One Meaning for Two Persons: An Actor-Partner Interdependence Model Analysis of Meaning in Life,Anxiety, and Depression Among Rehabilitation Patients and Caregivers

ObjectivePatients and caregivers in the inpatient physical rehabilitation setting are presented with life-changing medical conditions, and their meaning in life can change dramatically. Meaning in life is associated with fewer depressive and anxiety symptoms, but little is known about how they are related interdependently among patients and caregivers. In the current study, we aim to explore their dyadic relationships.DesignActor-partner interdependence model through structural equation modeling for dyadic analyses.Setting and ParticipantsA total of 160 pairs of patients and caregivers recruited from 6 inpatient rehabilitation hospitals in China.MethodsCross-sectional surveys were conducted among pairs of rehabilitation patients and caregivers. The presence of and search for meaning were measured with the Meaning in Life Questionnaire.ResultsIn 2 separate models, we found that patients' presence of meaning was negatively associated with their own depression (β = −0.61, P < .001) and anxiety (β = −0.55, P < .001), as well as their caregivers' depression (β = −0.32, P < .001) and anxiety (β = −0.31, P < .001). However, the caregivers’ presence of meaning was only negatively associated with their own depression (β = −0.25, P < .05) and anxiety (β = −0.21, P < .05). A search for meaning was not significantly associated with depression or anxiety.Conclusions and ImplicationsThe results indicate that the anxiety and depressive symptoms of rehabilitation inpatients and caregivers are associated with their own level of presence of meaning. Caregivers' depression and anxiety are interdependently associated with patients' presence of meaning. Clinicians should take dyadic interdependence into consideration when providing psychological services to rehabilitate patients and their caregivers. Meaning-centered interventions can be helpful for the dyads’ meaning-making and mental health.     

Efectividad de un programa de estiramientos sobre los niveles de ansiedad de los trabajadores de una plataforma logística: un estudio controlado aleatorizado

ObjectiveTo study the influence of a short programme of stretching exercises on anxiety levels of workers in a Spanish logistic company.MethodA controlled clinical trial was carried out by means of an inter-subject design of random homogeneous blocks. Participants were assigned to the experimental group (n = 67), treated with a programme of stretching exercises of 10-minute duration after working hours for a period of 3 months, or to the untreated control group (n = 67). The primary result variable was anxiety, and the secondary variables were burnout syndrome, quality of life and flexibility. An analysis of covariance (ANCOVA) by intention to treat was performed on each of the result variables by controlling the baseline scores, the age and the practice of introjective activities outside the program, with the size effect calculated by means of the partial eta-squared value (η²).ResultsThe results of the ANCOVA showed a moderate effect of the stretching exercise programme on the levels of anxiety (η² = 0,06; P = .004). Other effects found were substantial for flexibility (η² = 0,13; P < .001); moderately high for bodily pain (η² = 0,08; P = .001), and moderate for vitality (η² = 0,05; P = .016); mental health (η² = 0,05; P = .017); general health (η² = 0,04; P = .028) and exhaustion (η² = 0,04; P = .025).ConclusionsThe implementation of a short programme of stretching exercises in the work place was effective for reducing levels of anxiety, bodily pain and exhaustion, and for raising levels of vitality, mental health, general health and flexibility. This type of intervention could be seen as a low-cost strategy for improving the well-being of workers.     

Influence of rapid COVID-19 vaccine development on vaccine hesitancy

IntroductionIn the race to deploy vaccines to prevent COVID-19, there is a need to understand factors influencing vaccine hesitancy. Secondary risk theory is a useful framework to explain this, accounting for concerns about vaccine efficacy and safety.MethodsDuring the first week of July, 2020, participants (N = 216) evaluated one of three different hypothetical vaccine scenarios describing an FDA-approved vaccine becoming available “next week,” “in one year,” or “in two years.” Dependent variables were perceived vaccine efficacy, self-efficacy, perceived vaccine risk, and vaccination willingness. Covariates included vaccine conspiracy beliefs, science pessimism, media dependency, and perceived COVID-19 risk. Data analysis employed multiple analysis of covariance (MANCOVA).ResultsPerceived vaccine efficacy was lowest for the next-week vaccine (η²_p = .045). Self-efficacy was higher for the two-year vaccine than the next-week vaccine (η²_p = .029). Perceived vaccine risk was higher for the next-week vaccine than for the one-year vaccine (η²_p = .032). Vaccination willingness did not differ among experimental treatments. In addition, vaccine conspiracy beliefs were negatively related to perceived vaccine efficacy (η²_p = .142), self-efficacy (η²_p = .031), and vaccination willingness (η²_p = .143) and positively related to perceived vaccine risk (η²_p = .216).ConclusionsThe rapid development of the COVID-19 vaccine may have heightened public concerns over efficacy, availability, and safety. However, the current findings showed a general willingness to take even the most rapidly developed vaccine. Nonetheless, there remains a need to communicate publicly and transparently about vaccine efficacy and safety and work to reduce vaccine conspiracy beliefs.     

Sociodemographic and Lesbian-Specific Factors Associated with Physical Activity Among Adult Lesbians

BackgroundAlthough participation in moderate and vigorous physical activity (MVPA) results in health benefits, the majority of adult lesbians are not sufficiently active. The purpose of this study was to examine the relationships between sociodemographic factors (age, education level, body mass index [BMI], race, partner status, employment status, annual household income, general health status, diagnosis of chronic conditions, children under 18 years living at home) and lesbian-specific factors (connection with the lesbian community, public identification as a lesbian) to participation in MVPA.MethodsParticipants included 847 self-identified lesbians 18 to 74 years old (M_age = 40.5; SD = 11.6) who completed a 20-minute, web-based survey.FindingsThe binary logistic regression model that included the 10 demographic factors was significantly associated with MVPA, χ² (15, N = 847) = 105.62, p < .001. However, when the two lesbian-specific factors were added, the model did not improve significantly, χ² (2, N = 847) = 5.20, p = .07. BMI and general health status were significantly associated with MVPA (Wald χ² (2) = 19.5, p < .001) and (Wald χ² (4) = 41.2, p < .001). Obese participants had 54.5% lower odds than healthy weight participants to engage in sufficient amounts of MVPA. Participants who reported general health status as excellent compared with those who reported poor had 12.7 times greater odds of engaging in sufficient amounts of MVPA.ConclusionsFuture research should extend on this study by utilizing sampling methods that target the recruitment of lesbian women not actively involved in lesbian-related activities.     

The impact of side effect framing on COVID-19 booster vaccine intentions in an Australian sample

ObjectiveTo evaluate the effect of presenting positively attribute-framed side effect information on COVID-19 booster vaccine intention relative to standard negatively-framed wording and a no-intervention control.Design and participantsA representative sample of Australian adults (N = 1204) were randomised to one of six conditions within a factorial design: Framing (Positive; Negative; Control) × Vaccine (Familiar (Pfizer); Unfamiliar (Moderna)).InterventionNegative Framing involved presenting the likelihood of experiencing side effects (e.g., heart inflammation is very rare, 1 in every 80,000 will be affected), whereas Positive Framing involved presenting the same information but as the likelihood of not experiencing side effects (e.g., 79,999 in every 80,000 will not be affected).Primary outcomeBooster vaccine intention measured pre- and post-intervention.ResultsParticipants were more familiar with the Pfizer vaccine (t(1203) = 28.63, p <.001, Cohen’s d_z = 0.83). Positive Framing (M = 75.7, SE = 0.9, 95% CI = [73.9, 77.4]) increased vaccine intention relative to Negative Framing (M = 70.7, SE = 0.9, 95% CI = [68.9, 72.4]) overall (F(1, 1192) = 4.68, p =.031, η_p² = 0.004). Framing interacted with Vaccine and Baseline Intention (F(2, 1192) = 6.18, p =.002, η_p² = 0.01). Positive Framing was superior, or at least equal, to Negative Framing and Control at increasing Booster Intention, irrespective of participants’ pre-intervention level of intent and vaccine type. Side effect worry and perceived severity mediated the effect of Positive vs. Negative Framing across vaccines.ConclusionPositive framing of side effect information appears superior for increasing vaccine intent relative to the standard negative wording currently used.Pre-registrationSee: aspredicted.org/LDX_2ZL.     

A Delirium Risk Modification Program Is Associated With Hospital Outcomes

BackgroundDelirium has been associated with negative health consequences, which can potentially be improved by delirium risk modification. This study sought to determine if a quality improvement project to identify and modify delirium risk and discharge to rehabilitation is associated with improved outcomes for patients and health care systems.MethodsIn older veterans admitted to a tertiary VA hospital, delirium risk was assessed using cognitive impairment, vision impairment, and dehydration. Delirium risk was communicated to providers via electronic medical record. To modify delirium risk, interventions were provided in cognitive stimulation, sensory improvement, and sleep promotion. Primary outcomes included length of stay, restraint use, discharge to rehabilitation, and hospital variable direct costs. Outcomes were compared using a propensity-matched cohort of patients without intervention. Number of intervention categories was compared with primary outcomes.ResultsPatients (n = 1527) were older (78.2 ± 8.3 years) and male (98%). Propensity-matched patients (n = 566) were well matched for age, gender, cognitive deficits, vision impairment, and dehydration. Patients with interventions were discharged to rehabilitation similarly (mean difference [MD] 2.2%, 95% CI −2.5−6.9) and had lower lengths of stay (MD −0.7 day, 95% CI −1.3 to −0.1), lower restraint use (MD −4.0%, 95% CI −6.7 to −1.2) and trended toward lower variable direct costs (MD −$1390, 95% CI −3586−807). Increasing number of interventions was associated with shorter length of stay, lower rate of restraint use, and lower variable direct costs.ConclusionsThis delirium risk modification project was associated with patient outcomes and reduced costs. Serious consideration should be given to delirium risk identification and modification programs.     

Effects of a Humanoid Companion Robot on Dementia Symptoms and Caregiver Distress for Residents in Long-Term Care

ObjectivesTo test the effects of deploying a humanoid companion robot (Kabochan) in comparison with usual care for long-term care facilities’ residents with dementia.DesignA 2-arm, randomized controlled trial with ABAB withdrawal design, lasting 32 weeks. After an 8-week baseline period, Kabochan was introduced in a nonfacilitated, individual approach with experimental-group participants (n = 52) for 8 weeks, then removed for 8 weeks, and then reintroduced for another 8 weeks. The control group (n = 51) received the usual standardized care.Setting and ParticipantsSeven long-term care facilities in Hong Kong. 103 residents (76% women, 87.2 ± 7.4 years) with a clinical diagnosis of dementia.MeasuresOutcome assessments occurred at 5 time points: baseline (week 1) and the end of each phase (weeks 8, 16, 24, and 32). Primary outcomes were assessed with the Neuropsychiatric Inventory Questionnaire (symptom severity and caregiver distress subscales) and the Geriatric Depression Scale; secondary outcomes were measured by the Hong Kong Montreal Cognitive Assessment 5-minute Protocol, the Modified Barthel Index for Activities of Daily Living, and the Quality of Life–Alzheimer's disease scale.ResultsA multivariate analysis of variance indicated a statistically significant group × time interaction for neuropsychiatric-related caregiver distress at week 16 (F = 6.72, P = .011), with a moderate effect size (η_p² = 0.06). When Kabochan was removed in the withdrawal phase (weeks 17–24), the neuropsychiatric symptoms became more severe at week 24 for the intervention group (F = 4.68, P = .003), although the effect size was small to moderate (η_p² = 0.04). No statistical between-group differences were found in other health outcomes.Conclusions and ImplicationsThe Kabochan was potentially effective at reducing short-term neuropsychiatric symptoms and relevant caregiver distress for residents with dementia. An individualized care plan with continuous monitoring is required to integrate the humanoid robot into routine dementia care.     

Longitudinal associations between changes in screen-time and mental health outcomes in adolescents

IntroductionThe primary aim was to examine longitudinal associations between changes in screen-time and mental health outcomes among adolescents.MethodsAdolescents (N = 322, 65.5% females, mean age = 14.4 ± 0.6 years) reported screen-time and mental health at two time points over a school year. Multi-level linear regression analyses were conducted after adjusting for covariates.ResultsChanges in total recreational screen-time (β = −0.09 p = 0.048) and tablet/mobile phone use (β = −0.18, p < 0.001) were negatively associated with physical self-concept. Changes in total recreational screen-time (β = −0.20, p = 0.001) and computer use (β = −0.23, p = 0.003) were negatively associated with psychological well-being. A positive association was found with television/DVD use and psychological difficulties (β = 0.16, p = 0.015). No associations were found for non-recreational screen-time.ConclusionChanges in recreational screen-time were associated with changes in a range of mental health outcomes.     

Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control

BackgroundThe Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth.Objectives(1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health.DesignThe TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire.Participants/settingThere were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test.InterventionYouth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education.Main outcome measuresBehavioral and physiologic outcomes related to diabetes.Statistical analysisChanges in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models.ResultsThe study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months’ follow-up, there was a reduction in kilocalories (mean = −346 kcal/d; P < .001), sugar-sweetened beverages (mean = −2 fluid oz/d; P = .032), red/processed meat (mean = −1.5 oz/d; P = .008), and sodium (mean = −650 mg/d; P < .001) but no change in AHEI-2010 score (P = .600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = −5.90 mm Hg; P = .036).ConclusionsDespite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.     

Associations between intimate partner violence,violence-related policies,and HIV diagnosis rate among women in the United States

PurposeTo assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies.MethodsData on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination.ResultsStates with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = −0.05; 95% CI = −0.07, −0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = −0.009; 95% CI = −0.04, 0.02; P = .59).ConclusionsHIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.     

Symptoms and quality of life indicators among children with chronic medical conditions

BackgroundChildren with chronic conditions often experience numerous symptoms, but few research studies examine patterns of symptoms and quality of life (QoL) indicators.ObjectiveTo examine if reliable latent classes of children with chronic medical conditions can be identified based on the clustering of symptoms and QoL indicators.MethodsStructured interviews were conducted with children ages 9–21 living with chronic medical conditions (N = 90). Multiple symptoms (e.g., pain, sleep, fatigue, and depression) and QoL indicators (e.g., life satisfaction and social support) were measured. Physical health and emotional, social, and school functioning were measured using the Pediatric Quality of Life Inventory (PedsQL). Latent class analysis was used to classify each child into a latent class whose members report similar patterns of responses.ResultsA three-class solution had the best model fit. Class 1 (high-symptom group; n = 15, 16.7%) reported the most problems with symptoms and the lowest scores on the QoL indicators. Class 2 (moderate-symptom group; n = 39, 43.3%) reported moderate levels of both symptoms and QoL indicators. Class 3 (low-symptom group; n = 36, 40.0%) reported the lowest levels of symptoms and the highest scores on the QoL indicators.ConclusionsThe three latent classes identified in this study were distributed along the severity continuum. All symptoms and QoL indicators appeared to move in the same direction (e.g., worse symptoms with lower QoL). The PedsQL psychosocial health summary score (combining emotional, social, and school functioning scores) discriminated well between children with different levels of disease burden.     

Post Hoc Analyses of a Randomized Controlled Trial for the Effect of Pharmacist Deprescribing Intervention on the Anticholinergic Burden in Frail Community-Dwelling Older Adults

ObjectivesAnticholinergic burden is detrimental to cognitive health. Multiple studies found that a high anticholinergic burden is associated with an increased risk for dementia, changes to the brain structure, function, and cognitive decline. We performed a post hoc analysis of a randomized controlled deprescribing trial. We compared the effect of the intervention on baseline anticholinergic burden across the treatment and control groups and the time of recruitment before and after a lockdown due to the COVID pandemic with subgroup analyses by baseline frailty index.DesignRandomized controlled trial.Settings and ParticipantsWe analyzed data from a de-prescribing trial of older adults (>65 years) previously conducted in New Zealand that was focused on reducing the Drug Burden Index (DBI).MethodsWe used the anticholinergic cognitive burden (ACB) to quantify the impact of the intervention on reducing the anticholinergic burden. Participants not taking anticholinergics at the start of the trial were excluded. The primary outcome for this subgroup analysis was a change in ACB, measured with the ĝ_Hedges statistic describing the difference in standard deviation units of this change between intervention and control. For this analysis, the trial participants were stratified into low, medium, and high frailty and timing into prior- and post-lockdown (public health measures for COVID-19).ResultsAmong the 295 participants in this analysis, the median (IQR) age was 79 (74, 85), and 67% were women. For the primary outcome ĝ_Hedges = −0.04 (95% CI −0.26 to 0.19) with a −0.23 mean reduction in ACB in the intervention arm and −0.19 in the control arm. Before lockdown ĝ_Hedges = −0.38 (95% CI −0.84 to 0.04) and post-lockdown ĝ_Hedges = 0.07 (95% CI −0.19 to 0.33). The mean change in ACB for each of the frailty strata was as follows: low frailty (−0.02; 95% CI −0.65 to 0.18); medium frailty (0.05; 95% CI −0.28 to 0.38); high frailty (0.08; 95% CI −0.40 to 0.56).Conclusions and ImplicationsThe study did not provide evidence for the effect of pharmacist deprescribing intervention on reducing the anticholinergic burden. However, this post hoc analysis examined the impact of COVID on the effectiveness of the intervention, and further research in this area may be warranted.     

Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data

ObjectivesThis study examined the association between intensive rehabilitation for subacute stroke patients and medical costs and readmission ratio during the year after discharge.DesignThis was a natural experiment study.Setting and ParticipantsWe identified individuals with a diagnosis of cerebrovascular disorder (ICD-10: I60-I69 cerebrovascular disease) in an insurance claims database in Japan from January 2005 to December 2017. From the database, 980 patients who were admitted to a convalescent rehabilitation unit with stroke were identified. After excluding 575 patients, 405 were eligible for the study.MethodsIn Japan, from April 2011, a new policy was established that allows special costs to be added as rehabilitation time increases. This policy provides an additional medical fee for inpatients in a convalescent rehabilitation unit who receive more than 120 minutes of rehabilitation therapy. We defined high-intensity rehabilitation as transfer from hospitalization to a convalescent rehabilitation unit after April 2011. Outcomes were total direct medical costs and readmission ratio during the year after discharge from the convalescent rehabilitation unit.ResultsDaily rehabilitation time, total rehabilitation time, and total medical costs of the high-intensity rehabilitation group were significantly higher than those of the low-intensity rehabilitation group (P < .001, P < .001, P = .011, respectively). However, there was no significant difference in the medical costs during the year after discharge (P = .653) or in the readmission ratio (hazard ratio: 1.09, 95% confidence interval: 0.55-2.18, P = .804).Conclusions and ImplicationsIntensive rehabilitation did not reduce medical costs or the readmission ratio during the first year after discharge. Future studies should consider the necessary rehabilitation intensity given the severity of the patient's condition, using large sample sizes.     

Discontinuity of Women Veterans’ Care in Patient-Centered Medical Homes: Does Workforce Gender Sensitivity Matter?

BackgroundPrior research has found that 25% of women veterans who are new to the Department of Veterans Affairs (VA) health care system discontinue services within 3 years of initial use. Although it has been suggested that providing more gender-sensitive care might improve women veterans' health care experiences, no study has yet documented an empirical relationship between clinic and provider factors associated with the provision of gender-sensitive care and women veterans’ care discontinuity.MethodsSurveys of primary care providers (n = 82) and staff members (n = 108) from 12 VA medical centers were linked to administrative data for women veteran patients with at least one primary care visit in 2014 and 2015 (n = 9,958). Patient care discontinuity was operationalized as having no additional primary care visit within 3 years after the patient's baseline visit. Key indicators of gender-sensitive comprehensive primary care included type of medical home (women's health-focused vs. general primary care), workforce gender sensitivity, team functioning, perceived quality of provider/staff communication, leadership support for medical home implementation, and other structural components of care delivery (e.g., chaperone availability). We used logistic regression to assess the association between these indicators and women's care discontinuity, measuring discontinuity for both new and continuing VA users and controlling for patient characteristics.ResultsEleven percent of women patients discontinued primary care within 3 years. Poor workforce gender sensitivity (lowest quartile vs. top three quartiles) was significantly associated with higher odds of discontinuity (odds ratio, 1.26; 95% confidence interval, 1.01–1.57); other indicators were not associated with discontinuity.ConclusionsThis study is the first to document a relationship between workforce gender sensitivity and women veterans’ care continuity. This finding underscores the need for additional attention to enhancing workforce gender sensitivity in VA.     

Fostering Resilience among Mothers under Stress: “Authentic Connections Groups” for Medical Professionals

BackgroundWe report on effects of an intervention to foster resilience among professional women at high risk for stress and burnout: health care providers (physicians, PhD clinicians, physician assistants, and nurse practitioners) who are mothers.MethodsBetween February and November 2015, 40 mothers on staff at the Mayo Clinic, Arizona, were assigned randomly to either 1) 12 weekly 1-hour sessions of a structured, relational supportive intervention, the Authentic Connections Groups (n = 21) with protected time to attend sessions or to 2) 12 weekly hours of protected time to be used as desired (controls; n = 19). Participants were assessed at baseline, after the intervention, and 3 months follow-up on multiple psychological measures plus plasma cortisol.ResultsAcross the 12 weeks of the intervention groups, there were zero dropouts. After the intervention, analyses of covariance showed significantly greater improvements (p < .05) for mothers in the Authentic Connections Groups than control condition for depression and global symptoms. By 3 months follow-up, significant differences were seen for these two dimensions and almost all other central variables, including self-compassion, feeling loved, physical affection received, and parenting stress, with moderate effect sizes (η_p² 0.08–0.19; median, 0.16). Participants in the Authentic Connections Groups (but not control) condition also showed significant reductions in cortisol levels at both after the intervention and follow-up.ConclusionsFacilitated colleague support groups could be a viable, low-cost, preventive intervention to mitigate burnout and distress for mothers in high-stress professional settings such as hospitals, resulting in personal benefit, greater engagement at work, and attenuated stress associated with parenting.     

Health Indicators Associated with Falls Among Middle-aged and Older Women Enrolled in an Evidence-Based Program

BackgroundEvidence-based fall prevention programs primarily attract older women, who are increasingly burdened by fall-related injuries. However, little is known about the relationship between older female participants' baseline health status and self-reported falls over the course of fall prevention interventions. Using data from A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL) workshops, this study examines female participants' sociodemographics and health indicators associated with self-reported falls at baseline and postintervention.MethodsData were analyzed from 837 older women (M = 76.2 years) collected during the statewide AMOB/VLL dissemination in Texas. Longitudinal Poisson regression models, using the generalized estimating equation method, were used to investigate the associations of personal characteristics and health indicators with and reductions in the number of self-reported falls from baseline to postintervention.FindingsApproximately 21% of participants reported falling at baseline, and the number of reported falls significantly decreased from baseline to postintervention (β = -0.443). At baseline, more unhealthy physical days (β = 0.022), more unhealthy mental days (β = 0.018), and lower Falls Efficacy Scale scores (β = -0.052) were significantly associated with more falls reported at baseline. More falls at baseline was also associated with worse program attendance (β = -0.069). Greater improvements in Falls Efficacy Scale Scores (β = -0.069) and decreases in unhealthy physical health days (β = 0.026) over the course of the intervention were significantly associated with greater reductions in reported falls at postintervention, respectively.ConclusionsFindings have implications for identifying at-risk older women upon enrollment, expanding the reach of AMOB/VLL, and leveraging AMOB/VLL to refer participants to other evidence-based exercise, disease management, and mental health interventions.     

Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study

ObjectivesInformation on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function.DesignOur study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis Patients.Setting and participantsOf the 273 participants of the original trial, 270 participants (mean age 70.3 ± 6.4 years, 53% women) were included in this observational analysis.MethodsThe associations between (1) total number of drugs (or NSAIDs) at baseline or (2) cumulative number of drugs (or NASAIDs) repeatedly measured over 24 months and kidney function repeatedly measured over 24 months as estimated glomerular filtration rate (eGFR) were investigated using multivariable-adjusted repeated-measures analysis.ResultsPer drug at baseline, kidney function decreased by 0.64 mL/min/1.73 m² eGFR (Beta = −0.64; 95% CI −1.19 to −0.08; P = .024) over 24 months. With every additional drug taken cumulatively over 24 months, kidney function decreased by 0.39 mL/min/1.73 m² eGFR (Beta = −0.39; 95% CI −0.63 to −0.15; P = .002). In a high-risk subgroup, per NSAID taken cumulatively over 24 months, kidney function declined by 1.21 mL/min/1.73 m² eGFR (Beta = −1.21; 95% CI −2.35 to −0.07; P = .021).Conclusions and implicationsFor every additional drug prescribed among older adults, our study supports an independent and immediate harmful impact on kidney function. This negative impact seems to be about 3 times greater for NSAIDs compared with an additional average drug.     

The effects of homelessness on Veterans' health care service use: an evaluation of independence from comorbidities

ObjectivesThis study evaluates the prevalence of Multiple Comorbid Chronic Disease (MCCD) within homeless and non-homeless Veterans and the association between MCCD and inpatient medical care.MethodsAll individuals seen in the VA North Texas Health Care System between October 1, 2009 and September 30, 2010 (n = 102,034) were evaluated. Homelessness during the year and the number of common chronic diseases were evaluated for an association with likelihood of medical and psychiatric hospitalizations, bed days of care, inpatient substance treatment, rehabilitation admissions, and emergency department visits.ResultsHomeless Veterans had higher all-cause mortality rates and rates of use of almost all resources after controlling for chronic disease burden using the Charlson Comorbidity Index, psychiatric illnesses, substance use disorders, and demographic variables.ConclusionsHomelessness Veterans are vulnerable to a high use of resources and mortality, independent of medical and psychiatric conditions. This finding should focus additional attention on reducing homelessness.     

Psychotherapy for the Treatment of Anxiety and Depression in Patients with Parkinson Disease: A Meta-Analysis of Randomized Controlled Trials

ObjectiveAnxiety and depression are major psychiatric nonmotor symptoms (NMSs) of Parkinson disease (PD). Although several studies have investigated the effects of psychotherapeutic interventions, particularly cognitive-behavioral therapy (CBT), for alleviating anxiety and depression in patients with PD, the findings have been inconclusive because of the small sample size and the lack of a unified protocol for such treatments. Thus, the present meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effect of psychotherapy on PD-related anxiety and depression.DesignSystematic review and meta-analysis.Setting and ParticipantsRelevant RCTs were extracted from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases. This study was registered in PROSPERO under the number CRD 42020165052.MeasuresThe primary and secondary outcomes were changes in the anxiety score and depressive symptoms, respectively.ResultsFourteen RCTs including 507 patients with PD were analyzed. The interventions were classified as CBT and non-CBT. CBT significantly reduced anxiety at the end of the study (standardized mean difference = −0.85, 95% confidence interval = −1.12 to −0.58, P < .001, I² = 0%), whereas non-CBT did not. Greater heterogeneity in the effects of non-CBT treatment was observed. CBT was significantly beneficial for depression (standardized mean difference = −0.83, 95% confidence interval = −1.26 to −0.40, P < .001, I² = 55%). Despite the greater heterogeneity in the effects, non-CBT interventions were also effective in alleviating depressive symptoms.Conclusion and ImplicationsCBT is effective for the management of anxiety and depression in patients with PD. Routine treatment for patients with this condition is strongly recommended.     

The influence of health insurance towards accessing essential medicines: The experience from Shenzhen labor health insurance

ObjectivesDue to major problems of accessing essential medicines, this paper will evaluate the impact of the new Shenzhen labor health insurance on accessing essential medicines among migrant workers.MethodsMedicines data and revenues–expenditures reports from 19 community health service centers in Shenzhen city were collected. Insurance indicators within two periods before and after 1st June 2006 were compared. Paired t-tests using month-values of indicators were performed. P value <0.05 considered statistically significant.ResultsThe proportion of EMs in Medicine List of Shenzhen Labor health insurance is 88.5%. For each period, percentage costs of EM procured (P_eem) was 43.1% and increased to 46.1%; costs of medicines per outpatient visit (E_mpv) was 24.94 RMB and decreased to 22.20 RMB; percentage costs of medicine per outpatient visit (P_e) were 49.1% and decreased to 45.9%; number of outpatient visits (N_ov) was 428,328 and increased to 490,305. Values of t for differences in P_eem, E_mpv, P_e and N_ov between the two periods were −1.125 (P = 0.285), 3.096 (P = 0.010), 1.458 (P = 0.173) and −2.069 (P = 0.063), respectively.ConclusionsShenzhen labor health insurance had improved accessibility to EMs for migrant workers, and ensured for them basic health services. Popularization of this insurance will benefit more people.