Purpose
Coping behaviors may play a mediating role in producing the negative health outcomes observed in financially burdened cancer patients and survivors.
Methods
Exploratory factor and latent ...class analysis of survey data.
Results
A total of 510 people completed the survey, ages ranged from 25 to over 75 over half greater than 55 years old (57.8%). Most respondents identified as female (64.7%), white (70.8%), or African American (18.6%). A four-factor model of financial coping was revealed: care-altering, lifestyle-altering, self-advocacy, and financial help-seeking. Respondents grouped into three financial coping classes:
low burden/low coping
(
n
= 212),
high self-advocacy
(
n
= 143), and
high burden/high coping
(
n
= 155). African American respondents were at far greater odds than white respondents of being in the
high burden/high coping
class (OR = 5.82, 95% CI 3.01–6.64) or the self-advocacy class (OR = 1.99, 95% CI 1.19–2.80) than the low burden/low coping class. Compared to respondents aged 65 years and older, those 35–44 were more likely in the
high burden/high coping
class (OR = 12.27, 95% CI 7.03–19.87) and the
high self-advocacy
class (OR = 7.08, 95% CI 5.89–8.28) than the
low burden/low coping
class.
Conclusion
One-third of respondents were in the
high burden/high coping
class. Age and race/ethnicity were significantly associated with class membership. Some coping strategies may compromise health and well-being. Program and policy interventions that reduce the odds that patients will use strategies that undermine treatment outcomes and increase patient use of protective strategies are needed.
Patient satisfaction after total hip (THA) and total knee arthroplasty (TKA) is a core outcome selected by the Outcomes Measurement in Rheumatology. Up to 20% of THA/TKA patients are dissatisfied. ...Improving patient satisfaction is hindered by the lack of a validated measurement tool that can accurately measure change.
The psychometric properties of a proposed satisfaction instrument, consisting of 4 questions rated on a Likert scale, scored 1-100, were tested for validity, reliability, and sensitivity to change using data collected between 2007 and 2011 in an arthroplasty registry.
We demonstrated construct validity by confirming our hypothesis; satisfaction correlated with similar constructs. Satisfaction correlated moderately with pain relief (TKA ρ = 0.61, THA ρ = 0.47) and function (TKA ρ = 0.65, THA ρ = 0.51) at 2 years; there was no correlation with baseline/preoperative pain/function values, as expected. Overall Cronbach’s alpha >0.88 confirmed internal consistency. Test-retest reliability with weighted kappa ranged 0.60-0.75 for TKA and 0.36-0.56 for THA. Hip disability and Osteoarthritis Outcome Score/Knee injury and Osteoarthritis Outcome Scores quality of life improvement (>30 points) corresponds to a mean satisfaction score of 93.2 (standard deviation, 11.5) after THA and 90.4 (standard deviation, 13.8) after TKA, and increasing relief of pain and functional improvement increased the strength of their association with satisfaction. The satisfaction measure has no copyright and is available free of cost and represents minimal responder burden.
Patient satisfaction with THA/TKA can be measured with a validated 4-item questionnaire. This satisfaction measure can be included in a total joint arthroplasty core measurement set for total joint arthroplasty trials.
This study examined the effects of in utero exposure to maternal depression and Superstorm Sandy, a hurricane that hit metropolitan New York in 2012, on infant temperament at 6 months. Temperament ...was assessed using the Infant Behavior Questionnaire‐Revised. Maternal depression was measured by the Edinburgh Postnatal Depression Scale. The main effects and the interaction of maternal depression and Sandy exposure on infant temperament were examined using a multivariable generalized linear model. Results show that prenatal maternal depression was associated with lower emotion regulation and greater distress. Stratification and interaction analyses suggested that the adverse effects of prenatal maternal depression on problematic temperament were amplified by in utero Sandy exposure. This study underscores the importance of providing prenatal screening and treatment for maternal depression during pregnancy while also identifying high‐risk families who may have suffered from disaster‐related traumas to provide necessary services. As the frequency of natural disasters may increase due to climate change, it is important to understand the consequences of in utero stress on child development and to formulate plans for early identification.
RESUMEN
El estudio examinó los efectos del estar expuesto in‐utero a la depresión materna y a la Gran Tormenta Sandy, un huracán que afectó el área metropolitana de Nueva York en 2012, sobre el temperamento del infante a los 6 meses. Se evaluó el temperamento usando el Revisado Cuestionario de Conducta del Infante. La depresión materna fue medida por medio de la Escala de Depresión Posnatal de Edinburgh. Los principales efectos y la interacción de la depresión materna y el estar expuesto a Sandy sobre el temperamento del infante se examinaron usando el Modelo Lineal General de Variables Múltiples. Los resultados muestran que la depresión materna prenatal se asoció con una más baja regulación de la emoción y una mayor angustia. Los análisis de estratificación e interacción sugirieron que los efectos adversos de la depresión materna prenatal sobre el temperamento problemático se ampliaron por el hecho de haber estado expuesto a Sandy in‐utero. El estudio subraya la importancia de proveer examen y tratamiento prenatal para la depresión materna durante el embarazo, mientras simultáneamente se identifican las familias bajo alto riesgo que pudieran haber sufrido de traumas relacionados con desastres con el fin de proveer los servicios necesarios. Ya que la frecuencia de desastres naturales pudiera aumentar debido a los cambios climáticos, es importante comprender las consecuencias que el estrés in‐utero tiene sobre el desarrollo del niño y formular planes para la temprana identificación.
RÉSUMÉ
Cette étude a examiné les effets de l'exposition à la dépression maternelle et à la grande tempête Sandy in‐utero sur le tempérament du bébé à 6 mois, la tempête Sandy ayant été un cyclone ayant frappé la ville de New York aux Etats‐Unis en 2012. Le tempérament a été évalué en utilisant le Questionnaire Révisé du Comportement du Nourrisson. La dépression maternelle a été mesurée au moyen d'Echelle de Dépression Postnatale d'Edinburgh. Les principaux effets et l'interaction de la dépression maternelle et l'exposition à Sandy sur le tempérament du bébé ont été examinés en utilisant un Modèle Général de Linéarité (MGL). Les résultats montrent que la dépression maternelle prénatale est liée à une émotion‐régulation moindre et à une plus grande détresse. Les analyses de stratification et d'interaction suggèrent que les effets adverses de la dépression maternelle prénatale sur un tempérament problématique ont été amplifiés par l'exposition à Sandy in‐utero. Cette étude souligne l'importance qu'il y a d'offrir un dépistage et un traitement pour la dépression maternelle durant la grossesse, tout en identifiant simultanément les familles à haut risque qui peuvent avoir souffert de traumatismes liés à des désastres naturels de façon à offrir des services nécessaires. Comme la fréquence des catastrophes naturelles peut augmenter avec le changement climatique il est important de comprendre les conséquences du stress in‐utero sur le développement de l'enfant et de formuler des plans d'identification précoce.
ZUSAMMENFASSUNG
Die Studie untersuchte die Auswirkungen der in utero Exposition gegenüber mütterlicher Depression und dem Supersturm Sandy, einem Hurrikan, der 2012 den Großraum New York traf, auf das Säuglingstemperament im Alter von 6 Monaten. Das Temperament wurde anhand der revidierten Version des „Infant Behavior Questionnaire” bewertet. Die mütterliche Depression wurde mit der „Edinburgh Postnatal Depression Scale” gemessen. Die Haupteffekte sowie die Interaktion von mütterlicher Depression und der Sandy‐Exposition auf das Säuglingstemperament wurden mit Hilfe eines multivariablen allgemeinen linearen Modells untersucht. Die Ergebnisse zeigen, dass pränatale mütterliche Depression mit einer geringeren Emotionsregulation und größeren Belastung verbunden war. Stratifikations‐ und Interaktionsanalysen zeigten, dass die negativen Auswirkungen der pränatalen mütterlichen Depression auf das problematische Temperament durch die in utero Sandy‐Exposition verstärkt wurden. Die Studie unterstreicht, wie wichtig es ist, pränatale Vorsorgeuntersuchungen und Behandlungen für mütterliche Depression während der Schwangerschaft durchzuführen und gleichzeitig Hochrisikofamilien zu identifizieren, die möglicherweise an katastrophenbedingten Traumata gelitten haben, um sie mit den notwendigen Dienstleistungen zu versorgen. Da die Häufigkeit von Naturkatastrophen aufgrund des Klimawandels zunehmen könnte, ist es wichtig, die Folgen von Stress im Mutterleib auf die Entwicklung des Kindes zu verstehen und Pläne für eine frühzeitige Erkennung zu formulieren.
抄録
母親のうつ病と自然災害関連ストレス胎内暴露が生後６ヶ月の乳児の気質に及ぼす影響:大型ハリケーンサンディの被災児
母親のうつ病と2012年に首都ニューヨークを襲った大型ハリケーンサンディーへの胎内暴露が生後６ヶ月の乳児の気質に及ぼす影響ついて調査した研究である。気質は、乳幼児行動質問票改訂版を用いて評価された。母親のうつ病は、エジンバラ産後うつ病質問票により評価された。母親のうつ病とサンディーへの暴露が乳幼児の気質に及ぼした主な影響や相互作用は、多変量一般線形モデルを用いて検討した。結果、母親の産前うつ病は感情調節の低下と乳児の強い不穏状態に関連することが示された。層別解析と相互作用解分析では、母親の産前うつ病が問題気質に及ぼす悪影響は、サンディーへの胎内暴露により増幅されたことが示された。研究では、必要なサービスを提供するためには、災害関連トラウマを受けたハイリスク家族を早期に発見すると同時に、産前スクリーニングと妊娠中の母親のうつ病の治療提供することが重要であることを強調する。自然災害の頻度が気候変化により増加することが予想されるため、子宮内ストレスが子どもの成長に及ぼす結末への理解を深め、早期発見の対策を講じることが重要である。
摘要
子宮內受到母親抑鬱和自然災害相關壓力對6個月嬰兒氣質的影響:超級風暴桑迪的孩子
該研究調查子宮內受到孕婦抑鬱症和超級風暴桑迪 (在2012年襲擊紐約大都會的颶風), 對6個月嬰兒氣質的影響。作者使用嬰兒行為問卷調查評估氣質。通過愛丁堡產後抑鬱量表測量母親抑鬱症。研究使用多變量一般線性模型, 檢驗母親抑鬱和桑迪對嬰兒氣質的主要和交互效應。結果表明, 產前抑鬱症與較低的情緒調節和較大的痛苦有關。分層和相互作用分析表明, 產前母親抑鬱症對問題性氣質的不利影響, 通過受到桑迪影響而增強。這項研究強調在懷孕期間為產婦提供抑鬱症篩查和治療的重要性, 同時確定可能與災難有關創傷的高風險家庭, 以便提供必要的服務。由於氣候變化導致自然災害的頻率可能會增加, 因此必須了解子宮內受到壓力對兒童發育的影響, 並製定早期識別計劃。
ملخص
تاثير التعرض داخل الرحم للاكتئاب الأمومي والإجهاد العصبي المرتبط بالكوارث الطبيعية علي مزاج الرضيع في عمر 6 أشهر: أطفال ضحايا إعصار ساندي
تناولت الدراسة آثار التعرض داخل الرحم لاكتئاب الام وعاصفة ساندي التي ضربت نيويورك في سنة 2012 علي مزاج الرضع في عمر 6 أشهر. تم تقييم مزاج الطفل باستخدام الاستبيان المعدل لسلوك الرضع. وتم قياس الاكتئاب الأمومي بمقياس أدنبرة لاكتئاب ما بعد الولادة. كما تم دراسة الآثار الرئيسية والتفاعل بين الاكتئاب الأمومي والتعرض لإعصار ساندي وعلاج ذلك بمزاج الرضع باستخدام النموذج الخطي العام متعدد المتغيرات. وتبين النتائج ان الاكتئاب الأمومي السابق للولادة ارتبط بانخفاض مستوي تنظيم العاطفة وارتفاع مستوى الضيق. وتشير تحليلات التفاعل إلى أن الآثار السلبية للاكتئاب الأمومي قبل الولادة علي المزاج الصعب تزداد نتيجة التعرض لتجربة إعصار ساندي داخل الرحم. وتؤكد الدراسة علي اهميه توفير الفحص والعلاج قبل الولادة للاكتئاب الأمومي اثناء الحمل ، مع القيام في الوقت نفسه بتحديد الأسر المعرضة للمخاطرة الشديدة التي يحتمل ان تكون قد عانت من صدمات ناجمه عن الكوارث وذلك بهدف توفير الخدمات الضرورية لهم . ونظرا لان تواتر الكوارث الطبيعية قد يزداد بسبب تغير المناخ ، فمن المهم فهم عواقب الإجهاد العصبي الذي يحدث في الرحم علي نمو الطفل ووضع خطط للتعرف المبكر عليه.
Prior research has demonstrated the link between maternal depression during pregnancy (i.e., prenatal depression) and increased neurodevelopmental dysregulation in offspring. However, little is known ...about the roles of key hypothalamic–pituitary axis regulatory genes in the placenta modulating this association. This study will examine whether placental gene expression levels of 11β‐hydroxysteroid dehydrogenase type 2 (HSD11B2), glucocorticoid receptor (NR3C1), and mineralocorticoid receptor (NR3C2) can help elucidate the underlying mechanisms linking prenatal depression to infant temperament, particularly in infants with high negativity and low emotion regulation. Stored placenta tissues (N = 153) were used to quantify messenger ribonucleic acid levels of HSD11B2, NR3C1, and NR3C2. Assessments of prenatal depression and infant temperament at 6 months of age were ascertained via maternal report. Results found that prenatal depression was associated with increased Negative Affectivity (p < .05) after controlling for postnatal depression and psychosocial characteristics. Furthermore, the association between prenatal depression and Negative Affectivity was moderated by gene expression levels of HSD11B2, NR3C1, and NR3C2 such that greater gene expression significantly lessened the association between prenatal depression and Negative Affectivity. Our findings suggest that individual differences in placental gene expression may be used as an early marker of susceptibility or resilience to prenatal adversity.
Abstract
Many cancer patients experience a reduction in work status during cancer treatment. Authors analyzed cross-sectional survey data from U.S. cancer patients and survivors to examine the ...relationship between reduced work status and cost-related nonadherence, defined as skipping or forgoing medical treatments or medications due to cost. Of 381 respondents who were working at the time of diagnosis, 143 reported a reduction in work status during treatment. Age, racial identity, level of education, and treatment type were associated with reductions in work status. Respondents who reduced work status had higher odds of engaging in cost-related nonadherence than those with stable employment. Authors conclude that reduced work status is associated with nonadherence that can undermine treatment benefit and lead to disease progression. This association is troubling given that African American respondents were more likely to report reduced work status during treatment, potentially exacerbating existing cancer health disparities. To reduce treatment nonadherence, social workers should assess for potential employment problems and be prepared to intervene through counseling, community resource referrals, and direct financial assistance. Social workers should be aware of how structural racism is reproduced through inequitable labor policies and practices that have direct implications for health and access to care.
Objectives: Mental disorders and substance use disorders are highly comorbid. The “self-medication hypothesis” posits that individuals may use substances such as tobacco and alcohol to cope with ...symptoms associated with untreated mental health problems. The present study examined the association between having a currently untreated mental health condition and tobacco and alcohol use among male taxi drivers in NYC, a population at risk for poor mental and physical health outcomes. Methods: The sample included 1105 male, ethnoracially diverse, primarily foreign-born NYC taxi drivers participating in a health fair program. This secondary cross-sectional analysis utilized logistic regression modeling to examine whether endorsement of a currently untreated mental health problem (i.e., depression, anxiety, or posttraumatic stress disorder) was associated with alcohol and/or tobacco use, controlling for potential confounders. Results: 8.5% of drivers reported having mental health problems; among these, only 0.5% reported receiving treatment. Untreated mental health problems were associated with an increased risk of current tobacco/alcohol use after controlling for age, educational attainment, nativity, and pain history: drivers with untreated mental health problems had 1.9x the odds of reporting current tobacco use 95% CI: 1.10–3.19 and 1.6x the odds of reporting current alcohol use 95% CI: 1.01–2.46 than those without untreated mental health problems. Conclusions: Few drivers with mental health problems receive treatment. In line with the self-medication hypothesis, drivers with untreated mental health problems demonstrated significantly increased risk of tobacco and alcohol use. Efforts to encourage timely screening and treatment of mental health problems among taxi drivers are warranted.
Food insecurity is prevalent among low-income immigrant and minority patients with cancer. To our knowledge, this randomized controlled trial is the first to prospectively examine the impact on ...cancer outcomes of food insecurity interventions, with the goal of informing evidence-based interventions to address food insecurity in patients with cancer.
A three-arm randomized controlled trial was conducted among food-insecure (18-item US Department of Agriculture Household Food Security Survey Module score ≥ 3) patients with cancer (N = 117) at four New York City safety net cancer clinics. Arms included a hospital cancer clinic-based food pantry (arm 1), food voucher plus pantry (arm 2), and home grocery delivery plus pantry (arm 3). Treatment completion (primary outcome) and full appointment attendance were assessed at 6 months. Food security status, depression symptoms (Patient Health Questionnaire-9), and quality-of-life scores (Functional Assessment of Cancer Therapy-General) were assessed at baseline and at 6 months.
Voucher plus pantry had the highest treatment completion rate (94.6%), followed by grocery delivery plus pantry (82.5%) and pantry (77.5%;
= .046). Food security scores improved significantly in all arms, and Patient Health Questionnaire-9 and Functional Assessment of Cancer Therapy-General scores improved significantly in the pantry and delivery plus pantry arms.
Our findings in this preliminary study suggest that voucher plus pantry was the most effective intervention at improving treatment completion, and it met our a priori criterion for a promising intervention (≥ 90%). All interventions demonstrated the potential to improve food security among medically underserved, food-insecure patients with cancer at risk of impaired nutrition status, reduced quality of life, and poorer survival. All patients with cancer should be screened for food insecurity, with evidence-based food insecurity interventions made available.
The present study examines the relationship between sex, infant temperament, and childhood psychophysiological reactivity via electrodermal activity (EDA). Both temperament and EDA are known to be ...relatively stable traits across the lifespan reflecting individual reactivity and regulation linked to suboptimal behavioral development and risk for psychopathology. However, little is known about the role of sex in the relationship between temperament and EDA. As a part of a larger longitudinal study of behavioral development, 125 participants were followed from birth until the age of 3 years to examine the relationship between temperament and psychophysiological reactivity in different sex groups. Measurements of temperament at age 6 months, and EDA, via skin conductance response (SCR) rate to a series of six startling auditory stimuli at 3 years of age were collected. Median splits of SCR rate and three temperament dimensions (positive affect, negative affect, and regulation) were created to designate high/low groups. Results indicate sex moderated the relationships between temperament traits and SCR rates. Specifically, low positive affect was associated with an increased risk for high psychophysiological reactivity in boys (odds ratio = 3.8), whereas high regulation was associated with an increased risk for greater reactivity in girls (odds ratio = 4.2). While preliminary, these findings suggest the importance of sex in relation to psychophysiological and temperamental reactivity, risk factors for developmental psychopathology. As our participants age, follow-up research to investigate the stability of these associations will provide valuable insights for the potential of EDA as a psychophysiological marker for developmental psychopathology risk in young children.
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