Developmental Risk for Infants with Cleft Lip with or Without Cleft Palate Based on Caregiver-Proxy Reports.

OBJECTIVES: (1) Assess caregiver-reported development in infants born with cleft lip ± alveolus (CL ± A) and cleft lip and palate (CLP); (2) determine factors associated with increased developmental risk; and (3) determine consistency of developmental risk before and after surgery for cleft lip. DESIGN: Prospective, longitudinal assessment of development. Time (T) 1, prior to lip closure; T2, 2 months post lip closure. SETTING: Three US craniofacial teams and online parent support groups. PARTICIPANTS: 123 total caregivers (96% mothers); 100 at T1, 92 at T2, and 69 at both T1 and T2. MEASURE: Ages and Stages Questionnaire-3 (ASQ-3): Communication, Gross Motor, Fine Motor, Problem Solving, Personal Social Domains. RESULTS: At T1 47%; at T2 42% passed all 5 Domains; 36% of infants pass all 5 Domains at both T1 and T2. Infants with CLP were at greatest risk on Communication [B = 1.449 (CI = .149-20.079), p = .038; Odds Ratio (OR) = 4.3 (CI = .923-19.650)] and Gross Motor Domains [B = 1.753 (CI = .316-20.605), p = .034; OR = 5.8 (CI = 1.162-28.671)]. Male infants were at greatest risk on Fine Motor [B = 1.542 (CI = .495-20.005), p = .009; OR = 4.7 (CI = 1.278-17.101)] and Problem Solving Domains [B = 1.200 (CI = .118-19.708), p = .044; OR = 3.3 (CI = .896-12.285)]. CONCLUSIONS: Based on caregiver report, infants with CL ± A and CLP meet referral criteria at a high rate. Infants with CLP and male infants were at greatest risk. Regular developmental screening is recommended.

Common methods of determining meaningful change in clinical practice: implications for precision patient-reported outcomes.

PURPOSE: Patient-reported outcomes (PROs) are used in clinical practice for several purposes, including to monitor whether a treatment is working or whether a patient is experiencing adverse events from treatment. This study surveyed oncology providers (OP) and mental health providers (MHP) to determine how clinicians from different disciplines determine individual-level meaningful change on PROs. Understanding how clinicians determine change on PROs could help inform methods for individualizing meaningful change definitions, an approach we have dubbed "Precision PROs". METHODS: Three hundred and forty-seven providers utilizing PROs completed an online survey about PRO use to monitor patients in clinical practice. A question on methods used to determine individual-level meaningful change on PROs was developed with input from clinicians. Multivariate logistic regression analyses were used to assess whether specific methods were associated with clinician characteristics. RESULTS: The most commonly reported method was comparing the previous score to the current score (65%). Other methods included examining the numerical scores without a visual aid (59%), considering other factors affecting scores (42%), comparing scores to norms (31%) and using a graph of scores (29%). Provider age was negatively associated with odds of using a graph (OR = 0.95, 95% CI 0.91, 1.0) but no other method. Provider gender, hours per week in clinical practice and years in practice were not associated with odds of using a specific method. CONCLUSIONS: Most providers determined individual-level meaningful change without a visual aid and used only the previous score and current score, the minimum number (2 scores) to determine change. Consistent with current practice, future research on methods of determining within-individual meaningful change for clinical use should focus on methods requiring two rather than three or more scores. When attempting to personalize within-individual change definitions (Precision PROs), methods examining a baseline and single follow-up may be most useful for clinical practice.

Observations by Caregivers Using the Infant with Clefts Observation Outcomes Instrument (iCOO): A Comparison of Three Versus Seven-day Daily Diaries.

OBJECTIVE: Our goal was to compare data collected from 3- and 7-day Infant with Clefts Observation Outcomes (iCOO) diaries. DESIGN: Secondary data analysis of an observational longitudinal cohort study. Caregivers completed the daily iCOO for 7 days before cleft lip surgery (T0) and for 7 days after cleft lip repair (T1). We compared 3- and 7-day diaries collected at T0 and 3- and 7-day diaries collected at T1. SETTING: United States. PARTICIPANTS: Primary caregivers of infants with cleft lip with and without cleft palate (N = 131) planning lip repair and enrolled in original iCOO study. MAIN OUTCOMES MEASURE(S): Mean differences and Pearson correlation coefficients. RESULTS: Correlation coefficients were high for global impressions (>0.90) and scaled scores (0.80-0.98). Mean differences were small across iCOO domains at T0. T1 comparisons reflected the same pattern. CONCLUSIONS: Three-day diary data is comparable to 7-day diaries for measuring caregiver observations using iCOO across T0 and T1.

Exploration of Caregiver Interrater Agreement and Test-Retest Reliability on the Infant Cleft Observer Outcomes (iCOO).

Caregiver and observer-reported measures are frequently used as outcomes for research on infants and young children who are unable to report on their own health. Our team developed the Infant with Clefts Observation Outcomes Instrument (iCOO) for infants with cleft lip with or without cleft palate. This exploratory study compared test-retest and interrater reliabilities to inform whether differences in caregiver perspective might affect the iCOO.This study is a secondary analysis comparing caregiver interrater agreement to test-retest reliability. Twenty-five pairs of caregivers completed the iCOO before surgery, 1 week later for test-retest reliability, 2 days after surgery, and 2 months after surgery. Reliability was assessed using intraclass correlations (ICCs) and t-tests were used to compare ratings between caregivers.Infants had cleft lip (28%) or cleft lip and palate (72%). Primary caregivers were predominantly mothers (92%) and secondary caregivers were predominantly fathers (80%). Test-retest reliability met psychometric standards for most items on the iCOO (81%-86% of items). Caregiver agreement on the iCOO items was lower than test-retest reliability (33%-46% of items met psychometric standards). Caregivers did not systematically differ in whether they rated infants as healthier or less healthy than the other caregiver (5%-16% of items had statistically significant differences).Caregivers used the measure consistently, but had different experiences and perceptions of their infant's health and functioning. Future studies are needed to explore mechanisms for the differences in test-retest and interrater reliability. Whenever possible, the same caregiver should provide ratings of the infant, including on the iCOO.

Financial worry in people with cancer: Relationship to employment and outcomes.

BACKGROUND: People with cancer experience financial hardship. Most previous research has focused on material financial burden rather than financial worry. This study investigated employment predictors of financial worry and examined outcomes potentially affected by financial worry. METHODS: Data from the 2018 National Health Interview Study was used and limited to people diagnosed with cancer and having complete data on relevant variables (n = 2049). Preliminary analyses indicated three dimensions of financial worry: healthcare; lifestyle; and basic needs. Outcomes included cost-related nonadherence, and presence of depressive symptoms and anxiety. Multivariable regressions examined the association of financial worry with cost-related nonadherence and mental health and employment characteristics (paid hourly; sick leave; employer size) with financial worry while controlling for demographics. RESULTS: Mean age was 68.10 years (range: 20-85), and most had skin (33.6%), prostate (12.5%) or breast (21.4%) cancer. Hourly pay predicted more financial worry about affording healthcare (p < 0.001), basic needs (p < 0.001) and lifestyle (p < 0.001). Having paid sick leave predicted less worry about basic needs (p = 0.003). Worry about affording healthcare predicted more cost-related nonadherence (p < 0.001) even when controlling for other variables associated with financial hardship. Worry about lifestyle (p = 0.193) and basic needs (p = 0.688) were not associated with cost-related nonadherence. Worry about lifestyle (p < 0.001) predicted depression. Worry about affording healthcare (p = 0.042) and lifestyle (p < 0.001) predicted anxiety. CONCLUSIONS: Research is needed to determine the value of financial worry screening, particularly about affording healthcare, as well as material financial hardship. Financial worry should be included as an outcome in policy evaluations and interventions for financial hardship.

Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-Based Integrated Delivery System.

PURPOSE: Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients' social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system. METHODS: A survey was administered to Kaiser Permanente members on subsidized exchange health insurance plans (2018-2019). The survey included questions about 4 domains of social risks, desire for help, and attitudes. We conducted a descriptive analysis and estimated multivariate modified Poisson regression models. RESULTS: Of 438 participants, 212 (48%) reported at least 1 social risk factor. Housing instability was the most common (70%) factor reported. Members with social risks reported more discomfort being screened for social risks (14.2% vs 5.4%; P = .002) than those without risks, although 90% of participants believed that health systems should assist in addressing social risks. Among those with 1-2 social risks, however, only 27% desired assistance. Non-Hispanic Black participants who reported a social risk were more than twice as likely to desire assistance compared with non-Hispanic White participants (adjusted relative risk [RR] 2.2; 95% CI, 1.3-3.8). CONCLUSIONS: Athough most survey participants believed health systems have a role in addressing social risks, a minority of those reporting a risk wanted assistance and reported more discomfort being screened for risk factors than those without risks. Health systems should work to increase the comfort of patients in reporting risks, explore how to successfully assist them when desired, and offer resources to address these risks outside the health care sector.VISUAL ABSTRACT.

Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization.

BACKGROUND: Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to evaluate whether the social risk was associated with subsequent healthcare utilization. METHODS: We surveyed Kaiser Permanente members receiving subsidies from the healthcare exchange in Southern California to assess their social risk and desire for assistance using the Accountable Health Communities instrument. A subset of initial respondents was randomized to be re-surveyed at either three or six months later. RESULTS: A total of 228 participants completed the survey at both time points. Social risks were moderate to strongly stable across three and six months (Kappa range = .59-.89); however, social adversity profiles that included participants' desire for assistance were more labile (3-month Kappa = .52; 95% CI = .41-.64 & 6-month Kappa = .48; 95% CI = .36-.6). Only housing-related social risks were associated with an increase in acute care (emergency, urgent care) six months after initial screening; no other associations between social risk and utilization were observed. CONCLUSIONS: This study suggests that screening for social risk may be appropriate at intervals of six months, or perhaps longer, but that assessing desire for assistance may need to occur more frequently. Housing risks were associated with increases in acute care. Health systems may need to engage in screening and referral to resources to improve overall care and ultimately patient total health.

Infant with Clefts Observation Outcomes Instrument (iCOO): A New Outcome for Infants and Young Children with Orofacial Clefts.

OBJECTIVE: We evaluated the measurement properties for item and domain scores of the Infant with Clefts Observation Outcomes Instrument (iCOO). DESIGN: Cross-sectional (before lip surgery) and longitudinal study (preoperative baseline and 2 days and 2 months after lip surgery). SETTING: Three academic craniofacial centers and national online advertisements. PARTICIPANTS: Primary caregivers with an infant with cleft lip with or without cleft palate (CL ± P) scheduled to undergo primary lip repair. There were 133 primary caregivers at baseline, 115 at 2 days postsurgery, and 112 at 2 months postsurgery. MAIN OUTCOME MEASURE(S): Caregiver observation items (n = 61) and global impression of health and function items (n = 8) across eight health domains. RESULTS: Mean age at surgery was 6.0 months (range 2.7-11.8 months). Five of eight iCOO domains have scale scores, with Cronbach's alphas ranging from 0.67 to 0.87. Except for the Facial Skin and Mouth domain, iCOO scales had acceptable intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.84. The internal consistency of the Global Impression items across all domains was 0.90 and had acceptable ICCs (range 0.76-0.91). Sixteen out of 20 (nonscale) items had acceptable ICCs (range 0.66-0.96). As anticipated, iCOO scores 2 days postoperatively were generally lower than baseline and scores 2 months postsurgery were consistent with baseline or higher. The iCOO took approximately 10 min to complete. CONCLUSIONS: The iCOO meets measurement standards and may be used for assessing the impact of cleft-related treatments in clinical research and care. More research is needed on its use in various treatment contexts.

Caregiver Observations of Infant Well-Being Before and After Cleft Lip Surgery.

OBJECTIVE: To evaluate the sensitivity to change of daily ratings of the comfort (COMF) and behavioral/emotional health (BEH) domains of the Infants with Clefts Observation Outcomes Instrument (iCOO) at 3 time points, and to assess the association of post-surgical interventions on iCOO ratings. DESIGN: The COMF and BEH domains were completed by caregivers before (T0), immediately after (T1), and 2-months after (T2) cleft lip (CL) surgery. Analyses included descriptive statistics, correlations, t-tests, and generalized estimating equations. PARTICIPANTS: Caregivers (N = 140) of infants with CL with/without cleft palate. MAIN OUTCOME MEASURES: The COMF and BEH domain scores of the iCOO: Scale (SCALE), a summary of observable signs; and Global Impression (IMPR), a single item measuring caregivers' overall impression. RESULTS: Daily COMF and BEH SCALE and IMPR scores changed significantly during T1 (P's < 0.001) but not T0 or T2. Day 1 and 7 T0 scores were significantly higher than Day 1 and 7 T1 scores (P's <0.001 to <0.012) but similar at T2 (P's > 0.05). After CL surgery, the combined use of immobilizers and nasal stents and the use of multiple feeding methods with treatment for gastroesophageal reflux were associated with lower daily scores in COMF and BEH SCALE and IMPR (P's: 0.040 to <0.001). CONCLUSIONS: COMF and BEH iCOO scores were sensitive to daily changes in infant well-being following CL surgery. Future studies should further investigate impact of post-surgical treatments on infant well-being.

Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients.

BACKGROUND: Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare. OBJECTIVE: Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion. KEY RESULTS: Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18). CONCLUSIONS: Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.

Financial Anxiety is Associated With Cancer Screening Adherence in Women at High Risk of Breast Cancer.

BACKGROUND: Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. PURPOSE: This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. METHODS: Women (n = 324) aged 30-50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. RESULTS: More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). CONCLUSIONS: Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.

Association of healthcare utilization with financial worry and anxiety in a general population sample.

This study examined the association of healthcare use (HCU) with financial outcomes in a general population sample (n = 395) to determine if HCU was associated with increased financial worry as most research has examined socioeconomic indicators and material financial problems. Participants reported six types of HCUin the previous year, financial anxiety (FA) and worry about affording healthcare (WAH) in an online survey. In bivariate comparisons, WAH was associated with all forms of HCU and FA was associated with all forms of HCU except outpatient visits. In multivariate analyses, WAH was associated with outpatient visits, emergency room visits, number of doctors, number of scans and number of blood tests (p's<0.05) but not urgent care visits. FA was associated with emergency room visits, urgent care visits, and number of doctors (p's<0.05) but not other forms of HCU in multivariate comparisons. As many forms of HCU were associated with more WAH and FA, policy initiatives and patient-level interventions should focus on managing costs rather than shifting from emergency to outpatient care. Results also suggest that the financial costs of healthcare, as indexed by HCU, may have an effect on anxiety and worry specific to healthcare even when controlling for socioeconomic factors.

Age and gender differences in financial distress among hematopoietic cell transplant survivors.

PURPOSE: Cancer has long-term financial consequences. Adolescent and young adult (AYA) and middle-aged cancer survivors may experience more financial toxicity than older adults. This study examined age differences in financial distress in hematopoietic cell transplant survivors and whether these differences result from measurement bias, more financial barriers to care, or an overall higher level of distress. METHODS: Hematologic malignancy survivors (n = 1135, 2-10 years post-transplant) completed the Cancer and Treatment Distress Scale (CTXD) and demographics as part of the baseline assessment for a randomized clinical trial. The CTXD has seven subscales, but for this study, we examined the financial distress subscale and the overall score. Item response theory analyses tested for bias by age and gender. Multivariate linear regression tested the association of age and gender with the CTXD scores while controlling for financial barriers to care. RESULTS: No bias was found on the CTXD. AYA (p < 0.01) and middle-aged adults (p < 0.001) reported more financial and overall distress than older (age 65+) adults. The same association of age and financial distress was observed in women (p < 0.01). However, only middle-aged men (p < 0.01) reported more financial and overall distress than older men; AYA men did not (p > 0.18). Financial barriers to care were not associated with financial or overall distress. CONCLUSIONS: Part of the increase in financial distress with younger age may be due to a higher risk of general distress. Policy initiatives to control cancer costs should consider life stage and the unique financial challenges at different ages for men and women.

Measuring attributes of team functioning in primary care settings: development of the TEAMS tool.

This study examines attributes of a high-functioning primary care team by creating a survey measuring staff perceptions of team culture in primary care practices with innovative team-based workforce models. Survey data from a national study of 30 exemplar primary care practices with innovative team-based workforce models was used. Staff and clinicians (n = 943) at the 30 primary care sites completed a 31-item survey online. Survey items came from previous surveys of adaptive reserve and team culture. Factor analysis, reliability and validity were examined for the survey. Case summaries from site visits and survey comments were compared for high and low scoring sites to establish validity. Three core attributes of a high-functioning team were identified: joy in practice (4 items), personal growth (3 items), and leadership and learning (20 items). Four items did not measure any attribute. Using item correlations, the 20 items for leadership and learning were reduced to 7 items. All three attribute subscales had good reliability and validity. The final 14-item survey measuring joy in practice, personal growth and leadership and learning may be useful in clinical practice as a practical tool to gauge progress in developing a high-functioning team. Further research is needed to determine the sensitivity of this instrument to change over time with interventions designed to improve team functioning in primary care.

Financial difficulty, worry about affording care, and benefit finding in long-term survivors of cancer.

OBJECTIVE: To examine the associations of worry about affording care and reporting financial difficulties with benefit finding in long-term cancer survivors. METHODS: Long-term survivors of cancer (n = 547) in 3 integrated health care delivery systems completed the Medical Expenditure Panel Survey Cancer Survivorship Supplement. The relationship between benefit finding (becoming a stronger person, coping better, and making positive changes) and the potentially interacting factors of worry about affording care and financial difficulties was examined using multivariate logistic regression models. RESULTS: Of the total sample, 20% reported worry and 15% reported financial difficulty. Among those who reported no worry, financial difficulty was positively associated with becoming a stronger person (odds ratio [OR] = 2.89, 95% CI: 1.07, 7.80). Coping better was not associated with worry, financial difficulties, or the interaction of the two. Among those with no financial difficulty, worry was positively associated with making positive changes (OR = 2.64, 95% CI: 1.41, 4.96), and among those reporting no worry, financial difficulty had a non-significant positive association with making positive changes (OR = 1.98, 95% CI: 0.91, 4.31). Among those reporting worry, having financial difficulties was associated with lower odds of making positive changes (OR = 0.32, 95% CI: 0.13, 0.78). CONCLUSIONS: Our results suggest a complex relationship between financial difficulty, worry, and benefit finding. The combination of worry about affording care and financial difficulty needs to be addressed and further studied among cancer survivors, as the presence of both, but not alone, was negatively associated with making positive changes, an aspect of benefit finding.

Association of worry about cancer to benefit finding and functioning in long-term cancer survivors.

PURPOSE: Worry about cancer recurrence or progression is associated with negative effects of cancer, such as worse physical functioning, but associations with positive changes post-cancer, such as benefit finding, are unknown. We measured the proportion of patients reporting frequent worry about cancer recurrence or progression and examined the association between worry about cancer recurrence or progression to benefit finding and functioning in cancer. METHODS: We surveyed 594 long-term (5-10 years post-diagnosis) survivors of cancer (breast, prostate, colorectal, lung, melanoma) in this cross-sectional study. The survey asked about worry about cancer recurrence/progression, negative effects of cancer on mental and physical function, and benefit finding as a result of the cancer (positive effects). Multivariate regressions estimated associations of worry about cancer with negative and positive effects of cancer. RESULTS: Worrying about cancer often or all the time was reported by 19.6% of survivors. Worry about cancer was related to worse functioning (odds ratio (OR) range 1.40 to 1.46, all p's < .01). Worry about recurrence/progression was unrelated to benefit finding (all p's > .10). CONCLUSIONS: Worry about cancer was associated with negative, but not positive, effects of cancer. Treating worry about cancer is unlikely to reduce benefit finding after cancer. Given the high prevalence of worry about cancer and relationship to negative effects of cancer, clinical care should attempt to address this worry for long-term survivors.

Female Sexual Function Index Short Version: A MsFLASH Item Response Analysis.

The Female Sexual Function Index (FSFI) is a psychometrically sound and popular 19-item self-report measure, but its length may preclude its use in studies with multiple outcome measures, especially when sexual function is not a primary endpoint. Only one attempt has been made to create a shorter scale, resulting in the Italian FSFI-6, later translated into Spanish and Korean without further psychometric analysis. Our study evaluated whether a subset of items on the 19-item English-language FSFI would perform as well as the full-length FSFI in peri- and postmenopausal women. We used baseline data from 898 peri- and postmenopausal women recruited from multiple communities, ages 42-62 years, and enrolled in randomized controlled trials for vasomotor symptom management. Goals were to (1) create a psychometrically sound, shorter version of the FSFI for use in peri- and postmenopausal women as a continuous measure and (2) compare it to the Italian FSFI-6. Results indicated that a 9-item scale provided more information than the FSFI-6 across a spectrum of sexual functioning, was able to capture sample variability, and showed sufficient range without floor or ceiling effects. All but one of the items from the Italian 6-item version were included in the 9-item version. Most omitted FSFI items focused on frequency of events or experiences. When assessment of sexual function is a secondary endpoint and subject burden related to questionnaire length is a priority, the 9-item FSFI may provide important information about sexual function in English-speaking peri- and postmenopausal women.

Is heart rate variability associated with frequency and intensity of vasomotor symptoms among healthy perimenopausal and postmenopausal women?

OBJECTIVE: Research has suggested that the autonomic nervous system (ANS) is involved in the experience of vasomotor symptoms (VMS) during menopause. We examined the relationship of VMS intensity and heart rate variability (HRV), a measure of ANS function. METHODS: Women (n = 282) were recruited from three American states for a clinical trial of yoga, exercise, and omega-3 fatty acid supplements for VMS. To be eligible, women had to report at least 14 VMS per week, with some being moderate to severe. Sitting electrocardiograms were recorded for 15 min using Holter monitors at both baseline and 12-week follow-up. Time and frequency domain HRV measures were calculated. Women completed daily diary measures of VMS frequency and intensity for 2 weeks at baseline and for 1 week at the follow-up assessment 12 weeks later. Multivariable linear regression was used to assess the relationship between VMS and baseline HRV measures and to compare change in HRV with change in VMS over the 12 weeks. RESULTS: Baseline HRV was not associated with either VMS frequency or intensity at baseline. Change in HRV was not associated with change in VMS frequency or intensity across the follow-up. INTERPRETATION: Heart rate variability (HRV) was not associated with basal VMS frequency or intensity in perimenopausal and postmenopausal women experiencing high levels of VMS. Autonomic function may be associated with the onset or presence of VMS, but not with the number or intensity of these symptoms.

A psychometric examination of multimorbidity and mental health in older adults.

OBJECTIVES: Multimorbidity, the presence of multiple chronic medical conditions, is particularly prevalent in older adults. We examined the relationship of multimorbidity with mental health, social network and activity limitations in the National Health and Aging Trends Study, a nationally representative, age-stratified sample of older adults. METHOD: After excluding participants who used a proxy to complete the survey and those who did not answer any of the depressive symptoms, anxiety symptoms and positive and negative affect items, the final sample was 7026. A disease count of 10 conditions (heart disease, hypertension, arthritis, osteoporosis, diabetes, lung disease, stroke, dementia, cancer, fracture) was used. RESULTS: Factor analysis indicated a one factor structure for disease count was tenable, although cancer did not appear to fit the model. Therefore, a count of the nine other diseases was used. Disease count was related to increased depressive symptoms, anxiety symptoms and negative affect and less positive affect. All individual diseases including cancer were related to worse mental health as was having two or more conditions. Disease count, having two or more conditions and several individual diseases (heart disease, hypertension, arthritis, cancer and fracture) were also related to increases in social network size while other individual diseases (osteoporosis, diabetes, lung disease, stroke and dementia) were related to decreases in social network size. All the measures of multimorbidity and individual diseases were associated with the increased odds of activity limitations. CONCLUSIONS: Results support a broader focus for older adults with multimorbidity that includes mental health needs.

The Relationship of Perceived Risk and Biases in Perceived Risk to Fracture Prevention Behavior in Older Women.

BACKGROUND: A bias in perceived risk for health outcomes, including fracture, exists. PURPOSE: We compared perceived risk and biases in perceived risk for fracture to fracture preventive behavior. METHODS: Women over age 55 (n = 2874) completed a survey five times over 5 years, and data was pulled from the medical record. Perceived risk was measured by asking women to rate their risk of fracture compared to similar women. Actual risk was measured using FRAX score. Bias was measured using an interaction between perceived and actual risk. RESULTS: Higher perceived risk was related to lower quality of life and self-reported health, more medication and calcium use, increased bone density scan use, and less walking. Bias was only associated with less medication use. Neither perceived risk nor bias predicted medication adherence. CONCLUSIONS: Perceived risk, but not bias, may predict different fracture prevention behaviors. Clinicians may need to base interventions on risk perceptions.