Abriendo puertas para la vida: Programa de prevención de conductas suicidas a través de docentes Gatekeepers / Opening doors to life: A suicidal behavior prevention program involving Gatekeeper teachers / Abrindo portas para a vida: Programa de prevenção ao comportamento suicida por meio de professores Gatekeepers

Introducción: El suicidio es la tercera causa de muerte de jóvenes entre 15 y 19 años. Ante esto, los ambientes escolares pueden favorecer el fomento de la salud mental de los adolescentes, permitir la identificación temprana de factores de riesgo y aportar en la prevención de conductas suicidas. Una de las estrategias de prevención es el entrenamiento de "gatekeepers". Objetivo: Determinar el efecto del programa "Abriendo Puertas para la Vida" sobre conocimientos, actitudes y prácticas en prevención de conductas suicidas en un grupo de profesores de secundaria de una institución educativa de San Juan de Pasto, Colombia. Materiales y métodos: Estudio preexperimental, con un grupo de intervención y medidas pre y pos-seguimiento. Participaron nueve docentes voluntarios durante dos jornadas de formación. Resultados: Se identificaron cambios positivos en conocimientos, actitudes y prácticas de los participantes entre pretest y postest, en la mayoría de las subdimensiones evaluadas; sin embargo, tres años después, estos cambios se mantuvieron tan solo en conocimientos sobre las conductas suicidas y en actitudes hacia la prevención. Conclusión: El programa "Abriendo Puertas para la Vida" evidenció efectividad y pertinencia, sin embargo, el mantenimiento de sus efectos requiere de acciones de seguimiento y acompañamiento a los docentes formados.

Introduction: Suicide is the third cause of death in young people aged between 15 to 19 years. Thus, school environments can promote mental health of adolescents through early identification of risk factors and prevention of suicidal behaviors. One prevention strategy is the training of "gatekeepers". Objective: To determine the impact of the "Opening Doors to Life" program on the knowledge, attitudes, and practices regarding prevention of suicidal behavior in a set of high school teachers from an educational institution in San Juan de Pasto, Colombia. Materials and methods: A pre-experimental study with an intervention group and pre- and post-follow-up measurements. Nine volunteer teachers participated during two training sessions. Results: Positive changes regarding knowledge, attitudes, and practices of the participants during pretest and posttest were observed for the majority of evaluated sub-dimensions. However, after three years, the positive measures prevailed only for knowledge about suicidal behavior and attitudes toward prevention. Conclusion: The "Opening Doors to Life" program showed effectiveness and relevance. However, maintaining its impact requires follow-up actions and support of trained teachers.

Introdução: O suicídio é a terceira causa de morte de jovens entre 15 e 19 anos. Diante disso, os ambientes escolares podem promover a promoção da saúde mental em adolescentes, permitir a identificação precoce de fatores de risco e contribuir para a prevenção do comportamento suicida. Uma das estratégias de prevenção é a formação de "gatekeepers". Objetivo: Determinar o efeito do programa "Abrindo Portas para a Vida" nos conhecimentos, atitudes e práticas na prevenção do comportamento suicida em um grupo de professores do ensino médio de uma instituição educacional em San Juan de Pasto, Colômbia. Materiais e métodos: Estudo pré-experimental, com grupo de intervenção e medidas pré e pós-acompanhamento. Nove professores voluntários participaram durante dois dias de treinamento. Resultados: Foram identificadas mudanças positivas nos conhecimentos, atitudes e práticas dos participantes entre o pré-teste e o pós-teste, na maioria das subdimensões avaliadas; porém, três anos depois, essas mudanças se mantiveram apenas no conhecimento sobre comportamentos suicidas e atitudes frente à prevenção. Conclusão: O programa "Abrindo Portas para a Vida" mostrou efetividade e relevância, porém, a manutenção de seus efeitos requer ações de acompanhamento e apoio a professores capacitados.

Voice Disorder, Job Stress, and COVID-19 in Teachers: Impacts in Times of Pandemic

Introduction: The conditions of teachers' work during the COVID-19 pandemic affected teachers' lives regarding voice disorder and stress, even in emergency remote classroom situation. Objective: To analyze the relationship between the presence of voice disorder, job stress, and COVID-19 in teachers when in emergency remote classroom teaching situation at the time of the pandemic. Method: This is a primary, exploratory, observational cross-sectional study with the use of survey forwarded online during the period of emergency classes after the arrival of COVID-19 pandemic in Brazil. The teachers answered the sociodemographic questions about the presence of COVID-19 and the following instruments: Condition of Vocal Production-Teacher [Condição de Produção Vocal - Professor (CPV-P)], Screening Index for Voice Disorder (SIVD), and Job Stress Scale (JSS). Results: Of the 118 teachers analyzed, 94.1% were female; the average age was 44 years. The SIVD recorded the presence of voice disorder in 66.9% of the participants. Regarding the JSS, which are the findings related to stress at work in the demand domain, the teachers showed high levels, a fact which presupposes the existence of pressure of psychological nature to perform their work. Conclusion: The teachers self-reported the presence of voice disorder even in remote class situation, on the occasion of COVID-19, which were more common in older teachers. When comparing the presence of voice disorders, coronavirus symptoms, and stress domains in relation to demand, control, and social support, there was no significance. It is hoped that this study will help to reflect on the need to improve teachers' working conditions, strengthening work-related voice disorder actions and guiding actions for vocal care and well-being.

Introducción: Las condiciones de trabajo de los profesores durante la pandemia de COVID-19 afectaron sus vidas en lo que respecta al trastorno de la voz y el estrés, incluso en situaciones de emergencia en aulas remotas. Objetivo: Analizar la relación entre la presencia de trastorno de la voz, estrés laboral y COVID-19 en profesores cuando se encontraban en situación de emergencia de enseñanza en aulas remotas en la época de la pandemia. Método: Se trata de un estudio primario, exploratorio, observacional de tipo transversal, con el uso de encuesta remitida online durante el periodo de clases de emergencia tras la llegada de la pandemia de COVID-19 en Brasil. Los profesores respondieron a las preguntas sociodemográficas sobre la presencia de COVID-19 y a los siguientes instrumentos: Condición de Producción Vocal-Profesor (CPV-P), Índice de Detección de los Trastornos de la Voz (SIVD) y Escala de Estrés Laboral (JSS). Resultados: De los 118 profesores analizados, el 94,1% eran mujeres; la mediana de edad era de 44 años. El (SIVD) registró la presencia de trastorno de la voz en el 66,9% de los participantes. En cuanto a la JSS, que son los hallazgos relacionados con el estrés laboral en el dominio de la demanda, los profesores mostraron niveles elevados, hecho que presupone la existencia de presiones de naturaleza psicológica para realizar su trabajo. Conclusión: Los profesores autoinformaron de la presencia de trastornos de la voz incluso en situación de clase a distancia, con ocasión del COVID-19, que fueron más frecuentes en los profesores de más edad. Al comparar la presencia de trastornos de la voz, los síntomas del coronavirus y los dominios de estrés en relación con la demanda, el control y el apoyo social, no hubo resultados significativos. Se espera que este estudio ayude a reflexionar sobre la necesidad de mejorar las condiciones de trabajo de los docentes, fortaleciendo las acciones de Trastorno de la voz relacionado con el trabajo (WRVD) y orientando acciones para el cuidado y bienestar vocal.

The double burden of severe mental illness and cancer: a population-based study on colorectal cancer care pathways from screening to end-of-life care.

AIMS: Cancer is one of the main causes of death in persons with severe mental illness (SMI). Although their cancer incidence is similar, or sometimes even potentially lower compared to the general population, their cancer mortality remains higher. The role of healthcare provision and care equity in this mortality is increasingly being addressed in research, but available studies are limited in their scope. In this context, our aim was to compare colorectal cancer (CRC) care pathways from screening to end-of-life care in patients with and without pre-existing SMI on a national scale. METHODS: This research leverages real-world data from the French national health claims database, covering the entire population, to assess cancer screening, diagnosis, treatment and post-treatment follow-up as well as quality of care (QOC) pathways among patients with incident CRC in 2015-2018, considering whether they had pre-existing SMI. We matched patients with SMI with three patients without - on age, sex, region of residence, year of cancer incidence and cancer type and location at presentation - as well as nationally established quality of CRC care indicators and regression models adjusting for relevant socio-economic, clinical and care provider-related covariates. RESULTS: Among patients with incident CRC, 1,532 individuals with pre-existing SMI were matched with individuals without SMI. After adjusting for covariates, both colon and rectal cancer patients with SMI were less likely to participate in the national CRC screening programme and to receive advanced diagnostic examinations (e.g., colonoscopies and several complementary diagnostic examinations). They also had lower odds of receiving combined treatments (e.g., neoadjuvant chemotherapy, radiotherapy and excision) and of having access to targeted therapy or capecitabine but higher odds for invasive care (e.g., stoma). Colon cancer patients with SMI were also more likely to have no treatment at all, and rectal cancer patients with SMI were less likely to receive post-treatment follow-up. Suboptimal QOC was observed for both groups of patients, but to a higher extent for patients with SMI, with statistically significant differences for indicators focusing on diagnosis and post-treatment follow-up. CONCLUSIONS: Our findings reveal discrepancies across the care continuum of CRC between individuals with and without SMI and provide initial avenues on where to focus future efforts to address them, notably at the entry and exit stages of cancer care pathways, while calling for further research on the mechanisms preventing equity of physical healthcare for individuals with SMI.

Psychological outcomes in patients with rare cancers: a systematic review and meta-analysis.

Background: Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with rare cancers. Methods: This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis. Findings: We included 32 studies with 57,470 patients with rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes. Interpretation: We highlight the need for early identification of psychological maladjustment in patients with rare cancers. Additionally, studies to identify effective interventions are imperative. Funding: This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.

Impact of preoperative mental health diagnosis on postoperative opioid use patterns in spine fusion surgery: A systematic literature review.

Opioids are frequently prescribed for patients undergoing procedures such as spinal fusion surgery for the management of chronic back pain. However, the association between a preoperative mental health illness, such as depression or anxiety, and opioid use patterns after spinal fusion surgery remain unclear. Therefore, we performed a systematic literature review in accordance with PRISMA guidelines to identify articles from the PubMed Database that analyzed the relationship between preoperative mental health illness and postoperative opioid usage after spinal fusion surgery on June 1, 2023. The Methodological Index for Nonrandomized Studies (MINORS) was utilized to evaluate the quality of included articles. Seven studies with 139,580 patients and a mean MINORS score of 18 ± 0.5 were included in qualitative synthesis. The most common spine surgery performed was lumbar fusion (59 %) and the mean age across studies ranged from 50 to 62 years. The range of postoperative opioid usage patterns analyzed ranged from 1 to 24 months. The majority of studies (6/7; 86 %) reported that a preoperative diagnosis of mental health illness was associated with increased opioid dependence after spinal fusion surgery. Preoperative use of opioids for protracted periods was shown to be associated with postoperative chronic opioid dependence. Consensus findings suggest that having a preoperative diagnosis of a mental health illness such as depression or anxiety is associated with increased postoperative opioid use after spinal fusion surgery. Patient comorbidities, including diagnoses of mental health illness, must be considered by the spine surgeon in order to reduce rates of postoperative opioid dependence.

Maternal postpartum bonding impairment and increased substance use to cope with pandemic-related stress.

Substance use rates, particularly among women, increased substantially during the COVID-19 pandemic. Psychological and economic risks disproportionately experienced by women were associated with increase in substance use patterns during the pandemic. Using substances (i.e., tobacco, alcohol, cannabis) to cope with stress is well-documented; what is less known are protective factors that were associated with less substance use during the pandemic. We examined whether mothers of young children (N = 96) who reported postpartum bonding impairment before the start of the pandemic reported greater substance use during the pandemic as a means to cope. Results from linear regression analyses found that mothers who reported higher levels of pre-pandemic mother-infant bonding impairments reported greater use of alcohol and other substances as a means to cope with pandemic stressors. These findings suggest that social connections might be a strategy to reduce substance use as a maladaptive coping behavior, especially during widespread crises such as the recent pandemic or for mothers of young children. In particular, promoting postpartum bonding through interventions might help to reduce substance use among new mothers.

Emerging health disparities among college graduates: Understanding the health consequences of education-occupation mismatch.

This study examines the health consequences and underlying pathways of education-occupation mismatch. Using a longitudinal sample of college graduates from the Panel Studies of Income Dynamics (1984-2019) and employing longitudinal hybrid models, we found that contemporary vertical mismatch (between education level and educational requirements of occupation) was associated with poorer psychological well-being and bio-behaviors (obesity and smoking), but not physical health. In contrast, horizontal mismatch (between field of study and field required for occupation) did not show clear health consequences. Sequence analysis was employed to uncover the mismatch trajectories and revealed that persistent vertical mismatch over one's career had a greater impact on psychological distress and smoking than episodic mismatch experiences. Furthermore, the linkage between vertical mismatch and health outcomes was likely shaped by psychosocial processes rather than reduced material well-being. These findings imply that education-occupation vertical (mis)match produces health disparities between occupationally matched and mismatched college graduates.

The Association of Body Image Perceptions with Behavioral and Health Outcomes among Young Adults.

This study was conducted on 5 March 2024, by the Universidad Europea de Madrid. This study aims to explore how body image perceptions influence health behaviors and mental and physical health outcomes among a specific group of 605 young adults aged 20 to 35 engaged in strength training regimes. To measure these perceptions, the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was employed, an advanced tool that assesses multiple dimensions of body image through its subscales, including feelings of physical attractiveness, investment in one's appearance, and satisfaction with different body areas. Participants were segmented into two groups based on a median split of their self-reported body image. The survey assessed a diverse array of variables, including demographic details, physiological data, resistance training routines, and psychological attributes. In this revision, we consistently use the term 'dietary habits' to ensure clear and uniform language when discussing eating patterns. Notable differences were observed in dietary habits and exercise engagement, influenced significantly by body image perceptions. Negative body image was linked to less healthy dietary habits, diminished physical activity, and worse psychological outcomes, such as increased anxiety and depression. Conversely, a positive body image was associated with healthier dietary habits, more frequent physical activity, and better psychological health. The findings suggest that interventions aimed at improving body image could be crucial for enhancing overall health within this specific demographic. Due to the non-representative nature of the study group, conclusions are cautiously presented as applicable only to similar populations engaged in strength training. This study underscores the need for holistic strategies that encourage positive body image to improve both physical and psychological health outcomes in young adults.

Comparison between Physical Activity and Stress-Related Lifestyle between Orthorexic and Non-Orthorexic University Students: A Case-Control Study.

(1) Background: The literature regarding orthorexia nervosa (ON) has well documented the association with other mental disorders, such as obsessive-compulsive and eating disorders. However, the research has not taken into account stress-related behavior and the conduction of physical activity (PA), both structured and unstructured. (2) Methods: In this cross-sectional study, 165 students of the University of Parma (92 females and 74 males) aged between 18 and 49 years old (mean = 24.62 ± 4.81) were consecutively recruited. The ORTO-15 questionnaire was used to divide the total sample into a group without orthorexia (score > 40) and a group with orthorexia (score < 40). All subjects completed the P Stress Questionnaire, and specific items were extrapolated from the Eating Habits Structured Interview (EHSI) to investigate lifestyle, including structured and unstructured PA. (3) Results: Subjects with orthorexia represented 83% of the total sample and reported higher levels of stress-related risk behaviors (i.e., sense of responsibility (t = -1.99, p = 0.02), precision (t = -1.99, p = 0.03), stress disorders (t = -1.38, p = 0.05), reduced spare time (t = -1.97, p = 0.03), and hyperactivity (t = -1.68, p = 0.04)) and a higher frequency of PA (i.e., hours spent training in structured PA, daily (t = -1.68, p = 0.05), weekly (t = -1.91, p = 0.03), and monthly (t = -1.91, p = 0.03), the tendency to carry out physical exercise even if tired (t = -1.97, p = 0.02), and to adhere to unstructured PA (i.e., moving on foot or by bike rather than using transport (t = 1.27, p = 0.04)). (4) Conclusions: The results confirmed the presence of hyperactivity at a motor and behavioral level in people with orthorexia. Further studies are necessary to highlight the causality between ON, stress, and physical activity but it may be possible to hypothesize that "obsessive" physical exercise may not generate the benefits generally known by the literature.

Association between indoor air pollution and depression: a systematic review and meta-analysis of cohort studies.

OBJECTIVES: Incomplete combustion of solid fuel and exposure to secondhand smoke (SHS) are the primary causes of indoor air pollution (IAP), potentially leading to detrimental effects on individual mental health. However, current evidence regarding the association between IAP and depression remains inconclusive. This study aims to systematically investigate the evidence regarding the association between IAP and the risk of depression. DESIGN: Systematic review and meta-analysis of cohort studies. DATA SOURCES: Two independent reviewers searched PubMed, the Cochrane Library, Web of Science and EMBASE for available studies published up to 13 January 2024. ELIGIBILITY CRITERIA: We included all cohort studies published in English that aimed to explore the relationship between IAP from solid fuel use and SHS exposure and the risk of depression. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The association between IAP and depression was calculated using pooled relative risk (RR) with 95% CIs. Heterogeneity was assessed using the I2 value, and the effect estimates were pooled using fixed-effects or random-effects models depending on the results of homogeneity analysis. RESULTS: We included 12 articles with data from 61 217 participants. The overall findings demonstrated a significant association between IAP exposure and depression (RR=1.22, 95% CI: 1.13 to 1.31), although with substantial heterogeneity (I2=75%). Subgroup analyses based on pollutant type revealed that IAP from solid fuel use was associated with a higher risk of depression (RR=1.20, 95% CI: 1.13 to 1.26; I2=62%; 5 studies, 36 768 participants) than that from SHS exposure (RR=1.11, 95% CI: 0.87 to 1.41; I2=80%; 7 studies, 24 449 participants). In terms of fuel use, the use of solid fuel for cooking (RR: 1.23, 95% CI: 1.16 to 1.31; I2=58%; 4 studies, 34 044 participants) and heating (RR 1.15, 95% CI: 1.04 to 1.27; I2=65%; 3 studies, 24 874 participants) was associated with increased depression risk. CONCLUSIONS: The findings from this systematic review and meta-analysis of cohort studies indicated an association between exposure to IAP and depression. PROSPERO REGISTRATION NUMBER: CRD42022383285.

Relationship between self-psychological adjustment and post-traumatic growth in patients with lung cancer undergoing chemotherapy: a cross-sectional study.

OBJECTIVES: This study aimed to determine the potential profiles of self-psychological adjustment in patients with lung cancer undergoing chemotherapy, including sense of coherence (SOC) and positive cognitive emotion regulation (PCER). The relationship between these profiles with post-traumatic growth (PTG) and the relevant factors of self-psychological adjustment in different profiles was analysed. DESIGN: Cross-sectional study. SETTING: Patients with lung cancer undergoing chemotherapy in China. PARTICIPANTS: A total of 330 patients with lung cancer undergoing chemotherapy were recruited out of which 321 completed the questionnaires effectively. METHODS: Latent profile analysis was used to identify self-psychological adjustment classes based on the two subscales of the Sense of Coherence Scale and Cognitive Emotion Regulation Questionnaire. One-way analysis of variance and multinomial logistic regression were performed to examine the subgroup association with characteristics and PTG. RESULTS: Three latent profiles of self-psychological adjustment were identified: low level (54.5%), high SOC-low PCER (15.6%) and high PCER (29.9%). The results of univariate analysis showed a significant difference in PTG scores among different self-psychological adjustment subgroups (F=11.55, p<0.001). Patients in the high-PCER group were more likely living in urban areas (OR=2.41, 95% CI 1.17 to 4.97, p=0.02), and time since cancer diagnosis was ≥6 months and <1 year (OR=3.54, 95% CI 1.3 to 9.64, p<0.001). CONCLUSION: This study revealed that most patients with lung cancer undergoing chemotherapy belonged to the low-level group. Three profiles are associated with PTG. There were differences in characteristics between patients treated with chemotherapy for lung cancer in the high-PCER and low-PCER groups. Thus, these profiles provide useful information for developing targeted individualised interventions based on demographic characteristics that would assist PTG in patients with lung cancer undergoing chemotherapy.

Relationship between electronic cigarette use, dual smoking habits, and psychological distress among youth in Northern Thailand: A cross-sectional study.

INTRODUCTION: Amidst the escalating trend of electronic cigarette (e-cigarette) use and dual smoking habits among youth, understanding their potential impact on psychological well-being is imperative. Limited research has explored this relationship, particularly among youth in settings where e-cigarettes are banned. This study investigates the relationship between current e-cigarette and traditional cigarette use patterns and the presence of depression and anxiety symptoms among youth in Thailand. METHODS: Using a cross-sectional survey encompassing 3424 individuals aged 15-24 years in Northern Thailand from December 2021 to September 2022, we accessed cigarette and e-cigarette usage over the past 30 days alongside depression and anxiety symptoms over the past two weeks. Multivariable logistic regression was employed to analyze the association of these variables, adjusting for sociodemographic factors. RESULTS: Among the surveyed youths, 10.8% reported cigarette use, 6.2% utilized e-cigarettes, and 3.3% were dual users within the past 30 days. Regarding mental health, 33.96% exhibited moderate-severe to severe depression, while 52.54% experienced anxiety at similar levels. After adjusting for covariates, both current e-cigarette users and dual users exhibited heightened depression symptoms (AOR=1.80; 95% CI: 1.30-2.51, and AOR=2.30; 95% CI: 1.49-3.55, respectively) and only e-cigarette use had increased odds of increased anxiety levels (AOR=1.70; 95% CI: 1.24-2.32) compared to non-users. Notably, current cigarette smokers demonstrated no association with depression but had decreased odds of higher levels of anxiety compared to non-users (AOR=0.73; 95% CI: 0.55-0.96). CONCLUSIONS: A substantial number of Thai youths are using e-cigarettes and experiencing psychological distress. E-cigarette use is associated with heightened levels of depression and anxiety, whereas cigarette smoking is not associated with depression but is likely to be associated with an increased reporting of anxiety. These contradictory findings highlight the need for comprehensive investigations, especially when e-cigarettes are prohibited.

Patient-Reported Anxiety or Depression Increased the Risk of Dissatisfaction Despite Improvement in Pain or Function Following Total Knee Arthroplasty: A Swedish Register-Based Observational Study of 8,745 Patients.

BACKGROUND: Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We investigated if patient-reported anxiety or depression increased the risk of dissatisfaction 1 year after TKA in patients who improved in pain or function. METHODS: Data on primary TKAs due to osteoarthritis between 2017 and 2019 were obtained from the Swedish Knee Arthroplasty Register. Out of 14,120 patients, 9,911 completed the Knee injury and Osteoarthritis Outcome Score and satisfaction rate with the result of the surgery. According to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria patients were classified as responders (improved in pain or function) or nonresponders. Anxiety and depression were assessed through EuroQol-5 Dimension 3 levels. Log-linear regression models estimated the risk ratios (RRs) for dissatisfaction in all patients and stratified by age groups (< 65, 65 to 74, and > 74 years). There were 8,745 patients who were classified as responders whereas 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively. RESULTS: Anxiety or depression increased the risk of dissatisfaction preoperatively (RR 1.23, 95% confidence interval = 1.09 to 1.40) and postoperatively (RR 2.65, confidence interval 2.33 to 3.00). Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction. CONCLUSIONS: Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after TKA despite improvements in pain or function.

Exploring the Association Between Structural Racism and Mental Health: Geospatial and Machine Learning Analysis.

BACKGROUND: Structural racism produces mental health disparities. While studies have examined the impact of individual factors such as poverty and education, the collective contribution of these elements, as manifestations of structural racism, has been less explored. Milwaukee County, Wisconsin, with its racial and socioeconomic diversity, provides a unique context for this multifactorial investigation. OBJECTIVE: This research aimed to delineate the association between structural racism and mental health disparities in Milwaukee County, using a combination of geospatial and deep learning techniques. We used secondary data sets where all data were aggregated and anonymized before being released by federal agencies. METHODS: We compiled 217 georeferenced explanatory variables across domains, initially deliberately excluding race-based factors to focus on nonracial determinants. This approach was designed to reveal the underlying patterns of risk factors contributing to poor mental health, subsequently reintegrating race to assess the effects of racism quantitatively. The variable selection combined tree-based methods (random forest) and conventional techniques, supported by variance inflation factor and Pearson correlation analysis for multicollinearity mitigation. The geographically weighted random forest model was used to investigate spatial heterogeneity and dependence. Self-organizing maps, combined with K-means clustering, were used to analyze data from Milwaukee communities, focusing on quantifying the impact of structural racism on the prevalence of poor mental health. RESULTS: While 12 influential factors collectively accounted for 95.11% of the variability in mental health across communities, the top 6 factors-smoking, poverty, insufficient sleep, lack of health insurance, employment, and age-were particularly impactful. Predominantly, African American neighborhoods were disproportionately affected, which is 2.23 times more likely to encounter high-risk clusters for poor mental health. CONCLUSIONS: The findings demonstrate that structural racism shapes mental health disparities, with Black community members disproportionately impacted. The multifaceted methodological approach underscores the value of integrating geospatial analysis and deep learning to understand complex social determinants of mental health. These insights highlight the need for targeted interventions, addressing both individual and systemic factors to mitigate mental health disparities rooted in structural racism.

The Flourishing Scale: Psychometric Properties in Breast Cancer Patients.

BACKGROUND/OBJECTIVE: Promoting well-being is a key goal of cancer care, and it needs to be assessed using appropriate instruments. Flourishing is considered part of psychological well-being and it is commonly assessed with the Flourishing Scale (FS). To our knowledge, no studies have analyzed the psychometric properties of the FS in breast cancer patients. Our aim here was to provide validity evidence for use of the FS in this context. METHOD: Participants were 217 Spanish women with breast cancer who completed the FS and other scales assessing positive psychology constructs (life satisfaction, positive affect, resilience, self-esteem, optimism) and indicators of psychological maladjustment (negative affect, depression, anxiety, and stress). The internal structure of the FS was analyzed using confirmatory factor analysis (CFA). We calculated the average variance extracted (AVE) to evaluate convergent validity, and both McDonald's omega and Cronbach's alpha coefficients to estimate reliability. Item analysis was performed by computing corrected item-total correlations. Validity evidence based on relationships with other variables was obtained through Pearson correlation analysis, controlling for age and cancer stage. RESULTS: The CFA supported a single-factor structure, with adequate goodness-of-fit indices (CFI = 0.997, NNFI = 0.996, RMSEA = 0.069, and SRMR = 0.047) and standardized factor loadings ranging from 0.70 to 0.87. The value of the AVE was 0.63, and the reliability coefficient obtained with both procedures was 0.91. Corrected item-total correlations ranged from .62 to .78. Correlation analysis showed direct and strong associations between the FS score and scores on positive psychology constructs (range from 0.43 to 0.74), the strongest correlations being with positive affect and life satisfaction. The FS score was inversely correlated with scores on depression, anxiety, stress, negative affect, and pessimism (range from -0.14 to -0.52), the strongest association being with stress. DISCUSSION: The FS is a useful tool for exploring well-being in the breast cancer context, providing useful information for psychological assessment.

Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.

Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil.

São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.

Alterations in Circadian Rhythms, Sleep, and Physical Activity in COVID-19: Mechanisms, Interventions, and Lessons for the Future.

Although the world is acquitting from the throes of COVID-19 and returning to the regularity of life, its effects on physical and mental health are prominently evident in the post-pandemic era. The pandemic subjected us to inadequate sleep and physical activities, stress, irregular eating patterns, and work hours beyond the regular rest-activity cycle. Thus, perturbing the synchrony of the regular circadian clock functions led to chronic psychiatric and neurological disorders and poor immunological response in several COVID-19 survivors. Understanding the links between the host immune system and viral replication machinery from a clock-infection biology perspective promises novel avenues of intervention. Behavioral improvements in our daily lifestyle can reduce the severity and expedite the convalescent stage of COVID-19 by maintaining consistent eating, sleep, and physical activity schedules. Including dietary supplements and nutraceuticals with prophylactic value aids in combating COVID-19, as their deficiency can lead to a higher risk of infection, vulnerability, and severity of COVID-19. Thus, besides developing therapeutic measures, perpetual healthy practices could also contribute to combating the upcoming pandemics. This review highlights the impact of the COVID-19 pandemic on biological rhythms, sleep-wake cycles, physical activities, and eating patterns and how those disruptions possibly contribute to the response, severity, and outcome of SARS-CoV-2 infection.

Effect of acceptance and commitment therapy-based interventions on mental health and cognitive impairment for patients with advanced colorectal cancer.

BACKGROUND: The mental and emotional health of persons diagnosed with cancer is frequently affected. The acceptance and commitment therapy (ACT) is one of the psychological interventions that has proven successful in easing these psychological symptoms and enhancing cancer patients' psychological well-being. METHODS: A two-arm randomized controlled trial study was utilized, 30 eligible clients with colorectal cancer were chosen randomly and were given ACT therapy at a 1:1 ratio. ACT was delivered in six sessions for 3 weeks, followed by 3 months follow-up. RESULTS: The table shows a statistically significant increase in the mean scores of the mental health and its flourishing level among the study group than those of the control group. Cognitive impairment was significantly decreased among the study group than for those in the control group. CONCLUSION: The ACT-based interventions may be a promising approach for improving mental health and cognitive function in cancer patients, particularly those with advanced disease.

The Impact of COVID-19 on Mental Health and Sleep Function of Hospital Staff Working With COVID-19 Patients: A Cross-Sectional Nationwide Study.

The coronavirus disease 2019 (COVID-19) pandemic has presented a globally challenging situation for human physical and mental health. Healthcare workers (HCWs) are affected by increased levels of anxiety, stress, and insomnia. This study aimed to evaluate the effect of COVID-19 on HCWs anxiety, stress, and insomnia levels. This cross-sectional study employed the Hospital Anxiety and Depression Scale, Perceived Stress Scale 10, and Insomnia Severity Index to assess anxiety, stress, and insomnia among HCWs at 10 COVID-19 isolation and treatment hospitals/centers after the first COVID-19 wave in Jordan. A web-based survey was used to collect data from 183 participants. Statistical analysis of factors affecting the mean scores of anxiety, stress, and insomnia was carried using student t-test or ANOVA while factors associated with differences in anxiety, stress, and insomnia frequencies were tested using Chi-square/Fisher exact test. Multivariate analysis was performed to determine the independent risk factors. Among participants, 97.3% reported moderate to severe levels of stress, 68% reported borderline to high abnormal levels of anxiety, and 32% had moderate to severe insomnia. The mean of anxiety total score was 9.8 ± 4.8, stress total score was 22.7 ± 4.5, and insomnia total score was 11.0 ± 7.1. Significant positive correlations were noted between anxiety, stress, and insomnia (P < .005). Female gender, migraine, less working years, increased time spent with patients, lower workforce, clinical insomnia and high stress were significant independent factors associated with anxiety (P < .05). Younger age, being single or divorced, heart disease, smoking, occupation (nurses), lower workforce, vaccination dose, and anxiety were significant independent factors associated with insomnia (P < .05). Increased time spent with patients, lower workforce, lower spouse and colleagues support, sadness due to isolation and anxiety were significant independent factors associated with stress. HCWs at COVID-19 centers had high levels of stress, anxiety, and insomnia. Appropriate interventions to maintain HCWs mental health are recommended.