A systematic review of the effect of retention methods in population-based cohort studies

Background  

Longitudinal studies are of aetiological and public health relevance but can be undermined by attrition. The aim of this paper was to identify effective retention strategies to increase participation in population-based cohort studies.     

Race and ethnic variation in college students’ allostatic regulation of racism-related stress

Racism-related stress is thought to contribute to widespread race/ethnic health inequities via negative emotion and allostatic stress process up-regulation. Although prior studies document race-related stress and health correlations, due to methodological and technical limitations, they have been unable to directly test the stress-reactivity hypothesis in situ. Guided by theories of constructed emotion and allostasis, we developed a protocol using wearable sensors and daily surveys that allowed us to operationalize and time-couple self-reported racism-related experiences, negative emotions, and an independent biosignal of emotional arousal. We used data from 100 diverse young adults at a predominantly White college campus to assess racism-related stress reactivity using electrodermal activity (EDA), a biosignal of sympathetic nervous system activity. We find that racism-related experiences predict both increased negative emotion risk and heightened EDA, consistent with the proposed allostatic model of health and disease. Specific patterns varied across race/ethnic groups. For example, discrimination and rumination were associated with negative emotion for African American students, but only interpersonal discrimination predicted increased arousal via EDA. The pattern of results was more general for Latinx students, for whom interpersonal discrimination, vicarious racism exposure, and rumination significantly modulated arousal. As with Latinx students, African students were particularly responsive to vicarious racism while 1.5 generation Black students were generally not responsive to racism-related experiences. Overall, these findings provide support for allostasis-based theories of mental and physical health via a naturalistic assessment of the emotional and sympathetic nervous system responding to real-life social experiences.

Racism in the United States shapes interracial social interactions (1) and, mirroring society-wide trends in the racialization of American politics (2, 3), the situation may be worsening with rising racial animosity (4, 5). Consequently, racism-related stress is hypothesized to contribute to widespread minority health disparities (6) and Black/White mortality differentials on a scale sufficient to influence election outcomes (7). One possible explanation for these disparities is that race-related stress increases negative emotions and physiological wear and tear via modulation of the sympathetic-adrenal-medullary (SAM) axis, hypothalamic-pituitary-adrenal (HPA) axis, and immune system (8). Up-regulation of these systems, often referred to generically as “the stress process,” is the outcome of the brain’s predictive modeling and regulation of the body’s energetic needs, or allostasis (9). Here, race-related stress is thought to increase energy demands as the brain prepares the body to deal with threats by marshaling oxygen, glucose, and other energetic mediators (10). Consequently, researchers have argued that ongoing allostatic up-regulation of the autonomic and endocrine systems, combined with immune activity modulation, in response to racism-related threats is physiologically taxing and over time increases vulnerability to chronic disease (11, 12). For example, downstream physiological adaptions to a body energized on high alert are thought to increase risks for excess adiposity, hypertension, diabetes, and cardiovascular disease (13–15), traditionally the leading cause of death in the United States.Despite the theoretical importance of regulatory allostatic processes for understanding racial health inequities, racism-related physiological responding has not been directly measured in real time in the real world. Conducting these assessments is challenging because the timing of many socially mediated experiences, such as racism-related incidents, occur in “social time”; that is, they are dependent upon actions beyond the control of the individual, are largely unobserved, and are highly variable and stochastic. Acute physiological changes are thus responses to temporally variable stimuli and are modulated on precise time scales in the order of seconds (i.e., SAM) and minutes (i.e., HPA). Although systematic and metaanalytic reviews find evidence that discriminatory experiences are correlated with mental and physical health both early (6) and later in life (16), most studies are cross-sectional, retrospective, and rely on behavioral and psychological self-reports, even when employing temporally sensitive methodologies (17). Although a few recent studies in natural settings incorporating biomarkers consistent with models of allostasis have begun filtering into the literature (18), their measurement strategies are not time-synchronized with race-related experiences. These studies provide post hoc evidence of allostatic process modulation, but do not measure allostatic regulation concurrently as it transpires in situ.Our study was designed to address these limitations and to directly test allostatic modulation of the sympathetic component of the SAM response to racism-related stress. To these ends, we developed a prospective protocol capturing events throughout the day, including the timing of racism-related experiences of perceived interpersonal discrimination, rumination on racism, and vicarious racism exposure, as well as negative emotions. Our design also included a wearable device that continuously tracked SAM activity using an electrodermal activity (EDA) sensor, a direct measure of the sympathetic nervous system (SNS) division of the autonomic nervous system that indexes affective arousal. This approach facilitated approximate time-synchronization of racism-related experiences with the SNS-mediated first-stage allostatic stress-response pathway. We were therefore able to operationalize two key aspects of stress-response dynamics temporally coupled with racism-related stressors: Negative emotion and SNS arousal. To our knowledge, this study provides a temporally coregistered and ecologically embedded assessment of the dynamic links between race-related stressors, negative emotions, and the SAM-mediated SNS component of a stress response among individuals of diverse ethnic backgrounds.     

Creation and testing of the Geriatric Self-Efficacy Index for Urinary Incontinence

OBJECTIVES: To report on the content development, construct validity, and reliability testing of the Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI).
DESIGN: Prospective cohort study.
SETTING: Six UI outpatient clinics in Quebec, Canada.
PARTICIPANTS: Community-dwelling incontinent men and women aged 65 and older.
MEASUREMENTS: Thirty-eight items were generated using a literature search and interdisciplinary panel of experts. Item reduction was achieved through field-testing with 75 older men and women with UI attending an information session. The final 20-item draft, measuring older adults' level of confidence in preventing urine loss, was administered to a new group of consecutive patients 1 week before and at the time of their first visit to the UI clinic to enable evaluation of test–retest reliability. A 3-day voiding diary, quantifying the frequency of UI, and the Incontinence Quality of Life questionnaire were used to test construct validity.
RESULTS: One hundred sixteen of 300 eligible patients (39%) participated (mean age±standard deviation 74±6, range 65–87). The GSE-UI items showed normal distributions and no ceiling effects. Self-efficacy scores ranged from 16 to 193 (mean 104±41, possible range 0–200) and correlated positively with quality of life scores ( r =0.7, P <.001) and negatively with UI severity ( r =−0.4, P <.001). Internal consistency for the GSE-UI was 0.94 (Cronbach alpha). Initial test–retest reliability of the 20 items using intraclass correlations ranged from 0.50 to 0.86.
CONCLUSION: The GSE-UI will enable measurement of whether a person's confidence in their ability to prevent urine loss is an important mechanism contributing to improvements in UI.     

Brief Report: COVID-19 gender policy changes support female scientists and improve research quality

With more time being spent on caregiving responsibilities during the COVID-19 pandemic, female scientists’ productivity dropped. When female scientists conduct research, identity factors are better incorporated in research content. In order to mitigate damage to the research enterprise, funding agencies can play a role by putting in place gender equity policies that support all applicants and ensure research quality. A national health research funder implemented gender policy changes that included extending deadlines and factoring sex and gender into COVID-19 grant requirements. Following these changes, the funder received more applications from female scientists, awarded a greater proportion of grants to female compared to male scientists, and received and funded more grant applications that considered sex and gender in the content of COVID-19 research. Further work is urgently required to address inequities associated with identity characteristics beyond gender.     

Improving residents’ confidence in using psychosocial skills

OBJECTIVE: To evaluate an intensive training program’s effects on residents’ confidence in their ability in, anticipation of positive outcomes from, and personal commitment to psychosocial behaviors. DESIGN: Controlled randomized study. SETTING: A university- and community-based primary care residency training program. PARTICIPANTS: 26 first-year residents in internal medicine and family practice. INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills needed in primary care. MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from, and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization, and directive and nondirective facilitation of patient communication. RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p<0.03 for all tests), anticipated more positive outcomes for emotional sensitivity (p=0.05), managing somatization (p=0.03), and nondirectively facilitating patient communication (p=0.02), and were more strongly committed to being emotionally sensitive (p=0.055) and managing somatization (p=0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine than did the untrained residents (p<0.001). CONCLUSIONS: Intensive psychosocial training improves residents’ self-confidence in their ability regarding key psychosocial behaviors and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and personal commitment to some, but not all, psychosocial skills. Presented at the annual meeting of the Society of General Internal Medicine, Washington, DC, April 27–29, 1994. Supported by the Fetzer Institute in Kalamazoo, MI.     

Protocolized Laboratory Screening for the Medical Clearance of Psychiatric Patients in the Emergency Department: A Systematic Review

Objective

Emergency department (ED) patients with psychiatric chief complaints undergo medical screening to rule out underlying or comorbid medical illnesses prior to transfer to a psychiatric facility. This systematic review attempts to determine the clinical utility of protocolized laboratory screening for the streamlined medical clearance of ED psychiatric patients by determining the clinical significance of individual laboratory results.

Methods

We searched PubMed, Embase, and Scopus using the search terms “emergency department, psychiatry, diagnostic tests, laboratories, studies, testing, screening, and clearance” up to June 2017 for studies on adult psychiatric patients. This systematic review follows the recommendations of Meta‐analysis of Observational Studies in Epidemiology (MOOSE) statement. The quality of each study was rated according to the Newcastle‐Ottawa quality assessment scale.

Results

Four independent reviewers identified 2,847 publications. We extracted data from three studies (n = 629 patients). Included studies defined an abnormal test result as any laboratory result that falls out of the normal range. A laboratory test result was deemed as “clinically significant” only when patient disposition or treatment plan was changed because of that test result. Across the three studies the prevalence of clinically significant results were low (0.0%–0.4%).

Conclusions

The prevalence of clinically significant laboratory test results were low, suggesting that according to the available literature, routine laboratory testing does not significantly change patient disposition. Due to the paucity of available research on this subject, we could not determine the clinical utility of protocolized laboratory screening tests for medical clearance of psychiatric patients in the ED. Future research on the utility of routine laboratory testing is important in a move toward shared decision making and patient‐centered health care.