The development of depression and social anxiety symptoms in adolescents and the negative impact of the COVID-19 pandemic and desire for peer contact.

Introduction: Adolescence is a dynamic developmental phase in which contact with peers is crucial for socio-emotional development and wellbeing. Depression and social anxiety show patterns of high onset during this period, and more for girls than boys. Here we examine this development among Dutch adolescents, as well as how desire for more peer contact as a result of social distancing measures during the COVID-19 pandemic contributed to this increase. Methods: We used a longitudinal three-wave design to examine 406 typically developing Dutch adolescents across two consecutive cohorts; Cohort 1: 2016-2019 (N = 138, 53.6% girls, age at T0 M = 13.00, SD = 0.42), Cohort 2: 2017-2020 (N = 268, 63.1% girls, age at T0 M = 13.05, SD = 0.39), final wave during spring 2020 during the first COVID-19 lockdown. Self-report questionnaires were used to measure depression and social anxiety symptoms, desire for change in the amount of peer contact during lockdowns, and emotion regulation. Parallel process dual latent growth models and autoregressive cross-lagged models were used to test the hypotheses. Results: Results showed that symptoms of both depression and social anxiety increase during adolescence. Gender analysis reveal a higher initial level and increase in depression symptoms for girls, while levels for boys decreased. Adolescents exposed to the pandemic showed a steeper increase in depression but not in social anxiety. Desire for more peer contact was related to an increase in depression and social anxiety, though only in girls. No evidence was found for moderation of emotion regulation skills concerning COVID evoked emotions on the association between desire for peer contact and anxiety and depression symptom development. Discussion: Symptoms of social anxiety increased during adolescence in boys and girls. Symptoms of depression increased for girls, but decreased for boys. The increase in depression was greater in a cohort who experienced the COVID-19 pandemic. For girls, a desire for more peer contact was associated with an increase of depression and social anxiety symptoms in times of social restrictions.

Resilience and coping during protracted conflict: a comparative analysis of general and evacuees populations.

BACKGROUND: On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel's southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation. METHODS: Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14-21, 2024 (N = 1,360), and the evacuees' data from March 1-9, 2024 (N = 372; 133 from the north, 239 from the south). RESULTS: Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples. CONCLUSIONS: The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges.

Household income is associated with attack frequency, but not with the prevalence of headache: an analysis of self-reported headache in the general population in Germany.

BACKGROUND: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. METHODS: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month). RESULTS: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms. CONCLUSIONS: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate.

Patients with diabetes struggling to afford food and control their HbA1c in food-insecure areas in Bronx, NY.

OBJECTIVE: To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes. DESIGN: We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity. SETTING: The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY. PARTICIPANTS: Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019. RESULTS: 5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas. CONCLUSIONS: These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.

The Role of Season, Sunlight, and Light Sensitivity in Self-Reported Depressive Symptoms by Adults With Visual Impairment.

Purpose: Depression is common in people with visual impairment, and the onset may be influenced by aspects related to light. The aim was to explore the associations of season, sunlight, and light sensitivity with depressive symptoms in this population. Methods: Data regarding self-reported depressive symptoms from seven cross-sectional studies conducted between 2009 and 2018 were combined with information concerning sensitivity to light, season on the date of self-report, and potential sunlight exposure in the 2 weeks prior to self-report. The latter was calculated by summing up the daily sunlight hours detected by the weather station nearest to the residence of each participant. Logistic regression analyses were performed to investigate the associations. Results: Participants (N = 1925) experienced clinically significant depressive symptoms most often in winter (32.8%), followed by summer (27.4%), spring (26.2%), and fall (24.2%). The odds of experiencing depression in fall were significantly lower compared with winter (odds ratio [OR] = 0.67, P = 0.007). An increase in the hours of sunlight in the participant's environment was associated with lower odds to experience depressive symptoms (OR = 0.995, P = 0.011). People who were sensitive to bright light had higher odds of experiencing depressive symptoms (OR = 1.80, P < 0.001). Other differences found between subgroups were not consistent. Conclusions: It seems likely that season, sunlight, and light sensitivity play a role in depression among people with visual impairment. Further research is needed, exploring the experiences in this population, the actual sunlight exposure using objective measures, and treatment options. Translational Relevance: Clinicians should consider these factors when treating visually impaired patients with depressive symptoms.

Patterns of pain medication usage and self-reported pain in older Irish adults with osteoarthritis: A latent class analysis of data from the Irish Longitudinal Study on Ageing.

BACKGROUND: This study aimed to identify and describe links between pain medication use and self-reported pain among people aged ≥ 50 years with osteoarthritis (OA) in an Irish population, and to examine the relationships between pain, medication usage and socioeconomic and clinical characteristics. METHODS: Secondary data analysis of wave 1 cross-sectional data from The Irish Longitudinal Study on Ageing (TILDA) was undertaken of 1042 people with self-reported doctor-diagnosed OA. We examined use of medications typically included in OA clinical guidelines, including non-opioid analgesics (e.g. paracetamol), topical and oral non-steroidal anti-inflammatory drugs (NSAIDs), opioids and nutraceuticals. Latent Class Analysis (LCA) was used to identify underlying clinical subgroups based on medication usage patterns, and self-reported pain severity. Multinomial logistic regression was used to explore sociodemographic and clinical characteristic links to latent class membership. RESULTS: A total of 358 (34.4%) of the 1042 people in this analysis were taking pain medications including oral NSAIDs (17.5%), analgesics (11.4%) and opioids (8.7%). Nutraceutical (glucosamine/chondroitin) use was reported by 8.6% and topical NSAID use reported by 1.4%. Three latent classes were identified: (1) Low medication use/no pain (n = 382, 37%), (2) low medication use/moderate pain (n = 523, 50%) and (3) moderate medication use/high pain (n = 137, 13%). Poorer self-rated health and greater sleep disturbance were associated with classes 2 and 3; depressive symptoms and female gender were associated with class 2, and retirement associated with class 3. CONCLUSIONS: Whilst pain medication use varied with pain severity, different medication types reported broadly aligned with OA guidelines. The two subgroups exhibiting higher pain levels demonstrated poorer self-rated health and greater sleep disturbance.

Physical Activity and Sedentary Time in US Adults with and without Heart Failure: 2007-2018 NHANES.

OBJECTIVES: Current evidence describing physical activity (PA) and sedentary time (ST) in people with and without heart failure (HF) is limited. This study examines PA participation and ST in a nationally representative sample of US adults with and without self-reported HF. METHODS: The study sample (N = 21,633) included US adult (40 years old and older) participants from the 2007-2018 National Health and Nutrition Examination Survey. PA participation, ST, and HF status were assessed via a questionnaire. RESULTS: Compared with participants without HF (68%), 84% of participants with HF reported not meeting PA recommendations (P < 0.05). Compared with participants without HF (63%), 75% of participants with HF reported >4.5 hours/day of ST (P < 0.05). Unadjusted analysis suggests that participants with HF had 60% (P < 0.05) lower odds of reporting meeting PA recommendations when compared with those without HF. In a fully adjusted model, these odds were attenuated (odds ratio 0.74, P < 0.05). Similarly, unadjusted analysis illustrated those individuals with HF had 42% (P < 0.05) lower odds of reporting ≤4.5 hours/day of ST. In a fully adjusted model, these odds also were attenuated (odds ratio 0.66, P < 0.05). CONCLUSIONS: Our findings suggest that US adults with HF report significantly less PA and greater amounts of ST than those without HF.

[Increased self-reported eating disorder symptoms in outpatients at a Child and Adolescent Psychiatry Clinic in Sweden between 2018 and 2022]. / Fler tonåringar rapporterade ätstörningssymtom hos Bup.

Eating disorders are common disorders that cause significant suffering and functional impairment for those affected. They often emerge in adolescence and can go undetected for many years before an individual presents to services. Early diagnosis and treatment have been shown to significantly improve the prognosis, highlighting the need for proactive screening. This study compared the frequency of self-reported eating disorder symptoms in (n = 2137) outpatients at the Child and Adolescent Psychiatry Clinic (BUP) in Region Västmanland, Sweden between 2018 and 2022. The results showed that the proportion of young people reporting frequent eating disorder symptoms increased from 16% to 28% over this time period. This result is in line with previous research describing an increase in the prevalence of eating disorder symptoms among different groups in relation to the Covid-19 pandemic. It underscores the importance of screening for eating disorder symptoms to better address care needs.

Associations among claims-based care fragmentation, self-reported gaps in care coordination, and self-reported adverse events.

BACKGROUND: Fragmentation of care (that is, the use of multiple ambulatory providers without a dominant provider) may increase the risk of gaps in communication among providers. However, it is unclear whether people with fragmented care (as measured in claims) perceive more gaps in communication among their providers. It is also unclear whether people who perceive gaps in communication experience them as clinically significant (that is, whether they experience adverse events that they attribute to poor coordination). METHODS: We conducted a longitudinal study using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including a survey on perceptions of healthcare (2017-2018) and linked fee-for-service Medicare claims (for the 12 months prior to the survey) (N = 4,296). We estimated correlation coefficients to determine associations between claims-based and self-reported numbers of ambulatory visits and ambulatory providers. We then used logistic regression to determine associations between claims-based fragmentation (measured with the reversed Bice-Boxerman Index [rBBI]) and self-reported gaps in care coordination and, separately, between claims-based fragmentation and self-reported adverse events that the respondent attributed to poor coordination. RESULTS: The correlation coefficient between claims-based and self-report was 0.37 for the number of visits and 0.38 for the number of providers (p < 0.0001 for each). Individuals with high fragmentation by claims (rBBI ≥ 0.85) had a 23% increased adjusted odds of reporting any gap in care coordination (95% CI 3%, 48%) and, separately, a 61% increased adjusted odds of reporting an adverse event that they attributed to poor coordination (95% CI 11%, 134%). CONCLUSIONS: Medicare beneficiaries with claims-based fragmentation also report gaps in communication among their providers. Moreover, these gaps appear to be clinically significant, with beneficiaries reporting adverse events that they attribute to poor coordination.

Associations of screen time with symptoms of stress, anxiety, and depression in adolescents.

OBJECTIVE: To examine the associations between self-reported screen time and symptoms of stress, anxiety, and depression in adolescents. METHODS: A cross-sectional study was conducted with 982 adolescents aged between 12 and 15 years, enrolled in public schools in Jacarezinho (PR), Brazil. Screen time was assessed by the question "Considering a typical day, how much time do you spend watching TV, playing videogame, using computer or smartphone?" The DASS-21 questionnaire (short form) was used to assess symptoms of depression, anxiety, and stress. Crude and adjusted analyses (age, sex, and maternal level of education) between screen time and mental disorders symptoms were performed using general linear regression models, with Poisson distribution, with significance level at p<0.05. RESULTS: Higher depressive symptoms were observed in adolescents who reported screen time of 4-6 hours/day (PR 1.35, 95%CI 1.13-1.61) and ≥6 hours/day (PR 1.88, 95%CI 1.62-2.19), compared with their pairs with <2 hours/day. The same was observed for anxiety symptoms with screen time of 4-6 hours/day (PR 1.23, 95%CI 1.04-1.46) and ≥6 hours/day (PR 1.50, 95%CI 1.28-1.77); and stress, with 4-6 hours/day (PR 1.25, 95%CI 1.08-1.44) and ≥6 hours/day (PR 1.49, 95%CI 1.30-1.71), also compared with their pairs with <2 hours/day. CONCLUSIONS: Screen time was positively associated with depressive, anxiety, and stress symptoms in adolescents. Special attention should be given to those who spend more than four hours a day in front of a screen.

Association between bullying victimization and health risk behavior in adolescents.

OBJECTIVE: The aim of this study was to examine the association between bullying victimization and health risk behaviors in adolescents. METHODS: A representative sample of 1020 adolescents participated in the study. The variables such as bullying, health risk behaviors (tobacco, drugs, alcohol, sedentary behavior, smartphone use, level of physical activity, and sleep), and economic status were assessed using self-reported questionnaires. Odds ratios with 95% confidence intervals (95%CI) were obtained using binary logistic regression and ordinal, gross, and adjusted logistic regression (p<0.05). RESULTS: Victims of bullying were more likely to smoke (OR 1.75; 95%CI 1.28-2.40), consume alcohol (OR1.43; 95%CI 1.05-1.94), have worse sleep quality (OR 1.94; 95%CI 1.28-2.91), and more sedentary behavior (OR 1.43; 95%CI 1.08-1.89) than those who were not bullied. However, victims were more likely to have high levels of physical activity than their non-bullied peers (OR 1.66; 95%CI 1.22-2.27). CONCLUSIONS: Bullying victimization was associated with an increased predisposition for the adoption of health risk behaviors. Interestingly, victims were also more prone to participate in physical activity.

Association of the COVID-19 lockdown with health risk behaviors in South Korean adolescents.

Since there is no certainty about when the coronavirus disease 2019 (COVID-19) lockdown will be affected by health risk behaviors, so we investigate the effect of COVID-19-related health risk behavior changes using school-based self-reported data from a nationally representative South Korean adolescent population. We analyzed web-based self-reported data from the Korea Youth Risk Behavior Web-based Survey in 111,878 participants (57,069 in COVID-19 prepandemic); 54,809 in during the COVID-19 pandemic. This study included 12 to 18-year-olds. Self-report questionnaires were used to assess socioeconomic status, health risk behaviors, and psychological factors. Health risk behaviors such as alcohol consumption, substance use, and sexual experience significantly decreased in COVID-19 pandemic than in COVID-19 prepandemic. Psychosomatic changes such as stress levels, violence experience, depression, suicidal ideation, suicidal plans, and suicide attempts were significantly lower in COVID-19 pandemic compared to COVID-19 prepandemic (P < .001). After adjusting for multiple confounding variables, less alcohol consumption (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.88-0.93), less exercise (OR = 0.92; 95% CI = 0.89-0.94), less sexual experience (OR = 0.82; 95% CI = 0.77-0.86), less violence experience (OR = 0.61; 95% CI = 0.55-0.67), less stress (OR = 0.86; 95% CI = 0.84-0.88), less depression (OR = 0.85; 95% CI = 0.83-0.88), less suicidal ideation (OR = 0.93; 95% CI = 0.89-0.97), plans (OR = 0.82; 95% CI = 0.76-0.88), attempts (OR = 0.78; 95% CI = 0.71-0.85) were significantly associated with the COVID-19 pandemic compared to COVID-19 prepandemic. The COVID-19 pandemic was associated with changes in health risk behaviors among Korean adolescents, resulting in alcohol drinking, sexual experience, drug use, violence experience, and suicidal behaviors (idea, plan, and attempts) being decreased during the lockdown period.

Association between meeting 24-hour movement behavior guidelines and quality of life in adolescents with idiopathic scoliosis.

BACKGROUND: Meeting the 24-hour movement behavior (24-HMB) guideline helps enhance quality of life (QOL) of adolescents. This study aimed to assess the associations between the 24-HMB (physical activity, screen time, sleep) and QOL among adolescents with idiopathic scoliosis. METHODS: A cross-sectional study was conducted between September 2021 and September 2023. 24-HMB, QOL and demographic variables were collected through a self-reported questionnaire. Linear regression models and stratified analyses were used to explore statistical associations between the 24-HMB and QOL. RESULTS: A total of 1073 participants aged 10-18 years with a spinal Cobb angle between 10° and 40° were included. Overall, 20 participants (1.9%) met all three behavioral guidelines, and 272 participants (25.3%) met none. Compared to those who did not meet any of the guidelines, adolescents meeting both screen time and sleep duration (ß = 4.10, 95% CI: 2.02-6.18, P < 0.001) and all 3 guidelines (ß = 4.39, 95% CI: 0.27-8.51, P = 0.037) had higher QOL scores. Stratified analyses showed that the above associations were more pronounced in adolescents without back pain or with good self-image. CONCLUSIONS: These findings highlight the importance of adopting and maintaining healthy behavioral habits in order to improve QOL among adolescents with idiopathic scoliosis, especially in those without back pain or with good self-image.

Effects of perceived stress on college students' sleep quality: a moderated chain mediation model.

BACKGROUND: Perceived Stress has been shown as a key contributor to sleep quality, but the underlying mechanism between perceived stress and sleep quality remains unknown. This study aimed to investigate the impact of perceived stress on sleep quality of college students and the chain mediating roles of presence of meaning in life (PML) and depression, as well as the moderating role of search for meaning in life (SML). METHODS: Participants were 8178 college students (4599 boys and 3579 girls; Mage = 19.10 years, SD = 1.08) who completed self-report questionnaire, including the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), the Meaning in Life Questionnaire (MLQ), and the Patient Health Questionnaire-9 (PHQ-9). RESULTS: The results showed that higher perceived stress was directly related to poorer sleep quality. This negative impact on sleep quality was mediated through the chained roles of PML and depression. Additionally, the study found that SML moderates the influence of perceived stress, PML and depression on sleep quality. Specifically, for individuals actively search for meaning, the adverse effects of perceived stress and depression on sleep quality are diminished. Concurrently, the positive influence of PML on sleep quality is enhanced. CONCLUSION: This study revealed that the PML and depression mediate the effect of perceived stress on sleep quality, with SML playing a significant protective role. These results emphasize the necessity of integrating strategies to enhance PML and SML into interventions designed to improve emotion management and sleep quality among college students.

Disparities in adherence to physical activity guidelines among US adults: A population-based study.

The objective of this study was to determine adherence to national guidelines for aerobic and muscle-strengthening physical activity among United States (US) adults and identify factors associated with guideline nonadherence. The 2022 National Health Interview Survey data were analyzed to evaluate self-reported physical activity among 26,494 US adults. Adherence to national guidelines was defined as engaging in ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity aerobic activity/week, and muscle-strengthening activity ≥2 days/week. A multivariable logistic regression model evaluated associations between 24 sociodemographic and health variables with nonadherence to physical activity guidelines. Shapley Additive Explanations were used to assess the relative importance of each factor in the model. The population-weighted analysis revealed that only 24.3% of US adults met both the aerobic and muscle-strengthening activity guidelines. The regression model identified 17 factors significantly associated with nonadherence. When evaluating the relative importance of these variables, older age, lower educational attainment, and lower household income emerged as the primary determinants of nonadherence. Guideline adherence was lowest among subgroups with multiple risk factors, with only 6.5% of older adults with lower income and education meeting the guidelines. In contrast, adherence was 42.7% in younger respondents with higher incomes and educational attainment. In conclusion, physical activity rates among US adults remain below public health targets, with significant disparities among sociodemographic groups. Expanded outreach efforts targeting higher-risk populations are urgently needed to address barriers, promote physical activity engagement, and achieve health equity.

Social network, fair payment, subjective well-being, and general health: a moderation mediation analysis.

Objective: This research aimed to investigate whether subjective general health mediated the relationship between social networks and subjective well-being and whether the perception of fair payment moderated the mediating effect of subjective general health on subjective well-being. Methods: Data were drawn from round 9 of the European Social Survey (ESS), involving 3,843 respondents from 19 countries, with ages ranging from 65 to 90 years (Meanage = 73.88 ± 6.61 years). The participants completed self-reported measures assessing subjective well-being, social networks, subjective general health, and perception of fair payment. Results: Subjective general health played a mediating role in the relationship between social networks and subjective well-being. The perception of fair payment emerged as a moderator in the mediating effect of subjective general health on the association between social networks and subjective well-being. Conclusion: This study suggests that the impact of social networks on both subjective general health and subjective well-being is contingent upon individuals' perceptions of fair payment. These results highlight the significance of social networks in fostering social connections and promoting overall subjective well-being.

Association Between Abnormal Sleep Duration and Stroke in the United States.

INTRODUCTION: The new American Heart Association Life's Essential 8 construct of ideal cardiovascular health now includes sleep duration. Little is known, however, about sleep duration in individuals with prior stroke. Our objective was to compare sleep duration among individuals with and without prior stroke. METHODS: Using the National Health and Nutrition Examination Surveys (NHANES) database (2005-2018), individuals 18 years or older were identified (n = 37,987 without self-reported stroke; n = 1,572 with self-reported stroke). Prevalence of normal sleep duration (7-8 or 6-8 hours/night because of multiple definitions in the literature) was compared between persons with and without self-reported history of stroke using the Rao-Scott χ2 test. Multinomial logistic regression analysis was used to evaluate the relationship between prior stroke and abnormal sleep before and after adjusting for demographic and clinical variables. RESULTS: Compared with individuals without stroke, those with prior stroke were more likely to report >8 hours/night (unadjusted odds ratio (OR) 2.03, 95% confidence interval (CI) 1.64-2.51), <7 hours/night (1.29, 1.08-1.53), and <6 hours/night (1.87, 1.53-2.29). After adjustment, these associations were attenuated (adjusted OR 1.54, 95% CI 1.22-1.94 and 1.15, 0.96-1.38 and 1.50, 1.21-1.85). DISCUSSION: US stroke survivors are more likely to have abnormal sleep duration than those without prior stroke. Limitations of this study include the cross-sectional and self-reported nature of the data.

Civic knowledge and self-reported political astuteness of academic nurse educators in the United States.

BACKGROUND: A nurse's perspective is unique and invaluable to health policy. Although political astuteness is essential for nurses and nurse educators to be effective participants in health policy, there is a gap in the nursing literature on civic knowledge and its potential relationship to political astuteness. PURPOSE: This research aimed to assess the civic knowledge and self-reported political astuteness of academic nurse educators, their associated factors, and the relationship between these two concepts. METHODS: This cross-sectional study used a national sample of academic nurse educators who answered 10 questions taken from the United States Citizenship and Immigration Services (USCIS) Naturalization test and completed the Political Astuteness Inventory (PAI). RESULTS: Over 51 % of the sample (n = 122) did not provide enough correct answers to pass the Naturalization test and over 35 % were determined to be either completely or slightly unaware politically. There was a medium positive correlation (r = 0.313, p < .001) between civic knowledge and self-reported political astuteness. CONCLUSION: Although nurse educators could be well-positioned to impact health policy, they may not have the knowledge or skills to fulfill this potential. Strategies for improving political astuteness include increasing civic knowledge and encouraging professional collaboration to promote nursing solidarity, influence, and power.

Associations of fear of physical activity, coping style and self-reported exercise behavior in patients with chronic heart failure.

AIMS: Fear of physical activity (PA) is discussed as a barrier to regular exercise in patients with heart failure (HF), but HF-specific theoretical concepts are lacking. This study examined associations of fear of PA, heart-focused anxiety and trait anxiety with clinical characteristics and self-reported PA in outpatients with chronic HF. It was also investigated whether personality-related coping styles for dealing with health threats impact fear of PA via symptom perception. METHODS AND RESULTS: This cross-sectional study enrolled 185 HF outpatients from five hospitals (mean age 62 ± 11 years, mean ejection fraction 36.0 ± 12%, 24% women). Avoidance of PA, sports/exercise participation (yes/no) and the psychological characteristics were assessed by self-reports. Fear of PA was assessed by the Fear of Activity in Situations-Heart Failure (FActS-HF15) questionnaire. In multivariable regression analyses higher NYHA class (b = 0.26, p = 0.036) and a higher number of HF drugs including antidepressants (b = 0.25, p = 0.017) were independently associated with higher fear of PA, but not with heart-focused fear and trait anxiety. Of the three anxiety scores only increased fear of PA was independently associated with more avoidance behavior regarding PA (b = 0.45, SE = 0.06, p < 0.001) and with increased odds of no sports/exercise participation (OR = 1.34, 95% CI 1.03-1.74, p = 0.028). Attention towards cardiac symptoms and symptom distress were positively associated with fear of PA (p < 0.001), which explained higher fear of PA in patients with a vigilant (directing attention towards health threats) coping style (p = 0.004). CONCLUSIONS: Fear of PA assessed by the FActS-HF15 is a specific type of anxiety in patients with HF. Attention towards and being distressed by HF symptoms appear to play a central role in fear of PA, particularly in vigilant patients who are used to direct their attention towards health threats. These findings provide approaches for tailored interventions to reduce fear of PA and to increase PA in patients with HF. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02898246.

Effects of falls on self-rated health and anxiety in Chinese older persons with chronic multimorbidity : moderating role of psychological resilience.

INTRODUCTION: This study investigated the effects of falls on self-rated health and anxiety symptoms and the moderating role of psychological resilience in Chinese older persons with chronic multimorbidity. METHODS: Data were taken from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a linear regression model to evaluate the associations among falls and self-rated health and anxiety symptoms, the moderating role of psychological resilience was verified by moderation analysis, and we also used a replacement model to test robustness. Finally, the results of the study were further verified via heterogeneity analysis through subgroup regression. RESULTS: A total of 2933 people aged 60 years or older with chronic multimorbidity were included in our study. The linear regression results revealed that falls were significantly negatively correlated with the self-rated health symptoms of older Chinese people with chronic multimorbidity (ß = -0.1703, p < 0.01) and significantly positively correlated with anxiety symptoms (ß = 0.5590, p < 0.01). Among the moderating effects, we found that psychological resilience played a moderating role between falls and anxiety symptoms (ß = - 0.151 [-0.217, -0.084], p < 0.01). Finally, we found heterogeneity in the study results by sex, residence and number of chronic diseases. CONCLUSION: Falls are associated with poorer self-rated health and higher anxiety levels among older persons with chronic multimorbidity in China. High levels of psychological resilience have a moderating effect on the development of anxiety symptoms.