo of follow-up. DEL consisted of 6 mo of usual care followed by 6 mo of the same exercise programme. HRQoL was assessed using the Short Form-36 at baseline and 6 and 12 mo. Intention to treat was utilised for the analyses that included group × time repeated-measures analysis of variance using log transformed data.

KEY FINDINGS AND LIMITATIONS

There were a significant group × time interaction for the physical functioning domain (p = 0.045) and physical component summary score (p = 0.005), and a significant time effect for bodily pain (p < 0.001) and vitality domains (p < 0.001), with HRQoL maintained in IMEX and declining in DEL at 6 mo. Exercise in DEL reversed declines in vitality and in the physical component summary score, with no differences at 12 mo compared with baseline. Limitations include treatment alterations during the intervention.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Concurrently initiating exercise and ADT in patients with PCa preserves HRQoL, whereas exercise initiated while on established ADT regimens reverses declines in some HRQoL domains.

PATIENT SUMMARY

To avoid initial treatment-related adverse effects on health-related quality of life, exercise medicine should be initiated at the start of treatment.

An Investigation of the Longitudinal Bidirectional Associations Between Interactive Versus Passive Social Media Behaviors and Youth Internalizing Difficulties. A Within-Person Approach

Ongoing concerns about the mental health of young people have intensified interest in the role of social media, with research suggesting that the nature of social media behaviors-whether interactive or passive-may differentially impact mental health. However, the bidirectional relationships between specific types of social media use and internalizing difficulties (anxiety and depression) remain underexplored, particularly at the within-person level over time. Data were extracted from the Dutch population-based Longitudinal Internet Studies for the Social Sciences (LISS) panel. Four yearly studies assessing time spent on interactive (communication) and passive use of social media in October (2019-2022) and four annual studies evaluating internalizing difficulties (anxiety and depression) in November (2019-2022) were used. Respondents who were 16- 25 years old in October 2019 (N = 321; M = 20.49; SD = 2.94; 61.7% female). Random Intercept Cross Lagged Path Models were used to analyze the data. There were no significant associations between passive social media use and internalizing difficulties at the within-person level over time. Within-person interactive use was associated with decreases in internalizing difficulties at one time point (2021 to 2022). The results provide marginal evidence that distinct social media behaviors are prospective factors associated with internalizing difficulties in young people.

Behind closed doors: Homeboundness and psychosocial outcomes. Evidence from a longitudinal study of middle-aged and older adults

OBJECTIVES

To examine how homeboundness is associated with psychosocial outcomes in terms of life satisfaction, positive affect, negative affect and loneliness among middle-aged and older adults.

METHODS

Longitudinal data were taken from the nationally representative sample German Ageing Survey (wave 1 to wave 4; n = 18,491 observations). This study included community-dwelling individuals aged 40 years and over in Germany. The mean age in the analytic sample was 62.3 years (SD: 11.8 years). Established tools were used to quantify the psychosocial outcomes. Spending six or more days per week at home was defined as homeboundness. It was adjusted for several time-varying covariates. An asymmetric linear FE regression model with cluster-robust standard errors was applied.

RESULTS

There was a robust association between the onset of homeboundness and an increase in loneliness. Among individuals aged 40 to 64 years, the onset of homeboundness was significantly associated with decreases in positive affect, whereas the end of homeboundness was significantly associated with decreases in negative affect. In contrast, changes in homeboundness status were not significantly associated with changes in psychosocial outcomes among individuals aged 65 years and over.

CONCLUSION

The onset of homeboundness in particular can contribute to unfavorable psychosocial outcomes, particularly in terms of increases in loneliness. Efforts to avoid homeboundness may assist in ageing successfully.

Quality of life and return to work rates in the first two years following major burn injury

BACKGROUND

A better understanding of how major burns patients recover following injury is vital in assessing trauma care and informing healthcare and rehabilitation provision. We aimed to describe the longer-term health and return to work status of major burns patients and identify factors associated with positive outcomes i.e., reporting no problems with health-related quality of life, returning to work).

METHODS

This registry-based cohort study included adult (≥ 16 years) patients with a burn injury affecting ≥ 20 % total body surface area registered by the Victorian State Trauma Registry with a date of injury from July 1 2009 to June 30 2022. Patients were followed-up at six, 12, and 24 months post-injury, completing the 3-level or 5-level EuroQoL 5 dimensions questionnaire (depending on their date of injury) and return to work-related questions at each time point. Mixed effect regression models were used to predict factors associated with quality of life outcomes. Modified binary Poisson models were used to model the probability of experiencing no problems in each of the quality of life domains, and mixed effects linear regression was used to model the overall utility score.

RESULTS

Two hundred and eighty-seven patients were included; 63 (21.9 %) did not die but were completely lost to follow-up. The prevalence of reporting no problems at 24 months post-injury was 70.2 % for mobility, 77.8 % for self-care, 48.0 % for usual activities, 49.7 % for pain or discomfort, and 51.5 % for anxiety or depression. The predicted probability of reporting no problems in each of the EQ-5D health states was lowest at six-months and increased over time.

CONCLUSIONS

The prevalence of ongoing problems - particularly with usual activities, pain, and anxiety/depression - at 24 months post-injury is high, confirming that major burns are often an ongoing disorder. Greater investment in interventions designed to reduce these problems is needed.

A Mixed Methods Effectiveness Study of a Peer Support Intervention for Older Adults During the COVID-19 Pandemic: Results of a Randomized Clinical Trial

OBJECTIVE

Low-income white older adults and those of color are at greater risk for depression but less likely to receive care. We evaluated the impact of a one-to-one peer support intervention compared to active control delivered by nonpeers for this population.

DESIGN

Mixed methods, single-blind randomized controlled trial.

SETTING

Community-based social service and aging organizations and geriatric primary care.

PARTICIPANTS

Low-income white older adults and those of color 50+ with depression.

INTERVENTIONS

Peer Enhanced Depression Care and nonpeer, social interaction control.

MEASUREMENTS

Primary outcome was depression (PHQ-9). Data were collected at baseline, postinterventions, 3, 6, 9, and 12 months. Poststudy interviews were conducted with both groups.

RESULTS

Among 149 randomized participants, the mean age was 70, 84% were women, 52% Black and 41% White. Both groups experienced an average decrease of 3.7 (SE: 0.55, 95% CI: [-4.77, -2.63]) points in depression from baseline to postintervention and 2.56 (SE: 0.71, 95% CI: [-3.95, -1.17]) points from baseline to 12 months. Effect sizes at postintervention (Cohen's d = 0.81) and at 12-months (Cohen's d = 0.52) indicate large and medium effects, respectively. Both groups experienced decreases in loneliness and increases in adaptive coping and self-efficacy. Qualitative findings suggest the intervention group learned coping skills and experienced behavior change, whereas control group described a general positive experience.

CONCLUSIONS

Peer support intervention was not superior to social interactions delivered by nonpeers. Divergent quantitative and qualitative results suggest the need for additional effectiveness trials of peer support interventions outside of pandemic conditions. Trial Registration ClinicalTrials.gov Identifier: NCT04319094.

Heart Failure Symptoms Improve With More Intense Physical Activity

BACKGROUND

Little is known about how changes in physical activity (PA) over time may influence symptoms in people with heart failure (HF).

METHODS

A secondary analysis was conducted with data from an RCT of an exercise intervention in patients with ICDs (implantable cardioverter defibrillator) and a HF diagnosis (n = 96). Data were collected at baseline and 2 months of PA intervention. Physical activity (PA Steps = mean steps/day; PA Intensity = mean steps/min for most intense 30 minutes/day) were measured over 5 days at each timepoint. Physical symptoms were measured using the Patient Concerns Assessment, the SF-36 Vitality, and Bodily Pain subscales for fatigue and pain. Psychological symptoms were assessed using the Patient Health Questionnaire-9, and the State-Trait Anxiety Index. Associations between PA and physical and psychological symptoms were analyzed with multivariate regression.

RESULTS

Patients (n = 96) were predominately male (83%) and Caucasian (79%), aged 55.8 ± 12.3 years, BMI of 29.7 ± 5.1, with heart failure with reduced ejection fraction (HFrEF; 30.9 ± 9.9%). An increase in PA Steps was associated with improvement in anxiety (β = -1.178, p = .048). An increase in PA Intensity was associated with significant reductions in depression (β = -0.127, p = .021), anxiety (β = -0.234, p = .037), and fatigue (β = 0.528, p = .022). Decreases in PA Steps and PA Intensity were not associated with changes in any symptoms.

CONCLUSION

For HF patients with an ICD, more intense PA over 2 months was associated with improved psychological symptoms and reduced fatigue. Decreases in PA (total and intensity) were not associated with changes in symptoms. Interventions promoting increasing the intensity of PA over time may be an effective approach to reduce some HF symptoms.

Update on esophageal function, acid and non-acid reflux after one-anastomosis gastric bypass (OAGB): high-resolution manometry, impedance-24-h pH-metry, and gastroscopy in a prospective mid-term study

BACKGROUND

One-anastomosis gastric bypass (OAGB) is the third most common metabolic/bariatric procedure worldwide. A point for discussion regarding OAGB is acid and non-acid reflux in mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing pre- and postoperative results of 24-h pH-metry, high-resolution manometry (HRM), and gastroscopy.

SETTING

Cross-sectional study and university hospital based.

METHODS

This study includes primary OAGB patients operated at the Medical University of Vienna before 31st December 2022. After a mean follow-up of 4.1 ± 2.9 years, the preoperative examinations were repeated. Additionally, history of weight, remission of obesity-related complications (ORC), and quality of life (QOL) were evaluated.

RESULTS

A total of 50 patients were included in this study and went through all examinations. Preoperative weight was 125.5 ± 21.0 kg with a BMI of 44.6 ± 5.4 kg/m2 and total weight loss after 4.1 ± 2.9 years was 37.1 ± 8.1%. Remission of ORC and QOL outcomes was successful in all categories. Gastroscopy showed anastomositis, esophagitis, Barrett's esophagus, and bile in the pouch in 38.0%, 34.0%, 6.0%, and 48.0%, respectively. In HRM, the postoperative lower esophageal sphincter pressure was 29.6 ± 15.1 mmHg (unchanged to preoperative). The total number of refluxes was equal to preoperative, whereas decreased acid refluxes were replaced by increasing non-acid refluxes. Impedance-24-h pH-metry showed that acid exposure time of the esophagus and DeMeester score decreased significantly to 1.6 ± 1.4% (p = 0.001) and 10.3 ± 9.6 (p = 0.046).

CONCLUSION

This study has shown decreased rates of acid reflux and increased rates of non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed significant signs of chronic reflux exposure of the anastomosis, the pouch, and the distal esophagus, even in asymptomatic patients. General follow-up visits in patients after OAGB should be considered.

Hemostatic Efficacy of TachoSil in Loop Electrosurgical Excisional Procedure: A Prospective Randomized Controlled Study

OBJECTIVE

The aim of the study was to evaluate the hemostatic efficacy of the fibrin sealant patch (TachoSil) after loop electrosurgical excision (LEEP) and its influence on other complications and quality of life (QoL).

MATERIALS AND METHODS

This single-blind, prospective, randomized study involved patients undergoing LEEP with or without TachoSil (1:1) between August 2014 and August 2015 in Asan Medical Center, Korea. Primary outcome measures were bleeding duration and the frequency of additional treatment owing to vaginal bleeding within 2 weeks after LEEP. Secondary outcome measures were vaginal bleeding volume using pictorial blood loss assessment chart (PBAC) score, the amount of vaginal discharge, the frequency of external genitalia, vaginal, and cervical infections within 2 weeks after LEEP, and changes in QoL.

RESULTS

Of the 140 patients enrolled, 126 (90.0%) were successfully followed up and analyzed. The median vaginal bleeding duration and frequency of additional treatment owing to vaginal bleeding showed no significant difference in the TachoSil applied and nonapplied groups ( p = .96 and p = .61, respectively). In addition, no significant difference was also observed in vaginal bleeding volume between 2 groups ( p = .64). In subgroup analysis for patients who underwent large LEEP (the longest dimension of ≥2 cm), significant improvement was observed at physical functioning in QoL at 2-3 ( p = .03) and 6 weeks ( p = .03) after LEEP of the TachoSil applied group, compared to the nonapplied group.

CONCLUSIONS

TachoSil did not demonstrate significant hemostatic efficacy after LEEP. However, TachoSil improved patient recognition on physical function in patients who underwent large LEEP.

Design and development of a Telemedicine Assessment Toolkit (TAT) for the assessment of audiovisual telemedicine encounters

Although the use of audiovisual telemedicine has grown in recent years especially during recent COVID-19-related lockdowns, evidence shows there is still a lack of tools that can be used for the assessment of telemedicine encounters. The few validated questionnaires that are available for assessing telemedicine encounters are not often used. Non-validated questionnaires dominate research, leading to results that cannot be compared or extrapolated to other research or medical sites. Development of standard measures for the assessment of telemedicine encounters has been advocated by stakeholders. The objective of this study is to provide a comprehensive set of measures by developing a conceptual approach and a preliminary Telemedicine Assessment Toolkit (TAT) for the assessment of audiovisual telemedicine encounters. A two-step conceptual approach was used to identify potential domains and sub-domains by qualitative analysis of a pool of questions from studies published from 2016 to 2021. Questions were adopted from validated questionnaires or generated to represent the underlying concept of each sub-domain, resulting in a core block of comprehensive questions. A toolkit is proposed with question-measures that cover the sub-domains relevant to the assessment of telemedicine encounters. This study recommended 11 domains to be used for the assessment of telemedicine encounters: "usability," "patient satisfaction," "patient-provider interaction," "patient perspectives," "telemedicine readiness," "qualitative feedback," "comparison to standard (in-person) care," "privacy," "technology," "patient feeling," and "patient costs." Of the 11 domains, 26 underlying sub-domains were created. From the subdomains, a 30-question core block was proposed. The core-block together with a precursor block aimed to retrieve demographic/patient characteristics and, together with a customizable clinical outcomes block, complete the comprehensive toolkit. The toolkit, upon testing and validation, would enable researchers and system owners to assess patient-oriented aspects of audiovisual telemedicine encounters more accurately and accelerate the adoption of common audiovisual telemedicine assessment measures.

Vision Problems As a Contributor to Lower Engagement in Care Among Aging Men Living with HIV

PURPOSE

To investigate vision impairment as a barrier to engagement in medical care among aging persons living with HIV (PLWH) who experience multimorbidity and complex care needs.

SETTING

Multicenter AIDS Cohort Study (MACS), a prospective observational cohort of aging PLWH men.

METHODS

We examined relationships of self-reported vision difficulty with indicators of care engagement: 1) adherence to HIV antiretroviral therapy (ART; defined as taking ≥95% of medications); 2) self-reported avoidance of medical care; 3) self-reported tendency to ask a doctor questions about care (>2 questions at a medical visit), as well as with quality of life. A modified version of the National Eye Institute Vision Function Questionnaire was administered at three semi-annual visits (from October 2017 to March 2019) to assess difficulty performing vision-dependent tasks.

RESULTS

We included 1063 PLWH (median age 57 years, 31% Black). Data on care engagement outcomes were analyzed using repeated measures logistic regression with generalized estimating equations adjusted for race, and at visit values for age, education level, depressive symptoms, alcohol use, and smoking status. Compared to no vision difficulty, those reporting moderate to extreme vision difficulty on at least one task had 2.2 times higher odds (95% CI: 1.4, 3.4) of having less than optimal ART adherence, 1.9 times higher odds (95% CI: 1.1, 3.4) of avoiding necessary medical care and median quality of life scores 8 points lower.

CONCLUSION

These findings suggest vision impairment decreases medical care engagement including HIV care and quality of life among aging PLWH.

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.

A randomized controlled trial: Mobile app vs videoconference telerehabilitation for rotator cuff tendinopathy

IntroductionThe aim of this study was to compare the effectiveness of two methods of telerehabilitation (TR) delivery: mobile health TR (mHealth-TR) and video conference TR (VC-TR) in improving outcomes for patients with RC tendinopathy.MethodsEighty-five participants diagnosed with RC tendinopathy were randomized into synchronous (VC-TR) and asynchronous (mHealth-TR) groups. Both groups received an identical 8-week exercise programme delivered through their assigned platform. The programme included scapular mobilization, range-of-motion, strengthening, and stretching exercises. The primary outcomes were pain level (Visual Analogue Scale [VAS]), disability (Disabilities of the Arm, Shoulder and Hand [DASH] score), quality of life (Short Form-36 Health Survey [SF-36] score), and shoulder mobility (universal goniometer). The assessments were carried out at baseline, after the treatment (week 8) and at a follow-up of 16 weeks.ResultsThe mean participant age was 51.8 years (SD 9.24), with 27% (n = 23) male. No significant between-group differences were observed for pain (VAS) or shoulder mobility (P > .05 for both). However, a significant group-by-time interaction effect was found for disability, measured by the DASH score (F(1,83) = 10.56, P = .001), and quality of life, measured by the SF-36 overall score (excluding physical role functioning, emotional role functioning, and social function) (Vitality/Energy: F(1,83) = 7.34, P = .006; Pain: F(1,83) = 4.78, P = .034; General Health: F(1,83) = 4.82, P = .032). Post-hoc analysis indicated significant improvements in disability and quality of life scores in the synchronous VC-TR group compared to the asynchronous mHealth-TR group. Specifically, DASH scores in the synchronous group decreased by 9.41 points (95% CI: 3.46 to 15.36, P = .002) from baseline to after treatment, and by 9.34 points (95% CI: 3.48 to 15.20, P = .002) by the 16th week. For quality of life, the VC-TR group showed significant improvements in the Vitality/Energy, Pain, and General Health domains from baseline to follow-up, with mean differences of 6.41, 11.68, and 10.83, respectively (all P < .05).DiscussionThis study suggests that patients with RC tendinopathy may experience greater improvements in pain management, disability, and overall quality of life through synchronous VC-TR compared to asynchronous mHealth-TR.

What determines the 'culture of silence'? Disclosing and reporting sexual harassment among university employees and students at a large Swedish public university

BACKGROUND

The MeToo-movement challenges the 'culture of silence' regarding sexual harassment (SH). There are few studies regarding this phenomenon in academic settings. The aim of this study was to investigate the relationship between having reported or disclosed SH, on the one hand, and background factors and general health and wellbeing of exposed individuals, types of SH and perpetrator characteristics, on the other hand.

METHODS AND RESULTS

A questionnaire sent to all employees and students at a large Swedish university was returned by 33% (N = 2736) and 32% (N = 9677), respectively. This study is based on the 469 employees and 2044 students who affirmed that they had been exposed to SH at the university. Analyses were made by means of chi2 tests and logistic regression. Among employees, 38.8% had disclosed, i.e., talked to someone at the university about their experience, and 17.3% had formally reported, i.e., talked to someone at the university who had the obligation to act on this information. The corresponding figures among students were 11.2% and 4.0%. A higher professional rank was linked to lower disclosing and reporting behavior, although not statistically significantly. Among students, exposure to attempted or completed rape was linked to low rates of disclosing (24.3%) and reporting (8.1%). An asymmetrical power relationship was associated with higher rates of disclosing and reporting; although statistically significant for reporting only among employees, and for disclosing only among students. None of the health-related outcomes were related to disclosing or reporting.

CONCLUSIONS

The study confirmed a culture of silence regarding SH in the university setting. Several factors were linked to this, which can be associated with gendered and other power relations in society at large and in the academic setting in particular. Similar factors affected employees as well as students, but the culture of silence seemed more pronounced among students.

Optimal dietary patterns for healthy aging

As the global population ages, it is critical to identify diets that, beyond preventing noncommunicable diseases, optimally promote healthy aging. Here, using longitudinal questionnaire data from the Nurses' Health Study (1986-2016) and the Health Professionals Follow-Up Study (1986-2016), we examined the association of long-term adherence to eight dietary patterns and ultraprocessed food consumption with healthy aging, as assessed according to measures of cognitive, physical and mental health, as well as living to 70 years of age free of chronic diseases. After up to 30 years of follow-up, 9,771 (9.3%) of 105,015 participants (66% women, mean age = 53 years (s.d. = 8)) achieved healthy aging. For each dietary pattern, higher adherence was associated with greater odds of healthy aging and its domains. The odds ratios for the highest quintile versus the lowest ranged from 1.45 (95% confidence interval (CI) = 1.35-1.57; healthful plant-based diet) to 1.86 (95% CI = 1.71-2.01; Alternative Healthy Eating Index). When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01-2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Our findings suggest that dietary patterns rich in plant-based foods, with moderate inclusion of healthy animal-based foods, may enhance overall healthy aging, guiding future dietary guidelines.

What are the determinants of functional decline in older adults with cancer? Results from the INCAPAC study

INTRODUCTION

Older adults with cancer are exposed to greater difficulties in carrying out their daily activities due to cancer itself, its treatment, or both. The aim of this study was to describe functional decline after cancer diagnosis and to investigate the determinants of this decline among older individuals with cancer.

MATERIALS AND METHODS

Using the Gironde cancer registries, older subjects (≥65 years) with a diagnosis of cancer between 2005 and 2018 were identified in three prospective cohorts on aging. Functional decline was defined as an increase of 1 point for Activities of Daily Living (ADL), 2 points for Instrumental Activities of Daily Living (IADL), and 3 points for the overall score (ADL + IADL) between cancer pre- and post-diagnosis visits. Logistic regression models were used to identify determinants of functional decline among older subjects who underwent a post-diagnostic assessment. Additionally, multinomial logistic regression models were performed to account for individuals who had died prior to the post-diagnostic cancer visit.

RESULTS

A total of 306 individuals followed-up after the cancer diagnosis were included (median age at cancer diagnosis: 83; 44 % female). Older age at cancer, low educational level, impaired initial functional status, and poor five-year cancer-related prognosis were significantly associated with functional decline across all three scores. Multinomial logistic regression analyses (n = 489) yielded similar results, but only cancer-related factors, specifically unfavorable vital prognosis, were associated with higher risk of death.

DISCUSSION

Functional decline in older individuals with cancer is both multifactorial and multidimensional. Further studies are needed to disentangle the effects of cancer and aging.

Growing Up with Haemophilia: Quality of Life and School Functioning of a Group of Mexican Adolescents

Haemophilia, like many other chronic rare diseases, causes limitations to daily activities, stunting the growth and impairing the quality of life as well as the psychosocial functioning and education of those affected. However, these consequences are distributed differently among those affected depending on the available contextual resources. The aim of this study was to analyse the variables associated with the academic functioning and quality of life of a group of 57 Mexican adolescents (x ¯ = 14,16 years old; SD = 1,91) suffering from haemophilia, in order to identify specific protective factors. Two tools were employed, an ad hoc questionnaire to collect general data and the Paediatric Quality of Life Questionnaire (PedsQL). The participants reported repercussions such as pain (75.4%), having difficulties walking (19.3%) and building relationships with other adolescents (17.5%), missed school days (78.9%), and/or having trouble keeping up with academic activities (38.6%). Adolescents with Type A Haemophilia displayed higher levels on the scales investigating social relations (t = 2,356; p < 0,05; δ = 1,44), academic functioning (t = 3,713; p < 0,01; δ = 2,27), psychosocial health (t = 2,561; p < 0,05; δ = 1,56), and total health-related quality of life (HRQoL) (t = 2,467; p < 0,05; δ = 1,49) than their peers with Type B. The results indicate that haemophilia has an impact on the adolescents' global development and their academic performance; however, this impact is reduced by the presence of some of contextual variables/resources.

Integrating multidimensional data analytics for precision diagnosis of chronic low back pain

Low back pain (LBP) is a leading cause of disability worldwide, with up to 25% of cases become chronic (cLBP). Whilst multi-factorial, the relative importance of contributors to cLBP remains unclear. We leveraged a comprehensive multi-dimensional data-set and machine learning-based variable importance selection to identify the most effective modalities for differentiating whether a person has cLBP. The dataset included questionnaire data, clinical and functional assessments, and spino-pelvic magnetic resonance imaging (MRI), encompassing a total of 144 parameters from 1,161 adults with (n = 512) and without cLBP (n = 649). Boruta and random forest were utilised for variable importance selection and cLBP classification respectively. A multimodal model including questionnaire, clinical, and MRI data was the most effective in differentiating people with and without cLBP. From this, the most robust variables (n = 9) were psychosocial factors, neck and hip mobility, as well as lower lumbar disc herniation and degeneration. This finding persisted in an unseen holdout dataset. Beyond demonstrating the importance of a multi-dimensional approach to cLBP, our findings will guide the development of targeted diagnostics and personalized treatment strategies for cLBP patients.

Comparing Five Major Knee Osteoarthritis Cohort Studies: Similarities, Differences, and Unique Aspects of CHECK, OAI, FNIH, IMI-APPROACH, and MOST

ObjectiveTo analyze and synthesize the information available from five pivotal, large-scale, multicenter, observational studies (CHECK, OAI, FNIH Biomarkers Consortium, IMI-APPROACH, and MOST) focusing on knee osteoarthritis (OA), which can be used to elucidate disease progression, risk factors, and the effectiveness of potential interventions.DesignFor this narrative review, a comprehensive literature search and data extraction from official web pages and scientific databases were conducted to compare methodologies, in- and exclusion criteria, outcomes, and cohort characteristics across the studies. Thematic, comparative, and qualitative analyses were employed to identify trends, commonalities, and disparities among the findings.ResultsThe studies collectively enhanced understanding of the onset and progression of knee OA, and in several of the studies, hip OA, emphasizing the importance of both systemic and local risk factors. Advanced imaging and biomarkers are important components in all the cohorts, with the goal of aiding early diagnosis and tracking disease progression. All cohorts evaluated unique markers generally not available in the other cohorts, while other factors overlap, suggesting possibilities for combining or cross-validating between cohorts.ConclusionsThe collaborative efforts of major OA research significantly advance our understanding of knee OA. These studies highlight the importance of a multifaceted approach, integrating advanced imaging, biomarkers, and longitudinal data to tackle the complexities of OA. By synthesizing findings and addressing knowledge gaps such as heterogeneity of patients and used measurements, and use of novel pain measures, future research can develop more effective diagnostic tools and treatments, ultimately enhancing the quality of life for OA patients.

Demographically adjusted normative study of everyday cognition in the ACTIVE sample

Objective: The goals of this project were to (1) provide demographically adjusted normative data for three performance-based tests of everyday cognition: The Everyday Problems Test, Observed Tasks of Daily Living-Revised, and Timed Instrumental Activities of Daily Living and (2) examine the relationships between test performance and traditional cognitive test scores and relevant self-report measures. Method: A sample of 2,767 Black (n = 726) and White (n = 2,041) older adults (aged 65-94) in the ACTIVE baseline sample were included in this study. Normed scores adjusting for age, education, gender, and race were created using multivariable fractional polynomial regressions. Adjusted scores were unrelated to age, education, gender, and race. A Poisson regression was performed to predict participants' number of demographically adjusted low (<16th percentile) test scores. Results: Higher intellectual self-efficacy (coef = -0.20), immediate memory (-0.21), reasoning (-0.25), recognition vocabulary (-0.04), and digit-symbol substitution (-0.01) significantly predicted fewer low test scores while higher physical health related QOL (0.21) and daily activity limitations (0.10) significantly predicted more low test scores (p < .01). Conclusions: Generally, persons with more widespread impairment on the tests evinced more cognitive, emotional, and functional problems. The three demographically adjusted scores fit excellently on a single factor, which uniquely accounted for 19%-36% of variance in the three test scores, in excess of what was already explained by the covariates, indicating the presence of reliable shared variance among the three tests that was not attributable to demographics nor any of the other covariates.

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.

CAHQL: A Patient-Reported Outcome Instrument to Assess Health-Related Quality of Life in Congenital Adrenal Hyperplasia

CONTEXT

Measuring health-related quality of life (HRQoL) is a crucial aspect of evaluating health care outcomes. Patients with congenital adrenal hyperplasia (CAH) often self-report deficiencies in HRQoL.

OBJECTIVE

The aim of our study was to develop a disease-specific patient-reported outcome (PRO) instrument to evaluate the HRQoL of patients > 16 years old with classic CAH.

METHODS

Following the FDA guidelines for developing PRO instruments, we developed a conceptual framework for the instrument. A preliminary instrument was created after interviewing a representative sample of 12 patients (aged 16 to 68 years) with CAH and 3 parents and obtaining expert feedback from 4 endocrinologists. The instrument was edited after cognitive interviews with 6 patients. Internal consistency of the instrument was evaluated using Cronbach's alpha. Validity was assessed by comparing the scores of our instrument with scores from widely used validated instruments for HRQoL and PRO not specific to CAH.

RESULTS

Sixty-nine patients 16 to 75 years old participated in validating our preliminary instrument. The final questionnaire consists of 44 questions within 7 domains: General Health, Adrenal Insufficiency, Glucocorticoid Excess, Physical Functioning, Mental Health and Cognition, Social Functioning, and Sexual Functioning, with acceptable internal consistency (Chronbach's alpha ≥ .6) and validity (r = -0.350 to 0.866).

CONCLUSION

CAHQL is the first validated PRO instrument to capture disease-specific HRQoL outcomes in CAH. In addition to its anticipated use in the clinical setting, the instrument could be used to assess the efficacy of novel treatments in development.

Using global positioning systems to explore food insecurity among older adults living with HIV, with and without criminal justice involvement

This study assessed the feasibility and acceptability of using global positioning systems (GPS) to evaluate food insecurity among older people living with HIV (PLWH), including those with criminal justice involvement. Approximately 25 PLWH participants were recruited via community engagement from September 2023 to January 2024. Bivariate analyses identified demographic characteristics, and chi-square tests investigated the association between arrest/incarceration history and food security. Spatial analysis examined patterns, calculated distances traveled and determined the frequency of visits to specific locations over seven days. Around 20.8% (n = 5) of participants had a CD4 count of ≤299 cells/mm³, indicating possible advanced HIV status. Food insecurity was higher among participants with lower education levels (61.5%; n = 8) and incomes ≤$20,000 annually (69.2%; n = 9). Those with arrest histories had slightly higher food insecurity rates (54.5%; n = 6) compared to those never arrested (45.5%; n = 5), though differences were not statistically significant. Most participants successfully charged and carried their GPS devices and retained food receipts. GPS compliance was higher at the start and middle of the study period but declined toward the end. Findings support that integrating geospatial technology is both feasible and acceptable for assessing food insecurity among older PLWH.

Efficacy of somapacitan in treatment-fatigue adult patients with growth hormone deficiency previously treated with once-daily growth hormone injections: a 24-week randomized active-controlled trial

OBJECTIVE

We evaluated the efficacy of somapacitan in a 24-week, randomized, active-controlled study in patients with growth hormone deficiency (GHD) who experienced fatigue from daily growth hormone (GH) injections.

METHODS

29 adult patients with GHD, pre-treated with daily GH for ≥ 5 years, who had reported treatment-related fatigue, were randomized to somapacitan or daily GH. Outcome measures were changes in treatment satisfaction assessed by Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9), IGF-1 SDS, glucose and lipid parameters, body composition, bone mineral density (BMD), carotid intima media thickness and reactive hyperaemia index, from baseline to week 24.

RESULTS

The difference in change in TSQM-9 score for convenience was significant, in favor of somapacitan (estimated difference, somapacitan-daily GH [95% CI]:23.2 [7.9; 38.4] points, P=0.004). No differences between treatment arms in estimated changes from baseline to study-end were observed for IGF-1 levels, glucose and lipid profile, visceral adipose tissue, fat mass (%), lean body mass, and vascular parameters. There was significant difference in BMD of the lumbar spine (estimated difference, somapacitan-daily GH [95% CI]-0.036 (-0.064, -0.009) gr/cm2, P=0.011).

CONCLUSION

In AGHD patients who were fatigued from the long-term daily GH injections, somapacitan was reported to be more convenient than daily GH. It was effective in maintaining IGF-1 levels and body composition, glucose, lipids, and vascular parameters, comparable to daily GH. Non-significant decrease in BMD with somapacitan could reflect a favorable increase in bone metabolic units, as previously observed in naïve patients with GHD during the initial 6-month period of GH therapy.

Exploring hand function in newly diagnosed primary Sjögren's syndrome: Clinical, radiographic, and ultrasonographic insights

BACKGROUND

Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease. Musculoskeletal and neurological system involvement occurs in patients with pSS, which may lead to impairment in hand function. Hand dysfunction and its underlying causes remain an underexplored area in pSS.

PURPOSE

This study aims to evaluate hand function in patients with newly diagnosed pSS, exploring the associations with disease activity, clinical parameters, and radiographic and ultrasonographic findings.

STUDY DESIGN

Cross-sectional.

METHODS

Fifty patients with newly diagnosed pSS and 50 healthy controls were recruited in this study. Hand functions were evaluated using the Duruöz Hand Index (DHI) and hand grip strength measurements. Detailed hand physical examination was made. Carpal tunnel syndrome (CTS) was assessed with the CTS -6 questionnaire and electrodiagnostic methods. Hands A-P radiography was evaluated for joint erosion, joint space narrowing. Ultrasonographic assessment of hand was made for intercarpal and metacarpophalangeal joint synovitis and extensor tenosynovitis. Additional evaluations included the Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36), Fatigue severity scale (FSS) and the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI).

RESULTS

Patients with pSS exhibited significantly higher DHI scores compared to controls (p = 0.027, r = 0.22) and lower non-dominant hand grip strength (p = 0.016, r = 0.30), while dominant hand grip strength did not differ significantly (p = 0.520, r = 0.08). Higher HADS anxiety (p < 0.001, r = 0.63) and depression scores (p < 0.001, r = 0.55) were noted in pSS patients. Additionally, these patients had reduced SF-36 scores (p < 0.001, r = 0.53). DHI scores were significantly correlated with ESSDAI (ρ = 0.413, p = 0.003), SF-36 (ρ = -0.605, p < 0.001), HADS (**ρ = 0.307 for anxiety, p = 0.030; ρ = 0.286 for depression, p = 0.044), hand grip strength (ρ = -0.298 for dominant hand, p = 0.036; ρ = -0.280 for non-dominant hand, p = 0.049), Health Assessment Questionnaire (HAQ) (ρ = 0.893, p < 0.001), and FSS (ρ = 0.378, p = 0.007). Ultrasonographic evaluations revealed synovitis and/or tenosynovitis in 18% of patients, while CTS was detected in 32%.

CONCLUSIONS

This study highlights significant hand function impairments in newly diagnosed pSS patients, with DHI scores correlating with disease activity, psychological well-being, and general health. These findings underscore the importance of early and comprehensive hand assessments using advanced diagnostic tools to improve patient outcomes.

Health-related quality of life significantly improved in obese patients with psoriatic arthritis one year after a structured weight loss intervention

OBJECTIVE

In this interventional weight loss study, health-related quality of life (HRQoL), anxiety, depression and fatigue were compared at baseline (BL) and at 12 months (M12) in patients with psoriatic arthritis (PsA) and controls.

METHODS

PsA patients (n = 39) between 25 and 75 years of age, with body mass index (BMI) ≥ 33 kg/m2 were included in a weight loss intervention with very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI < 40 or ≥ 40 kg/m2. The 36-item short-form health survey (SF-36) was used to assess HRQoL. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Assessments were done at BL, M3, M6 and M12. As controls (n = 39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the PsA patients.

RESULTS

In PsA patients, physical HRQoL, as demonstrated by the physical component summary (PCS) of SF-36, improved from median (IQR) 34 (25-45) at BL to 43 (34-50) at M12, p = 0.009. No significant effect on mental HRQoL, demonstrated by the mental component summary (MCS) score, was seen. Similarly in controls, PCS significantly improved (median IQR, 44 (36-50) at BL to 52 (44-55) at M12, p < 0.001), whereas no significant improvement was seen in MCS. Anxiety and depression decreased significantly in both PsA patients and controls.

CONCLUSIONS

The weight loss intervention was associated with significant improvements in physical HRQoL, as well as anxiety and depression, in PsA patients and controls.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.

The Cancer and Work Scale (CAWSE): Assessing Return to Work Likelihood and Employment Sustainability After Cancer

Background: Returning to and sustaining employment after cancer presents significant challenges for individuals touched by cancer (ITBC). While vocational rehabilitation and workplace accommodations are critical, existing return to work (RTW) assessments lack cancer-specific considerations, limiting their clinical and occupational utility. Purpose: This study aimed to develop and validate the Cancer and Work Scale (CAWSE), a psychometrically robust tool designed to assess RTW likelihood and employment sustainability among ITBC, while also providing avenues for targeted interventions. Methods: A two-phase cross-sectional study was conducted. Study I (n = 130) assessed content validity and construct development, leading to a refined 43-item CAWSE. Study II (n = 216) employed exploratory and confirmatory factor analyses to establish structural validity, reliability, and responsiveness. Additional validation included correlations with fatigue, cognitive difficulties, depression, and anxiety. Results: Factor analysis supported a seven-factor structure with 31 final items. The CAWSE demonstrated good internal consistency (α = 0.787), construct validity, and moderate responsiveness (AUC = 0.659). High sensitivity allowed for accurate identification of RTW difficulties, with an established cut-off score of 123.5 on the total CAWSE. Implications: The CAWSE fills a critical gap in oncology-specific vocational rehabilitation, offering healthcare providers a validated tool for targeted interventions to enhance RTW outcomes and long-term employment sustainability for ITBC.

Effects of a Postural Hammock in People with Chronic Neck Pain and Chronic Low Back Pain: A Randomized Controlled Trial

Background and Objectives: Musculoskeletal disorders (MD) affect over 1.7 billion people worldwide, with neck and low back pain being prevalent and debilitating conditions. Current treatments include various interventions, but novel approaches are needed to improve functionality and reduce disability. To evaluate the effects of a postural hammock on pain and functionality in people with chronic neck and low back pain. Materials and Methods: A randomized controlled trial was conducted with participants experiencing chronic neck and/or low back pain. They were assigned to either an experimental group using a postural hammock or a control group lying on a mat. Participants underwent five sessions of 10 min each over five consecutive days. Results: Forty-three subjects completed the study. While both groups showed improvements, the experimental group exhibited significant increases in hamstring flexibility and pain tolerance, measured through the Visual Analog Scale (VAS) and pressure pain thresholds (PPT). Postural hammock use demonstrated potential benefits in pain management and flexibility compared to conventional methods. Conclusions: Using a postural hammock may offer benefits for individuals with chronic back pain. Future research should explore combining hammock therapy with other interventions to enhance outcomes and improve the quality of life for patients with back pain.

The Banded One-Anastomosis Gastric Bypass Trial (RiMini Trial): Protocol of a Prospective Single-Center Randomized Controlled Trial

BACKGROUND

Long-term recurrent weight gain remains a persistent challenge in metabolic bariatric surgery (MBS). One strategy for managing recurrent weight gain involves the placement of a non-adjustable silicone ring around the reduced stomach pouch. This technique may lead to more significant weight loss and a reduced risk of long-term recurrent weight gain. Although several studies have demonstrated the effectiveness of silicone rings in combination with Roux-en-Y gastric bypass (RYGB), randomized studies providing long-term data on the effectiveness of primary banded one-anastomosis gastric bypass (OAGB) are lacking.

METHODS

A total of 210 patients will be included in this prospective, non-blinded, single-center randomized controlled trial. The primary endpoint is the difference in total weight loss percentage (%TWL) 5 years post-surgery. Secondary outcomes include excess weight loss percentage (%EWL), changes in obesity complications, quality of life, and adverse events related to the surgical procedures. The study population will consist of patients eligible for primary OAGB aged 18 years and older.

CONCLUSIONS

The RiMini trial aims to investigate whether there is a significant difference in long-term weight reduction expressed as %TWL in patients undergoing an OAGB with or without the addition of a silicone ring 5 years after surgery.

TRIAL REGISTRATION

This study is registered at Clinicaltrials.gov (NCT05472922) on the 25th of July, 2022.

Assessing disease progression in spinal muscular atrophy, current gaps, and opportunities: a narrative review

Spinal Muscular Atrophy is a genetic disorder causing muscle atrophy and progressive weakness. People living with the condition can have a significant heterogenous phenotype ranging from arrest of motor development to mild impairment. Assessing disease severity has been done using a range of outcome measures that can be classified by body structure or function, by activities or by participation. Functional outocome measures can be generic measures, used to compare individuals or populations against general norms, or disease-specific measures designed to fit disease characteristics. Outcome measures assessing participation are primarily used to capture patients' perceptions of health-related quality of life, daily activity abilities, caregiver burden, and the impact of physical symptoms like fatigue or pain. When assessing disease progression, often the focus on functional abilities has served as an overall indicator of change. With the appearance of disease modifying therapies and the need to evaluate the impact that they had in the course of the disease, new requirements for the existing assessments measure had appeared. The current available toolkit is able to capture a significant spectrum of both, natural history and effect of new treatments but the increased survival, changes in fatigue, bulbar function and others will benefit from further assessment.

Health-related quality of life in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post COVID-19 Condition: a systematic review

PURPOSE

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post COVID-19 Condition (PCC) are debilitating, chronic multi-systemic illnesses that require multidisciplinary care. However, people with ME/CFS (pwME/CFS) and people with PCC (pwPCC) are often precluded from accessing necessary disability and social support services. These unmet care needs exacerbate the existing illness burdens experienced by pwME/CFS and pwPCC. To deliver appropriate care and optimise health outcomes for pwME/CFS and pwPCC, the development of evidence-based healthcare policies that recognise the disabling impacts of these illnesses must be prioritised. This systematic review summarises the health-related quality of life (HRQoL) of pwME/CFS and pwPCC when compared with healthy controls (HCs) to elucidate the impacts of these illnesses and guide healthcare policy reform.

METHODS

CINAHL, Embase, MEDLINE, PubMed, PsycINFO and the Web of Science Core Collection were systematically searched from 1st January 2003 to 23rd July 2024. Eligible publications included observational studies capturing quantitative HRQoL data among pwME/CFS or pwPCC when compared with HCs. The use of validated patient-reported outcome measures (PROMs) was mandatory. Eligible studies were also required to employ the most stringent diagnostic criteria currently available, including the Canadian Consensus Criteria or International Consensus Criteria for ME/CFS and the World Health Organization case definition for PCC (PROSPERO ID: CRD42024501309).

RESULTS

This review captured 16 studies, including eight studies among pwME/CFS, seven studies among pwPCC and one study among both illness cohorts. Most participants were female and middle-aged. All pwPCC had experienced prolonged COVID-19 symptoms for at least three months. When compared with HCs, all HRQoL domains were significantly impaired among pwME/CFS and pwPCC. Both illnesses had a salient impact on physical health, including pain and ability to perform daily and work activities. While direct comparisons between pwME/CFS and pwPCC were limited by inconsistencies in the PROMs employed, comparable impact trends across HRQoL domain scores were observed.

CONCLUSION

ME/CFS and PCC have similar, profound impacts on HRQoL that warrant access to multidisciplinary disability and social support services. Future research must harmonise HRQoL data collection and prioritise longitudinal investigations among pwME/CFS and pwPCC to characterise PCC subgroups (including those fulfilling ME/CFS criteria) and predictors of prognosis.

Psychometric benefits of adding bolt-ons to the EQ-5D-5L in populations undergoing minimally invasive cosmetic procedures

OBJECTIVES

There is growing interest in measuring health outcomes associated with minimally invasive cosmetic procedures (MICPs), such as botulinum toxin and hyaluronic acid injections. However, the EQ-5D may have limited content validity for this purpose. This study aims to psychometrically test five additional dimensions ('bolt-ons') for the EQ-5D-5L in individuals planning or undergoing MICPs.

METHODS

In 2023, a cross-sectional, online survey was conducted with 149 women planning MICPs and 215 who had recently undergone them. Respondents completed the EQ-5D-5L, five bolt-ons (skin irritation, self-confidence, sleep, social relationships, tiredness), the Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). The following psychometric properties were tested for the EQ-5D-5L + bolt-on(s): ceiling, convergent and divergent validity, explanatory power and known-groups validity.

RESULTS

Adding tiredness (22%), self-confidence (23%) or sleep bolt-ons (27%) substantially reduced the ceiling of the EQ-5D-5L (47%). The self-confidence and social relationships bolt-ons showed a moderate or strong correlation with the RSES and BFNE-S total scores (-0.462 to -0.679). The tiredness and self-confidence bolt-ons improved the EQ-5D-5L's explained variance in EQ VAS scores from 37% to 45%. The self-confidence and social relationships bolt-ons improved the EQ-5D-5L's discrimination between known groups based on self-esteem and bodily appearance (relative efficiency: 2.72 to 2.82).

CONCLUSIONS

Relevant bolt-ons substantially enhance the psychometric performance of the EQ-5D-5L in MICP populations. The self-confidence and tiredness bolt-ons may be recommended as primary choices for use alongside the EQ-5D-5L, both in clinical studies and as part of sensitivity analyses in economic evaluations of MICPs.

Comparison of health-related quality of life trajectories in older breast cancer survivors and noncancerous controls over 10 years: A SEER-MHOS analysis

PURPOSE

This study analyzed the long-term effects of cancer on the health-related quality of life (HRQOL) of older breast cancer survivors for 10 years, including a control group to distinguish between the impacts of cancer treatment and aging.

METHODS

The SEER-MHOS data resource was used in the analysis. Cases were 674 older women diagnosed with breast cancer in 1998-2015 at age 65 and older and participated in Medicare Health Outcomes Survey within 24 months before their cancer diagnosis and at least once within 10 years of post-diagnosis. Propensity score-matched controls (n = 674) were randomly selected from noncancer cohorts. Participants reported their HRQOL using SF-36/VR-12. Repeated measures two-way analysis of variance was used to assess the effects of time, group, and the interaction between time and group on long-term HRQOL trajectory up to 10 years of follow-up.

RESULTS

At baseline, cases fared worse than controls in all HRQOL domains. Over time, physical component summary, physical functioning, general health, role limitation due to physical health, bodily pain, social functioning, and vitality worsened (Ptime < 0.05) with significant differences between the groups at some points (Pgroup < 0.05), while mental component summary, mental health, and role limitation due to emotional problems remained relatively constant (Ptime ≥ 0.05). Cases had consistently lower general health than controls with a greater gap at the end of observation.

CONCLUSIONS

Both cases and controls experienced physical HRQOL deterioration, but relatively stable mental HRQOL over 10 years.

IMPLICATIONS FOR CANCER SURVIVORS

Early interventions focusing on physical health are warranted to maintain HRQOL among older women diagnosed with breast cancer.

The Eradication of Hepatitis C Virus after Liver Transplantation Improved Liver Function and Maintained the Health-related Quality of Life

BACKGROUND

The outcomes of hepatitis C virus eradication and health-related quality of life in the patients treated with direct-acting antivirals (DAAs) after liver transplantation were examined.

METHODS

Thirty-five patients with HCV infection treated with sofosbuvir/ledipasvir after liver transplantation were enrolled in the study. The achievement rate of sustained viral response (SVR), liver function and health-related quality of life based on Short-Form-36 version 2 were evaluated.

RESULTS

All 35 patients achieved SVR and liver function was improved to a level comparable to that of non-transplanted cases by the DAA treatment. As to health-related quality of life, the scores of general health, vitality and mental health were comparable to Japanese national standard scores among 8 subscales of Short-Form-36 version 2.

CONCLUSION

HCV eradication after liver transplantation is useful for not only improving liver function but maintaining health-related quality of life.

Advancing drug development in myelodysplastic syndromes

ABSTRACT

Myelodysplastic syndromes/neoplasms (MDSs) are heterogeneous stem cell malignancies characterized by poor prognosis and no curative therapies outside of allogeneic hematopoietic stem cell transplantation. Despite some recent approvals by the US Food and Drug Administration, (eg, luspatercept, ivosidenib, decitabine/cedazuridine, and imetelstat), there has been little progress in the development of truly transformative therapies for the treatment of patients with MDS. Challenges to advancing drug development in MDS are multifold but may be grouped into specific categories, including criteria for risk stratification and eligibility, response definitions, time-to-event end points, transfusion end points, functional assessments, and biomarker development. Strategies to address these challenges and optimize future clinical trial design for patients with MDS are presented here.

Assessment of the Quality of Life of Patients with Diabetes and Prediabetes in Poland: A Cross-Sectional Study

Background: Diabetes mellitus is one of the greatest public health challenges worldwide and one of the major conditions contributing to a poorer quality of life. The main factors that may deteriorate quality of life among patients with diabetes include age, financial status, educational background, quality of healthcare services and presence of disease complications. This study aimed to assess the quality of life among patients with type 1 and type 2 diabetes and prediabetes in Poland using the example of the Podlaskie Province, taking into account selected sociodemographic variables. Methods: A total of 874 patients participated in the study, including 448 women (55.8%) and 386 men (44.2%). The study was conducted from July 2022 to July 2023 among participants of the "Zatrzymaj cukrzycę! Polski Rejestr Diabetologiczny PolReD" ("Stop Diabetes! Polish Diabetes Registry (PolRed)") project or those hospitalised in the Department of Endocrinology, Diabetology and Internal Medicine at the University Clinical Hospital in Bialystok. The study used a diagnostic survey method using a survey questionnaire developed by the authors and the 36-Item Short Form Survey (SF-36). Results: The overall study group had the highest level of quality of life assessment in the domains of social functioning (M = 69.48; SD ± 28.07), physical functioning (M = 64.54; SD ± 31.57) and role limitations due to emotional problems (M = 62.40; SD ± 45.21), and the lowest level of quality of life in the domain of general health perceptions (M = 42.21; SD ± 12.77). Age was found to be negatively correlated in all quality of life domains analysed (r = -0.438; p < 0.001)-quality of life decreased with age in all investigated domains. Men had a statistically significantly (p < 0.05) higher quality of life in each analysed domain (M = 43.52-74.08; SD ± 12.68-44.09) compared to women (M = 41.18-65.88; SD ± 12.76-46.08). Place of residence also exhibited a statistically significant (p < 0.05) differentiated quality of life in terms of physical functioning. Conclusions: The assessment of quality of life among patients with type 1 and type 2 diabetes and those diagnosed with prediabetes from the Podlaskie Province depends on the type of hyperglycaemic disorder. The assessment of quality of life among patients with type 1 and type 2 diabetes and prediabetes is determined by specific socio-demographic factors, including, above all, age and gender. Respondents with type 1 diabetes have a higher quality of life in terms of role limitations due to physical health, role limitations due to emotional problems, pain (bodily pain) and general health compared to respondents with type 2 diabetes.

Phase 2b program with sonlicromanol in patients with mitochondrial disease due to m.3243A>G mutation

Mitochondrial disease incorporates a group of rare conditions with no approved treatment to date, except for Leber hereditary optic neuropathy. Therapeutic options to alleviate the symptoms of mitochondrial disease are urgently needed. Sonlicromanol is a promising candidate, as it positively alters the key metabolic and inflammatory pathways associated with mitochondrial disease. Sonlicromanol is a reductive and oxidative distress modulator, selectively inhibiting microsomal prostaglandin E1 synthase activity. This phase 2b program, aimed at evaluating sonlicromanol in adults with m.3243A>G mutation and primary mitochondrial disease, consisted of a randomized controlled (RCT) study (dose-selection) followed by a 52-week open-label extension study (EXT, long-term tolerability, safety and efficacy of sonlicromanol). Patients were randomized (1:1:1) to receive 100 or 50 mg sonlicromanol or placebo twice daily (bid) for 28 days with a ≥2-week wash-out period between treatments. Patients who completed the RCT study entered the EXT study, wherein they received 100 mg sonlicromanol bid. Overall, 27 patients were randomized (24 RCT patients completed all periods). Fifteen patients entered the EXT, and 12 patients were included in the EXT analysis set. All patients reported good tolerability and favourable safety, with pharmacokinetic results comparable to the earlier phase 2a study. The RCT primary end point [change from placebo in the attentional domain of the cognition score (visual identification; Cogstate IDN)] did not reach statistical significance. Using a categorization of the subject's period baseline a treatment effect over placebo was observed if their baseline was more affected (P = 0.0338). Using this approach, there were signals of improvements over placebo in at least one dose in the Beck Depression Inventory (BDI, P = 0.0143), Cognitive Failure Questionnaire (P = 0.0113) and the depression subscale of the Hospital Anxiety and Depression Scale (P = 0.0256). Statistically and/or clinically meaningful improvements were observed in the patient- and clinician-reported outcome measures at the end of the EXT study [Test of Attentional Performance (TAP) with alarm, P = 0.0102; TAP without alarm, P = 0.0047; BDI somatic, P = 0.0261; BDI total, P = 0.0563; SF12 physical component score, P = 0.0008]. Seven of nine domains of RAND-Short Form-36-like SF-36 pain improved (P = 0.0105). Other promising results were observed in the Neuro-Quality of Life Short Form-Fatigue Scale (P = 0.0036), mini-Balance Evaluation Systems test (P = 0.0009), McGill Pain Questionnaire (P = 0.0105), EuroQol EQ-5D-5L-Visual Analog Scale (P = 0.0213) and EQ-5D-5L-Index (P = 0.0173). Most patients showed improvement in the Five Times Sit-To-Stand Test. Sonlicromanol was well-tolerated and demonstrated a favourable benefit/risk ratio for up to 1 year. Sonlicromanol was efficacious in patients when affected at baseline, as seen across a variety of clinically relevant domains. Long-term treatment showed more pronounced changes from baseline.

A comparison among employees in Germany and Denmark of associations between quality of leadership and subsequent 5-year development of mental distress

We hypothesised that the association between quality of leadership and mental distress would be stronger in Germany than in Denmark. The two countries differ in terms of working life cultures and labour markets, factors possibly mitigating the association of quality of leadership with mental distress. Data were based on the German Study on Mental Health at Work (2012-2017) and the Danish Work Environment Cohort Study (2000-2005 and 2005-2010), comprising 9,613 observations. A two-part model approach was employed, combining logistic and generalized linear regression models, with mental distress at follow-up as outcome variable. Heterogeneity of the country-specific estimates was assessed using a Cochran Q test. Among all participating employees, the logistic regression showed that higher quality of leadership was associated with lower mental distress (> 0) in both Germany and Denmark. This association was stronger in Germany, with the country difference being statistically significant (p = 0.036). Among employees with mental distress at follow-up, the generalized linear models revealed that quality of leadership was associated with decreased mental distress in Denmark, but not in Germany, with the country difference also being significant (p = 0.014). The inconsistent results did not support our hypothesis of a stronger association between quality of leadership and mental health in Germany. All results taken into consideration, the findings suggest that poor quality of leadership is associated with the development of mental distress in both countries. Further research is needed to examine the association between quality of leadership and mental health in other countries.

Associations of a Composite Stress Measurement Tool With Cardiovascular Risk Factors and Outcomes: Findings From the Dallas Heart Study

BACKGROUND

Most data linking chronic stress with cardiovascular disease (CVD) risk factors and outcomes have focused on single-domain stress measurements. We evaluated the association between a novel composite measure of chronic perceived stress and CVD risk factors and outcomes in a diverse population.

METHODS AND RESULTS

Individual chronic stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated to create a novel composite stress score (CSS). Participants from the DHS (Dallas Heart Study) phase 2 (2007-2009) visit without prevalent CVD who completed chronic stress questionnaires were included (n=2685). Associations between CSS and demographics, cardiac risk factors, and health behaviors were assessed in multivariable analyses. Cox proportional hazards models adjusting for traditional risk factors were used to determine associations of the CSS with adjudicated atherosclerotic CVD and global CVD (atherosclerotic CVD, heart failure, and atrial fibrillation) outcomes. CSS was higher among participants who were younger, women, and Black or Hispanic individuals, with lower income and educational attainment (P<0.0001 for each). In multivariable regression models adjusting for age, sex, race and ethnicity, income and education, higher CSS associated with hypertension, smoking, higher body mass index, hemoglobin A1C, high-sensitivity C-reactive protein, and sedentary time (P<0.01 for each). Over a median follow-up of 12.4 years, higher CSS associated with atherosclerotic CVD (adjusted hazard ratio [HR]. 1.22 per SD [95% CI, 1.01-1.47]) and global CVD (adjusted HR, 1.20 [95% CI, 1.03-1.40]). No interactions were seen between CSS, demographic factors, and outcomes.

CONCLUSIONS

Composite measures of chronic stress are higher in vulnerable populations and may help identify individuals at risk for CVD who may benefit from enhanced prevention strategies.

Evaluation of the effects of menstrual headaches on health-related quality of life in young women: a cross-sectional study

PURPOSE

This study aims to determine the effects of menstrual headaches on quality of life in young women. It also determines the frequency and examines variables associated with menstrual headaches.

MATERIALS AND METHODS

A cross-sectional study was conducted from October 2021 to April 2022 among 984 young women aged 18-28. The SF-36 Health-Related Quality of Life questionnaire was used for assessment, and data were analysed using IBM SPSS 20.0. Sociodemographic factors, menstrual characteristics, and lifestyle habits were included as variables.

RESULTS

Menstrual headaches were reported by 35.6% (n = 318) of participants. These headaches were significantly associated with disrupted family structures, shorter menstrual cycles, dysmenorrhoea, smoking, cola-containing drink consumption, medication-dependent chronic diseases, and early menarche. Women with menstrual headaches had lower median scores across all SF-36 subscales compared to those without. This study also found that delayed-onset menstrual headaches are more common than early-onset menstrual headaches in women.

CONCLUSION

Menstrual headaches adversely affect health-related quality of life in women. The prevalence and severity of these risk factors can be reduced by modifying lifestyles and implementing targeted interventions. A healthcare provider plays a critical role in helping women learn self-management strategies to alleviate menstrual headaches' adverse effects.

Factors associated with perceived medication safety during transitions of care in patients with cancer: A secondary data analysis of a cross-sectional survey

PURPOSE

This study aimed to investigate perceived medication safety in patients with cancer during transitions of care and identify factors associated with their safety perceptions.

METHODS

A secondary data analysis was performed on a cross-sectional survey data of from patients with four types of cancer (i.e., colorectal, lung, prostate, and breast). Perceived medication safety was measured by the sum score of four survey items that assessed patients' feelings about medication safety during transitions of care. Potential associated factors included sociodemographic and clinical factors (i.e., cancer types, taking oral anticancer agents), self-rated health, perceived safety in communicating with clinicians, beliefs about medications, and medication self-management ability. Descriptive statistics, bivariate correlations, and multiple linear regressions were performed.

RESULTS

A total of 183 patients were included, with a mean (SD) age of 65.04 (11.07). Participants reported a moderate level of perceived medication safety (mean [SD] = 13.56 [1.85], median = 13, IQR: 12-15). Multiple linear regression analysis revealed that better medication self-management ability (coefficient = 0.29, p < .001), feeling safer in communication with healthcare providers (coefficient = 0.87, p < .001), and having less concern about medications (coefficient = -0.11, p < .001) were significantly associated with higher perceived medication safety. Additionally, younger age (coefficient = -0.03, p = .02) was associated with higher perceived medication safety. The final model explained 43% of the variance.

CONCLUSIONS

The study's findings underscore the importance of effective communication and self-management in enhancing medication safety in patients with cancer during transitions of care, particularly for older adults needing additional support.

Higher Rates of Depression in Polymyalgia Rheumatica Are Strongly Associated With Poor Physical Function

OBJECTIVE

To assess the prevalence of and risk factors for depression in a cohort of patients with polymyalgia rheumatica (PMR) compared with a cohort of participants without PMR (control group).

METHODS

In a longitudinal cohort study, patients with recently diagnosed PMR (within 3 months of starting treatment) were recruited together with matched control subjects. Assessments were undertaken 3 and 21 months after initiation of steroid therapy. Mood was assessed using the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Survey (SF-36) Mental Health (MH) scale, with scores ≥8 on the HADS and ≤56 on the SF-36 MH Scale indicating depression. Other data collected included current prednisolone dose, PMR-Activity Score, pain visual analog scale, SF-36, and Health Assessment Questionnaire Disability Index.

RESULTS

Thirty-six subjects with PMR and 32 control subjects were recruited. At baseline, depression rates were significantly higher in PMR cases than in control subjects (22.2% vs. 3.1% and 25.0% vs. 0.0% as determined by HADS and SF-36 MH Scale, respectively). After adjusting for a previous diagnosis of depression, poor physical function (Health Assessment Questionnaire Disability Index) had the strongest association with depression determined by SF-36 MH Scale, with odds ratios of 8.19 (95% confidence interval, 1.06-63.46; p = 0.04) and 13.25 (95% confidence interval, 1.15-152.31; p = 0.04) at baseline and follow-up, respectively. Other significant associations with depression were identified with current prednisolone dose, disease activity (PMR-Activity Score), pain (pain visual analog scale and SF-36 Bodily Pain Scale), and fatigue (SF-36 Vitality Scale).

CONCLUSION

Depression affects up to 1 in 4 patients with PMR. The strongest association is with poor physical function, highlighting the psychological impact of physical limitations in PMR and the need to address comorbid depression to optimize patient outcomes.

Cerebrospinal fluid metabolomics, lipidomics and serine pathway dysfunction in myalgic encephalomyelitis/chronic fatigue syndroome (ME/CFS)

We proposed that cerebrospinal fluid would provide objective evidence for disrupted brain metabolism in myalgic encephalomyelitis/chronic fatigue syndroome (ME/CFS). The concept of postexertional malaise (PEM) with disabling symptom exacerbation after limited exertion that does not respond to rest is a diagnostic criterion for ME/CFS. We proposed that submaximal exercise provocation would cause additional metabolic perturbations. The metabolomic and lipidomic constituents of cerebrospinal fluid from separate nonexercise and postexercise cohorts of ME/CFS and sedentary control subjects were contrasted using targeted mass spectrometry (Biocrates) and frequentist multivariate general linear regression analysis with diagnosis, exercise, gender, age and body mass index as independent variables. ME/CFS diagnosis was associated with elevated serine but reduced 5-methyltetrahydrofolate (5MTHF). One carbon pathways were disrupted. Methylation of glycine led to elevated sarcosine but further methylation to dimethylglycine and choline was decreased. Creatine and purine intermediates were elevated. Transaconitate from the tricarboxylic acid cycle was elevated in ME/CFS along with essential aromatic amino acids, lysine, purine, pyrimidine and microbiome metabolites. Serine is a precursor of phospholipids and sphingomyelins that were also elevated in ME/CFS. Exercise led to consumption of lipids in ME/CFS and controls while metabolites were consumed in ME/CFS but generated in controls. The findings differ from prior hypometabolic findings in ME/CFS plasma. The novel findings generate new hypotheses regarding serine-folate-glycine one carbon and serine-phospholipid metabolism, elevation of end products of catabolic pathways, shifts in folate, thiamine and other vitamins with exercise, and changes in sphingomyelins that may indicate myelin and white matter dysfunction in ME/CFS.

Pretreatment predictors of weight loss in a 12-month behavioral obesity treatment: a signal detection analysis of DIETFITS

OBJECTIVE

The objective of this study was to identify pretreatment predictors of weight loss in a 12-month behavioral obesity treatment that restricted either fat or carbohydrates.

METHODS

Participants were 436 adults with overweight or obesity from the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial. Signal detection analysis was used to identify which combinations of 51 pretreatment demographic, clinical, behavioral, and psychosocial variables, along with diet type (healthy low-fat vs. healthy low-carbohydrate), formed subgroups that varied in proportion of those achieving at least 5% weight loss at 12 months.

RESULTS

Overall, 51% of participants achieved at least 5% weight loss at 12 months, with eight subgroups identified through signal detection. Diet type was not a key factor. Among racial and ethnic minority participants, the best predictors of weight loss were lower levels of emotional eating, less friend discouragement, and presence of metabolic syndrome. Among non-Hispanic White participants, the best predictors were high confidence in participating fully in the intervention, more family encouragement, and lower outcome expectations.

CONCLUSIONS

We found that psychosocial and clinical factors, along with race and ethnicity, successfully differentiated subgroups that varied in their 12-month weight loss. Given the heterogeneity in response to behavioral obesity treatment, these results can help generate hypotheses to move intervention science toward a precision medicine approach by matching individuals to their most suitable obesity treatments.

Weak trunk extensors in adult spinal deformity patients are related to sagittal malalignment and kinematic limitations

BACKGROUND

Adult spinal deformity (ASD) is associated with muscles' degeneration that affects postural control and outcomes of an eventual corrective surgery. Evaluation of ASD is usually based on static radiographs and more recently on functional assessment. However, there has been limited exploration of muscle strength weakness in ASD. The aim was to investigate the relationship between trunk muscles' strength in ASD and its relationship with radiographic and kinematic alterations and quality-of-life decline.

METHODS

28 ASD and 18 asymptomatic subjects underwent biplanar radiographs with 3D calculation of spino-pelvic and global postural parameters. 3D movement analysis of gait, sitting to standing and stair ascent, was studied allowing the calculation of head, trunk and lower limbs 3D kinematics. Participants filled out health related quality of life questionnaires. A single operator measured 4 times the strength of the trunk muscles, using a hand-held dynamometer, to assess measurements' reliability. ASD population was divided into two groups based on the strength of trunk extensors: ASD-weak extensors (N = 11 patients having trunk extensors strength

RESULTS

Measurements of muscle strengths using the hand-held dynamometer were reliable (ICC>0.94). On standing radiographs, the ASD-weak extensors group showed an increased positive sagittal malalignment compared to the other groups (SVA=61 mm vs ASD-normal extensors: 18 mm, controls: -4 mm, p < 0.001). This sagittal malalignment remained during movement (kinematic-SVA=223 mm vs ASD-normal extensors:178 mm, controls:138 mm, p < 0.001). Muscle strength weakness was correlated to the decline of quality-of-life scores (PCS-SF36: r = 0.48, VAS for pain: ρ=-0.39).

CONCLUSIONS

This study showed that weak trunk extensors are associated with sagittal malalignment in static position, kinematic limitations during daily life activities and reduced quality of life scores. Future studies will investigate the effect of muscle strengthening on both static and dynamic alignment in ASD and their quality of life.

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Key Words

• 3D movement analysis
• Adult spinal deformity
• Functional assessment
• Muscle strength
• Trunk extensors

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MESH Headings

• Humans
• Female
• Male
• Biomechanical Phenomena
• Adult
• Quality of Life
• Muscle Strength/physiology
• Middle Aged
• Torso/physiopathology
• Torso/physiology
• Muscle Weakness/physiopathology
• Gait/physiology
• Muscle, Skeletal/physiopathology
• Muscle, Skeletal/diagnostic imaging
• Bone Malalignment/physiopathology
• Bone Malalignment/diagnostic imaging
• Spinal Curvatures/physiopathology
• Spinal Curvatures/diagnostic imaging
• Case-Control Studies
• Muscle Strength Dynamometer

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Affiliation(s)

Maria Saadé Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Rami Rachkidi Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Ali Rteil Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Elma Ayoub Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Elena Jaber Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Celine Chaaya Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Nabil Nassim Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Elio Mekhael Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Rami Rehayem Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Julien Abi Nahed Technology Innovation Unit, Hamad Medical Corporation, Doha, Qatar
Bilal Ramadan Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Mohamad Karam Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Ismat Ghanem Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Abir Massaad Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Ayman Assi Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France.

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