Among 170 adults with sickle cell disease, we evaluated chronic pain impact and disability prevalence, assessed age and gender differences, and identified psychosocial predictors of chronic pain ...intensity and disability. Most participants had a high level of disability. Chronic pain intensity and disability were significantly associated with pain catastrophizing and chronic pain self-efficacy, and worsened with age. Further research is needed to confirm study findings and develop interventions, including palliative care approaches that address catastrophizing and disability, particularly for young women and middle-aged adults with sickle cell disease. Moreover, consistent clinical assessment of chronic pain and psychosocial health should be implemented.
OBJECTIVES: To evaluate whether type and volume of Medicaid Home‐ and Community‐Based Services (HCBS) waiver program are associated with risk of hospitalization and whether this association changes ...over time.
DESIGN: Prospective.
SETTING: Indiana Medicaid claims data from June 2001 to December 2004.
PARTICIPANTS: Medicaid recipients (N=1,354) who enrolled in the Aged and Disabled waiver program between January 2002 and June 2004.
MEASUREMENTS: Time to hospital admission since enrollment in the HCBS waiver program, adjusted for demographics, comorbidities, prior use of health services, and volume of HCBS received, including attendant care, homemaking, and home‐delivered meals.
RESULTS: A greater volume of attendant care, homemaking services, and home‐delivered meals was associated with a lower risk of hospitalization. This effect diminished over time for attendant care and homemaking. The risk of hospitalization for subjects receiving 5 hours of attendant care per month was 54% (hazard ratio (HR)=0.46, 95% confidence interval (CI)=0.38–0.57) lower during the first month of enrollment and 20% lower by Month 10 (HR=0.80, 95% CI=0.73–0.88) than for those receiving no attendant care.
CONCLUSION: Greater volume of HCBS services was associated with lower risk of hospitalization. The findings highlight the potential importance of assessing and monitoring the volume of HCBS patients receive.
Head and neck cancer (HNC) patients may experience multiple co-occurring neuropsychological symptoms (NPS) cluster, including fatigue, depression, pain, sleep disturbance, and cognitive impairment. ...While inflammation has been attributed as a key mechanism for some of these symptoms, its association with the NPS as a cluster of symptoms is unknown. Thus, the aim of this study was to examine the association between peripheral inflammation and NPS cluster among HNC patients over cancer treatment (radiotherapy with or without chemotherapy).
HNC patients were recruited and followed at pre-treatment, end of treatment, three months and one-year post-treatment. Plasma inflammatory markers, including C-reactive protein (CRP), tumor necrosis factor-alpha (TNFA), soluble tumor necrosis factor receptor-2 (sTNFR2), interleukin-1 beta (IL1-β), interleukin-6 (IL-6), interleukin-10 (IL-10), monocyte chemotactic protein-1 (MCP-1), and interleukin-1 receptor antagonist (IL-1RA) and patient-reported NPS cluster were collected at the 4 time points. Associations between inflammatory markers and the NPS cluster were analyzed using linear mixed-effects models and generalized estimating equations (GEE) models controlling covariates.
147 HNC patients were eligible for analysis. 56% of the patients received chemoradiotherapy as treatment. The highest NPS cluster score was reported at the end of treatment, which gradually decreased over time. An increase in inflammatory markers including CRP, sTNFR2, IL-6 and IL-1RA was associated with higher continuous NPS cluster scores (p<0.001, p = 0.003, p<0.001, p<0.001; respectively). GEE further confirmed that patients with at least two moderate symptoms had elevated sTNFR2, IL-6, and IL-1RA (p = 0.017, p = 0.038, p = 0.008; respectively). Notably, this positive association between NPS cluster and inflammatory markers was still significant at one-year post-treatment for CRP (p = 0.001), sTNFR2 (p = 0.006), and IL-1RA (p = 0.043).
Most HNC patients experienced NPS clusters over time, especially immediately after the end of treatment. Elevated inflammation, as represented by inflammatory markers, was strongly associated with worse NPS cluster over time; this trend was also notable at one-year post-treatment. Our findings suggest that peripheral inflammation plays a pivotal role in the NPS cluster over cancer treatment, including long-term follow-ups. Interventions on reducing peripheral inflammation may contribute to alleviating the NPS cluster in cancer patients.
•Head and neck cancer patients experienced neuropsychological symptoms (NPS) cluster from pre- to post-treatment.•Worse NPS was observed immediately after the end of treatment.•Elevated peripheral inflammation was strongly associated with worse NPS cluster over cancer treatment.
Abstract only
Background:
Cardiovascular disease (CVD) is highly prevalent among older persons with HIV (OPWH) occurring on average a decade earlier than non-infected individuals largely due to ...chronic inflammation, vascular pathology, and psychosocial stressors. Effective cardiovascular risk reduction strategies such as exercise have been shown to lower both physiological and psychosocial stressors but have not been widely reported in the HIV population.
Objective:
To evaluate the effect of a one-year, moderate intensity aerobic exercise intervention on perceived stress among OPWH with ≥ 2 CVD risk factors.
Methods:
A secondary analysis was performed utilizing data from Project FiTBRAiN, a 2-arm RCT that included Let’s Move (moderate intensity aerobic exercise intervention) or Let’s Flex (flexibility/stretching attention control) groups. The 14-item Perceived Stress Scale (PSS) was utilized to measure participants’ perceived stress. Data analysis included an analysis of variance with pairwise and between-group differences reported.
Results:
Participants (n=115) reported a mean age of 55±5.2, and the majority were African American (n=100, 87.0%) and male (n=66, 57.4%). The most common cardiovascular comorbidities were elevated: total cholesterol (n=114, 99.1%), systolic blood pressure (n=108, 93.9%), diastolic blood pressure (n=98, 85.2%), and participants had a mean BMI of 28.29. Baseline 14-item PSS scores for the Let’s Move Program and Let’s Flex Program were 19.49 (SD=7.94) and 21.13 (SD=8.64), respectively, indicating moderate stress levels. Over all time points, the control group (Let’s Flex) had higher perceived stress than the intervention group (Let’s Move), but were not significant.
Conclusions:
Our findings suggest that moderate levels of psychological stress were present in this population and may be a risk factor for CVD among OPWH. The consistent finding that perceived stress remained lower over time indicates that aerobic exercise may be beneficial for stress reduction. Additional research is needed to determine the optimal dose and mode of exercise that is most beneficial for stress reduction in this population.
Whether a largescale disaster alters people's previous decisions about their end-of-life care is unknown.
We examined the effects of a disaster, the COVID-19 pandemic, on stability of end-of-life ...care preferences among dialysis patients and on patient-surrogate goals-of-care congruence.
We used a natural experimental design to examine goals-of-care preferences pre- and postexposure to the pandemic during a pragmatic trial testing SPIRIT (sharing patient's illness representations to increase trust), an evidence-based advance care planning (ACP) intervention. There were 151 patient-surrogate dyads who prior to the pandemic lockdown had completed baseline (T1) and postintervention assessments (T2) regarding their goals-of-care preferences in two end-of-life scenarios. Of those 151 dyads, 59 intervention, and 51 usual care dyads consented to be in the present study and completed the goals-of-care tool two additional times, at enrollment (T3) and six months later (T4), along with the COVID stress scale (CSS). Dyad congruence was ascertained by comparing patient and surrogate responses to the goals-of-care tool.
There were no changes over time in the proportions of patients who chose comfort-care-only in the goals-of-care tool. The proportion of patients who chose comfort-care-only and dyad congruence were higher in SPIRIT compared to usual care, but there was no interaction between that treatment effect and exposure to the pandemic. CSS was associated with neither patients' preferences nor dyad congruence.
The pandemic alone did not appear to influence patients' goals-of-care preferences or dyad congruence. This finding supports the stability of value-based end-of-life preferences in general, even during a disaster.
The present research paper is designed to explore the role of financial development indicators on income inequality in Australia using yearly data from 1980 to 2014. Our study also accounts for other ...potential determinants of income inequality such as inflation, per capita income and trade openness. Our results from Bayer and Hanck (2013) cointegration test confirm the long‐run equilibrium relationship across the models. Similarly, the long‐run estimates from the quantile regression models and non‐parametric approach indicate that the financial development indicators, foreign direct investment (FDI) inflows, inflation and trade openness have significant positive impact on income inequality in Australia. However, the growth in per capita income plays the opposite role. Given these findings, our study offers numerous policy and practical implications and adds an important value to the empirical literature on the nexus between financial development and income inequality.
ABSTRACT
Depressive symptoms, stress, fatigue, and lack of sleep are often experienced by women in the perinatal period and are potential contributors to adverse maternal and child health outcomes. ...To explore the evolution of symptoms and identify groups of women of similar severity and patterns, we utilized clustering of multidimensional symptom trajectories. In an observational study data were collected from pregnant women in the 3rd trimester (36 weeks prenatal) and in the postnatal period at weeks 1 and 2 as well as at 1‐, 2‐, 3‐, and 6‐months postpartum. Depressive symptoms and maternal stress were measured using the Edinburg Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS), respectively. Self‐reported duration of sleep and levels of fatigue also were collected. A model‐based clustering approach was used to classify women by their symptom severity. The sample included 151 pregnant women with a 6‐month follow‐up. Two clusters were identified. Cluster 1 (n = 43) comprised women with fewer depressive symptoms, less perceived stress, lower likelihood of being fatigued, increased sleep duration and a negative trend in EPDS (β = −0.05, CI −0.09, −0.001), and PSS (β = −0.09, CI −0.17, −0.01). Cluster 2 (n = 108) comprised women with higher EPDS and PSS scores, increased likelihood of fatigue and lower sleep duration with a positive trend in sleep hours (β = −0.02, CI 0.01, 0.03). Pro‐inflammatory markers interleukin‐6 and tumor necrosis factor‐α were associated with longer sleep duration and fewer depressive symptoms, respectively. Using this methodology in maternal and child health research can potentially predict women's risk of developing severe symptoms and help clinicians provide timely interventions.
Highlights • Cytokine elevation after childbirth continues throughout 6-months postpartum. • An early postpartum elevation in cortisol levels increases the odds of postpartum depression. • ...Cytokine–cortisol interactions differ among women who do or do not develop PPD. • Variation in early postpartum PNI activity may explain inflammatory-based depression.
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