Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey.

OBJECTIVES: To examine the prevalence of mental health symptoms during the first surge of COVID-19 in the USA, and their associations with COVID-19-related emotional distress, health self-management and healthcare utilisation. DESIGN: Cross-sectional analysis of wave 3 (1-22 May 2020) survey data from the ongoing Chicago COVID-19 Comorbidities (C3) study. SETTING: Seven academic and community health centres in Chicago, Illinois. PARTICIPANTS: 565 adults aged 23-88 with one or more chronic conditions completing at least one prior C3 study wave. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinically relevant anxiety and depressive symptoms as measured using Patient-Reported Outcomes Measurement Information System short forms. Self-reported emotional and health-related responses to COVID-19 were measured through a combination of single-item questions and validated measures. RESULTS: Rates of anxiety and depressive symptoms were 14% (81/563) and 15% (84/563), respectively. Anxiety and depressive symptoms were then each separately associated with greater worry about contracting COVID-19 (relative risk (RR) 2.32, 95% CI 1.52 to 3.53; RR 1.67, 95% CI 1.10 to 2.54), greater stress (RR 4.93, 95% CI 3.20 to 7.59; RR 3.01, 95% CI 1.96 to 4.61) and loneliness (RR 3.82, 95% CI 2.21 to 6.60; RR 5.37, 95% CI 3.21 to 8.98), greater avoidance of the doctor (RR 1.62, 95% CI 1.06 to 2.49; RR 1.54, 95% CI 1.00 to 2.36) and difficulty managing health (least square means (LS Means) 6.09, 95% CI 5.25 to 6.92 vs 4.23, 95% CI 3.70 to 4.75; LS Means 5.85, 95% CI 5.04 to 6.65 vs 4.22, 95% CI 3.70 to 4.75) and medications (LS Means 3.71, 95% CI 2.98 to 4.43 vs 2.47, 95% CI 2.02 to 2.92) due to the pandemic. CONCLUSIONS: Identifying and addressing mental health concerns may be an important factor to consider in COVID-19 prevention and management among high-risk medical populations.

Type 2 diabetes and colorectal cancer screening: Findings from the English Longitudinal Study of Ageing.

Objectives: Type 2 diabetes has been identified as a risk factor for colorectal cancer, but little is known about whether it influences participation in colorectal cancer screening programmes. This study tested the extent to which Type 2 diabetes is negatively associated with colorectal cancer screening uptake. Methods: We analysed individual data of screening eligible men and women aged 60­75 without cancer diagnosis from wave 6 of the English Longitudinal Study of Ageing (collected 2012­2013), to investigate whether Type 2 Diabetes influences colorectal cancer screening behaviour independently of demographic characteristics, body mass index, socio-economic status and other chronic diseases. Results: Individuals who reported to have Type 2 diabetes or had glycated haemoglobin (HbA1c) levels of 48 mmol/mol or higher were less likely to have ever completed a screening test (faecal occult blood test; 62.8% vs. 75.8%, p < 0.01) or to be up-to-date with their biennial screening invitation (60.2% vs. 72.0%, p < 0.05). The negative associations of Type 2 diabetes on colorectal cancer screening were found both in unadjusted and adjusted regression models. Conclusions: Future qualitative and quantitative research should identify reasons for this discrepancy, to inform interventions to increase screening uptake in this high-risk population.

Preparing pharmacy students to communicate effectively with adolescents.

OBJECTIVES: To develop an elective workshop designed to equip pharmacy students with skills to effectively communicate with adolescents. To conduct preliminary evaluation of the workshop to assess its impact on pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques. METHODS: Academics from three universities in three countries collaborated on the workshop development and evaluation. The workshop structure was designed upon the foundations of communication best practices and established techniques, and it consisted of two online modules and an in-person tutorial. Pharmacy students undertaking a 4-year Bachelor, Master or Doctor of Pharmacy degree from all three participating universities evaluated the workshop via pre- and post-questionnaires. KEY FINDINGS: A total of 81 pharmacy students volunteered to attend and evaluate the workshop. Of these 81 students, 31 completed paired pre- and post-questionnaires, 44 students completed unpaired questionnaires and six students were lost to follow-up. Of the paired pre- and post-questionnaires, students were mostly female (67.7%) with an average age of 24.9 years (standard deviation, SD = 5.6) and were in the first (32.3%), second (16.1%) or third (51.6%) year of their pharmacy programme. Over 80% of students somewhat or strongly agreed that the workshop made them feel more comfortable speaking with young people in pharmacy settings. Mean (SD) perceived confidence (pre = 21.7 (4.0) and post = 24.9 (4.5)) and knowledge scores (pre = 5.2 (1.5) and post = 6.6 (1.6)) significantly improved after undertaking the workshop. CONCLUSIONS: The workshop increased pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

A randomized trial of a prenatal genetic testing interactive computerized information aid.

OBJECTIVE: The aim of this study was to determine whether an interactive computer program could improve patient knowledge regarding genetic screening and diagnostic concepts. METHODS: In this randomized trial, women 6-26 weeks' gestation were assigned to standard care with provider-based counseling or to augmented counseling with an interactive computer program. The computer-based tool conveyed information about genetic testing options. Women were administered a 23-item test of content knowledge immediately and 2-4 weeks after exposure. Test scores were compared between groups at both points using T-tests. RESULTS: A total of 150 women were randomized equally between groups. Groups were similar with regard to demographic characteristics. Women randomized to the interactive tool correctly answered a significantly greater proportion of questions than those who received standard counseling (69.4% ± 14.2% vs. 46.0% ± 15.2%, p < 0.001) on the immediate questionnaire. One hundred and twenty-three (82%) participants participated in the follow-up test. Women randomized to the tool continued to correctly answer a significantly greater proportion of questions (60.6% ± 16% vs. 49.7% ± 18.9%, p = 0.001). Education, health literacy, electronic health literacy, and other discussions with providers were not associated with a differential benefit from the educational intervention. CONCLUSION: A patient-directed interactive computer program may help providers to convey relevant information about genetic screening and diagnostic concepts.