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1.
Support Care Cancer ; 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31916007

RESUMO

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.

2.
Front Psychol ; 10: 2622, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31824388

RESUMO

This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.

3.
J Interprof Care ; : 1-7, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573363

RESUMO

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.

4.
J Aging Health ; : 898264319826428, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30698482

RESUMO

OBJECTIVE: Financial problems in cancer survivors are associated with distress and reduced quality of life. Most studies have been cross-sectional, and a longitudinal study is needed to guide clinical interventions. METHOD: We used data from two surveys of the National Health and Aging Trends Study (NHATS). Participants ( n = 307) reported whether they experienced six indicators of financial burden. The Patient Health Questionnaire 4 assessed depressive symptoms and general anxiety. Cross-lagged panel analyses assessed whether financial burden predicted distress and health or vice versa. RESULTS: In the total sample, financial burden at the first survey predicted depressive symptoms ( p < .01), general anxiety ( p < .01), and self-rated health ( p < .01) at the second survey. Depressive symptoms, general anxiety, and self-rated health at the first survey did not predict later financial burden ( ps > .05). DISCUSSION: Results suggest financial problems predict later distress and poor health. This study highlights the need to address financial burden in cancer survivors.

5.
Medicine (Baltimore) ; 98(1): e14004, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608446

RESUMO

The aim of the study was to examine how multimorbidity influences the prevalence of financial burden among older adults with heart disease, diabetes, or cancer.The study was a cross-sectional analysis of prospective observational cohort survey study.Older adults (age 65 or older) who did not report 1/6 major chronic illnesses (n = 2773; reference group), reported 1/3 major chronic illnesses without comorbidity (heart disease n = 206; diabetes n = 460; cancer n = 417), and reported 1/3 major chronic illnesses with comorbidity (heart disease n = 232; diabetes n = 202; cancer n = 109).The measures were presence of chronic diseases (heart disease, diabetes, cancer), comorbid chronic diseases (stroke, lung disease, dementia), medical-related financial burden (credit card debt due to medical costs, paying medical bills over time), and overall financial burden (financial help from family, credit card debt, help with food, utilities, and other necessities).The proportion reporting financial burden ranged from 15% to 27% across samples. Heart disease was unrelated to medical or overall financial burden, regardless of comorbidity. Diabetes was unrelated to financial burden except diabetes without comorbidity was associated with lower odds of overall financial burden compared to healthy older adults (odds ratio [OR] = 0.655, 95% confidence interval [CI]: 0.468-0.917). Cancer with comorbidity, but not cancer without comorbidity, was associated with greater odds of medical related (OR = 1.678, 95% CI: 1.057-2.664) and overall financial burden (OR = 1.748, 95% CI: 1.064-2.872).The association of multimorbidity with financial burden likely varies based on specific diseases. Future research on financial burden should focus on specific disease combinations such as cancer with comorbidity.


Assuntos
Comorbidade/tendências , Diabetes Mellitus/economia , Cardiopatias/economia , Medicare/economia , Neoplasias/economia , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Neoplasias/epidemiologia , Prevalência , Estudos Prospectivos , Estados Unidos/epidemiologia
6.
Int J MS Care ; 20(3): 145-152, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29896052

RESUMO

Background: People with multiple sclerosis (MS) are at increased risk for depression and anxiety. The symptoms of MS are often similar to the somatic or physical symptoms of depression and anxiety (fatigue, trouble concentrating). This study examined whether MS symptoms and effects biased the assessment of somatic symptoms of anxiety and depression. Methods: People with MS (n = 513) completed a survey about MS symptoms, treatments, and distress. The Patient Health Questionnaire-9 assessed depression, and the patient-report version of the Primary Care Evaluation of Mental Disorders assessed anxiety. Participants were grouped into low versus high MS symptoms based on self-reported symptoms and as high versus low disability by the Expanded Disability Status Scale (EDSS). Groups were compared using differential item functioning analysis. Results: No bias was found on somatic symptoms of depression comparing high versus low MS symptom groups (P > .15) or comparing groups based on EDSS scores (P > .29). Two anxiety symptoms (fatigue and muscle tension) showed bias comparing high versus low MS symptom groups (P < .01) and comparing high versus low groups based on EDSS scores (P ≤ .01). Intraclass correlations suggested a small effect due to bias in the somatic symptoms of anxiety. Conclusions: Somatic symptoms of depression are unlikely to be biased by MS symptoms. However, the use of certain somatic symptoms to assess anxiety may be biased for those with high MS symptoms.

7.
Psychooncology ; 27(4): 1320-1326, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29462511

RESUMO

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.


Assuntos
Sobreviventes de Câncer/psicologia , Gastos em Saúde/estatística & dados numéricos , Neoplasias/psicologia , Sobreviventes/psicologia , Adaptação Psicológica , Adulto , Ansiedade/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Qualidade de Vida/psicologia , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos
8.
J Behav Health Serv Res ; 45(4): 690-699, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-28726086

RESUMO

The focus on recovery, not just symptom reduction, in mental health care brings a need for psychometrically sound measures of recovery. This study examined the factor structure and sensitivity to change of a common measure of mental health recovery, the Recovery Assessment Scale (RAS). We conducted a secondary data analysis from a randomized clinical trial of self-management for depression (n = 302). We tested both bifactor and the previously found five-factor model. Sensitivity to change was examined three ways: (1) between the intervention and control group; (2) across time in the intervention group; and (3) in those whose depression remitted. The previous five-factor model was supported. One subscale, no domination by symptoms, was particularly sensitive to change and showed sensitivity to change whereas the subscale reliance on others did not show change in any of the comparisons. Results suggest that the subscales of the RAS should be examined separately in future studies of recovery.


Assuntos
Depressão/psicologia , Transtorno Depressivo/psicologia , Escalas de Graduação Psiquiátrica/normas , Recuperação de Função Fisiológica , Adulto , Depressão/terapia , Transtorno Depressivo/terapia , Análise Fatorial , Feminino , Humanos , Masculino , Transtornos Mentais , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
9.
Assessment ; 24(3): 300-307, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26423348

RESUMO

This study examined the accuracy of depression cross-walk tables in a sample of people with multiple sclerosis (MS). The tables link scores of two commonly used depression measures to the Patient Reported Outcome Measurement Information System Depression (PROMIS-D) scale metric. We administered the 8-item PROMIS-D (Short-Form 8b; PROMIS-D-8), the 20-item Center for Epidemiologic Studies Depression Scale (CESD-20), and the 9-item Patient Health Questionnaire (PHQ-9) to 459 survey participants with MS. We examined correlations between actual PROMIS-D-8 scores and the scores predicted by cross-walks based on PHQ-9 and CESD-20 scores. Intraclass correlation coefficients were used to assess correspondence. Consistency in severity classification was also calculated. Finally, we used Bland-Altman plots to graphically examine the levels of agreement. The correlations between actual and cross-walked PROMIS-D-8 scores were strong (CESD-20 = .82; PHQ-9 = .74). The intraclass correlation was moderate (.77). Participants were consistently classified as having or not having at least moderate depressive symptoms by both actual and cross-walked scores derived from the CESD-20 (90%) and PHQ-9 (85%). Bland-Altman plots suggested the smaller differences between actual and cross-walked scores with greater-than-average depression severity. PROMIS cross-walk tables can be used to translate depression scores of people with MS to the PROMIS-D metric, promoting continuity with previous research.


Assuntos
Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Esclerose Múltipla/psicologia , Medidas de Resultados Relatados pelo Paciente , Determinação da Personalidade/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Adulto , Idoso , Transtorno Depressivo/classificação , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estatística como Assunto , Inquéritos e Questionários
10.
Support Care Cancer ; 25(5): 1417-1422, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27981365

RESUMO

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.


Assuntos
Adaptação Psicológica , Neoplasias/mortalidade , Neoplasias/psicologia , Sobreviventes/psicologia , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/psicologia , Qualidade de Vida , Inquéritos e Questionários
11.
J Occup Environ Med ; 58(11): 1144-1149, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27820765

RESUMO

OBJECTIVE: This study investigates the mediation effect of anxiety and depression on the relationship between perceived health-promoting workplace culture and presenteeism. METHODS: Paper surveys were distributed to 4703 state employees. Variables included symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]); anxiety (General Health Questionnaire-12 [GHQ-12]); perceived workplace support for healthy living and physical activity; and presenteeism (Work Productivity and Activity Impairment Questionnaire). Correlational analyses assessed relationships among culture, mental health, and productivity. RESULTS: Indirect effects of workplace culture on productivity, mediated by anxiety and depression symptoms were significant (P's = 0.002). Healthy living culture and anxiety were significantly associated (r = -0.110, P < 0.01), and anxiety and presenteeism were significantly associated (r = +0.239, P < 0.01). CONCLUSION: Anxiety and depression determine the impact of perceived health promotive workplace culture on employee productivity. The paper highlights importance of health promotive practices targeting employee mental well-being.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Presenteísmo , Local de Trabalho , Adulto , Estudos Transversais , Eficiência , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Cultura Organizacional
12.
J Altern Complement Med ; 22(11): 936-946, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27689427

RESUMO

BACKGROUND: Patient expectations may be associated with outcomes of complementary and alternative medicine (CAM) treatments for chronic pain. However, a psychometrically sound measure of such expectations is needed. OBJECTIVES: The purpose of this study was to develop and evaluate a questionnaire to assess individuals' expectations regarding outcomes of CAM treatments for chronic low back pain (CLBP), as well as a short form of the questionnaire. METHODS: An 18-item draft questionnaire was developed through literature review, cognitive interviews with individuals with CLBP, CAM practitioners, and expert consultation. Two samples completed the questionnaire: (1) a community sample (n = 141) completed it via an online survey before or soon after starting a CAM treatment for CLBP, and (2) participants (n = 181) in randomized clinical trials evaluating CAM treatments for CLBP or fibromyalgia completed it prior to or shortly after starting treatment. Factor structure, internal consistency, test-retest reliability, and criterion validity were examined. RESULTS: Based on factor analyses, 10 items reflecting expectations (used to create a total score) and three items reflecting hopes (not scored) were selected for the questionnaire. The questionnaire had high internal consistency, moderate test-retest reliability, and moderate correlations with other measures of expectations. A three-item short form also had adequate reliability and validity. CONCLUSIONS: The Expectations for Complementary and Alternative Medicine Treatments (EXPECT) questionnaire can be used in research to assess individuals' expectations of treatments for chronic pain. It is recommended that the three hope questions are included (but not scored) to help respondents distinguish between hopes and expectations. The short form may be appropriate for clinical settings and when expectation measurement is not a primary focus.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Terapias Complementares , Psicometria/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Dor nas Costas/epidemiologia , Dor Crônica/epidemiologia , Terapias Complementares/métodos , Terapias Complementares/psicologia , Terapias Complementares/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Psicometria/métodos , Reprodutibilidade dos Testes , Ioga , Adulto Jovem
13.
Rehabil Psychol ; 61(4): 430-434, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27571410

RESUMO

PURPOSE/OBJECTIVE: A measure of worry about affording health care was developed in people with multiple sclerosis (MS) to further the study of how trouble affording health care can affect health. This study examined whether the measure showed bias by gender, age, insurance type, income, and type of MS. Absence of bias would facilitate comparisons between groups in future studies. Research methods/Design: A sample of 433 people with MS completed the 5-item worry about affording health care measure. Demographic information was also collected. To test for bias, we used differential item function analysis with the graded response model of item response theory. We tested for bias from gender, age, insurance type, income, and type of MS. RESULTS: Differential item function analyses found no significant bias for the worry about affording health care measure when comparing the following groups: men to women; younger than 55 years old to 55 years and older; public insurance to no public insurance; lower income to higher income; and relapsing/remitting MS type to other MS types. CONCLUSIONS/IMPLICATIONS: This brief measure of worry about affording health care can be used in future studies without concern for measurement bias on the factors examined here. Future studies should examine the relationship of this worry to adherence to treatment and other factors that may be affected by worries about health care affordability. (PsycINFO Database Record


Assuntos
Ansiedade/diagnóstico , Ansiedade/psicologia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Esclerose Múltipla/economia , Esclerose Múltipla/psicologia , Inquéritos e Questionários , Adulto , Fatores Etários , Idoso , Viés , Avaliação da Deficiência , Feminino , Humanos , Renda , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/reabilitação , Cooperação do Paciente/psicologia , Psicometria/estatística & dados numéricos , Fatores Sexuais
14.
Arch Sex Behav ; 45(8): 1897-1905, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27502350

RESUMO

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.


Assuntos
Psicometria , Disfunções Sexuais Psicogênicas/diagnóstico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Psicometria/métodos , Psicometria/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Autorrelato , Tradução
15.
Complement Ther Med ; 26: 66-71, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27261984

RESUMO

OBJECTIVES: Heart rate variability (HRV) reflects the integration of the parasympathetic nervous system with the rest of the body. Studies on the effects of yoga and exercise on HRV have been mixed but suggest that exercise increases HRV. We conducted a secondary analysis of the effect of yoga and exercise on HRV based on a randomized clinical trial of treatments for vasomotor symptoms in peri/post-menopausal women. DESIGN: Randomized clinical trial of behavioral interventions in women with vasomotor symptoms (n=335), 40-62 years old from three clinical study sites. INTERVENTIONS: 12-weeks of a yoga program, designed specifically for mid-life women, or a supervised aerobic exercise-training program with specific intensity and energy expenditure goals, compared to a usual activity group. MAIN OUTCOME MEASURES: Time and frequency domain HRV measured at baseline and at 12 weeks for 15min using Holter monitors. RESULTS: Women had a median of 7.6 vasomotor symptoms per 24h. Time and frequency domain HRV measures did not change significantly in either of the intervention groups compared to the change in the usual activity group. HRV results did not differ when the analyses were restricted to post-menopausal women. CONCLUSIONS: Although yoga and exercise have been shown to increase parasympathetic-mediated HRV in other populations, neither intervention increased HRV in middle-aged women with vasomotor symptoms. Mixed results in previous research may be due to sample differences. Yoga and exercise likely improve short-term health in middle-aged women through mechanisms other than HRV.


Assuntos
Terapia por Exercício , Frequência Cardíaca/fisiologia , Menopausa/fisiologia , Ioga , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
16.
Eur J Oncol Nurs ; 20: 31-5, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26220893

RESUMO

PURPOSE: Benefit finding has been shown to be beneficial for people with cancer and may be an indication that one is coping adequately with the stress of cancer. This study evaluated the psychometric properties of a four-item benefit finding measure from the cancer survivorship supplement of the Medical Expenditure Panel Survey (MEPS). METHODS: Long-term survivors (5-10 years post-diagnosis) of breast, prostate, colorectal or lung cancer or melanoma (n = 594) completed the MEPS cancer supplement survey in 2013. Four items asked about benefit finding after the cancer: stronger person, coping better, positive changes and having healthier habits. Information on sociodemographics, disease and activity limitations after the cancer was also collected. We examined factor structure, reliability (Kuder-Richardson 20) and validity. RESULTS: The four benefit finding items did not appear to measure one factor. Three of the benefit finding items (stronger person, coping better, positive changes) were related to gender, receipt of chemotherapy and activity limitations but not cancer stage, time since diagnosis or income. Having healthier habits was unrelated to any sociodemographic or disease variable. CONCLUSIONS: Three of the items (stronger person, coping better, positive changes) appeared to have validity as they were related to variables that literature has shown are related to benefit finding. However, having healthier habits is likely measuring a separate but related construct. This short instrument may be used in future studies assessing benefit finding post cancer; however, the four items should be analyzed separately.


Assuntos
Adaptação Psicológica , Neoplasias/psicologia , Psicometria/instrumentação , Qualidade de Vida/psicologia , Sobreviventes/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos , Estados Unidos
17.
Clin Auton Res ; 26(1): 7-13, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26691637

RESUMO

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.


Assuntos
Frequência Cardíaca/fisiologia , Fogachos/fisiopatologia , Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Sudorese/fisiologia , Sistema Vasomotor/fisiopatologia
18.
Aging Ment Health ; 20(3): 309-17, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25675142

RESUMO

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.


Assuntos
Sintomas Afetivos/epidemiologia , Comorbidade , Depressão/epidemiologia , Nível de Saúde , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia
19.
Ann Behav Med ; 49(5): 696-703, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25837697

RESUMO

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.


Assuntos
Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/psicologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Registros Eletrônicos de Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Medição de Risco , Autorrelato
20.
Health Educ Behav ; 42(5): 669-76, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25794518

RESUMO

BACKGROUND: Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonrandomized one-arm design. METHODS: Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre-post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. RESULTS: Inclinometer measured sitting time decreased by 27 min/day (p < .05) and sit-to-stand transitions increased by 2 per day (p > .05), while standing time increased by 25 min/day (p < .05). Accelerometer measured sedentary time, light-intensity, and moderate-to-vigorous physical activity improved (all p values ≤ .05). Self-reported sitting time, gait speed, and depressive symptoms also improved (all p values < .05). Effect sizes were small. Study satisfaction was high. CONCLUSIONS: Reducing sitting time is feasible, and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity. Randomized trials of sedentary behavior reduction in overweight and obese older adults, most of whom have multiple chronic conditions, may be promising.


Assuntos
Obesidade , Comportamento Sedentário , Acelerometria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Exercício/fisiologia , Exercício/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Obesidade/terapia
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