Predicting Effective Adaptation to Breast Cancer to Help Women BOUNCE Back: Protocol for a Multicenter Clinical Pilot Study

Background: Despite the continued progress of medicine, dealing with breast cancer is becoming a major socioeconomic challenge, particularly due to its increasing incidence. The ability to better manage and adapt to the entire care process depends not only on the type of cancer but also on the patient's sociodemographic and psychological characteristics as well as on the social environment in which a person lives and interacts. Therefore, it is important to understand which factors may contribute to successful adaptation to breast cancer. To our knowledge, no studies have been performed on the combination effect of multiple psychological, biological, and functional variables in predicting the patient's ability to bounce back from a stressful life event, such as a breast cancer diagnosis. Here we describe the study protocol of a multicenter clinical study entitled "Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back" or, in short, BOUNCE. Objective: The aim of the study is to build a quantitative mathematical model of factors associated with the capacity for optimal adjustment to cancer and to study resilience through the cancer continuum in a population of patients with breast cancer. Methods: A total of 660 women with breast cancer will be recruited from five European cancer centers in Italy, Finland, Israel, and Portugal. Biomedical and psychosocial variables will be collected using the Noona Healthcare platform. Psychosocial, sociodemographic, lifestyle, and clinical variables will be measured every 3 months, starting from presurgery assessment (ie, baseline) to 18 months after surgery. Temporal data mining, time-series prediction, sequence classification methods, clustering time-series data, and temporal association rules will be used to develop the predictive model. Results: The recruitment process stared in January 2019 and ended in November 2021. Preliminary results have been published in a scientific journal and are available for consultation on the BOUNCE project website. Data analysis and dissemination of the study results will be performed in 2022. Conclusions: This study will develop a predictive model that is able to describe individual resilience and identify different resilience trajectories along the care process. The results will allow the implementation of tailored interventions according to patients' needs, supported by eHealth technologies. Trial registration: ClinicalTrials.gov NCT05095675; https://clinicaltrials.gov/ct2/show/NCT05095675. International registered report identifier (irrid): DERR1-10.2196/34564

General Education Learning Outcomes and Demographic Correlates in University Students in Hong Kong

Although there are studies showing that higher education would benefit university students, empirical research that comprehensively assesses student general education learning outcomes and related demographic correlates based on longitudinal data is minimal, especially in the Chinese context. To address the research gaps, the present study was conducted to investigate learning outcomes amongst university students in one university in Hong Kong based on a four-year longitudinal design (N = 460). Four dimensions of student general education learning outcomes were measured, including effective reasoning and problem solving, leadership, moral character, and integration of learning. Results suggested a U-shaped pattern of student learning outcomes for most dimensions, with no improvement or even a decrement in the second year and a steady growth thereafter. While family background did not affect student development, gender showed a significant moderating effect on students’ development in two dimensions (i.e., effective reasoning and problem solving, and integration of learning). These findings suggest that students benefit from general education-embedded university study in multiple dimensions, especially after the first year of transition period. Practical implications of the findings and future research directions were also discussed

Health complaints among adolescents: Associations with more screen-based behaviours and less physical activity

In this study, we investigated the relationship between screen-based behaviours, physical activity, and health complaints (headaches, feeling low, irritability, and nervousness). Screen-based behaviour included TV viewing, computer use, and time spent playing video games. Data were collected from 4462 Portuguese adolescents (2394 girls) aged 11-16 years. Girls who reported engaging in more screen-based behaviour (hours/day) also reported having more headaches, feeling lower, being more irritable, and feeling more nervous. Boys who reported more screen time were more irritable. Physical activity (times/week) was negatively associated with reports of feeling nervous among girls, and with headaches, feeling low, irritability, and feeling nervous among boys. Considering that time spent using the computer is related with more health complaints, and physical activity was related with fewer health complaints among boys, it is important to develop strategies to reduce adolescents' computer screen time, and to promote physical activity. © 2015 The Foundation for Professionals in Services for Adolescents

The impact of the economic crisis on the use of psychotropic medication in Portugal: Preliminary results of the national mental health survey follow-up

IntroductionEconomic crises can contribute to a worsening of mental health problems and, consequently, to a possible increase of the use of psychotropic medication.ObjectivesTo assess the use of psychotropic medication in Portugal before and after the onset of the economic crisis, and to better understand the impact of the economic crisis in this highly hit country.MethodsThis 2015 follow-up epidemiological study re-interviewed a probability sub-sample of respondents to the 2008 national mental health survey, the first nationally representative study of psychiatric morbidity and treatment patterns in Portugal. Socio-demographic and clinical variables were assessed using a structured interview in 2008 (n = 2060) and 2015 (n = 911). All participants were questioned about the last 12 month use of psychotropic medication for mental health problems. Descriptive analysis was conducted to assess the use of psychotropic medication by group and gender in 2008 and 2015.ResultsBetween 2008 and 2015 there was an overall increase in the use of the main groups of psychotropic medication (22.5% to 28.6%), with a particularly relevant increase in the consumption of anti-depressants and anxiolytics. The use of psychotropic medication was higher among women in 2008 and 2015 (31.1% and 36.7%) compared to men. However, the increase in consumption was more relevant in men (13.3% to 20.0%), particularly in relation to anxiolytics (6.0% to 11.6%).ConclusionsThe economic crisis was associated with a substantial increase of psychotropic medication's use in Portugal, consistent with the increased prevalence of mental health problems that this study also found.FundingEEA Grants Programa Iniciativas em Saúde Pública.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Impact of economic crises on mental health care: a systematic review

Aims Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. Methods Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. Conclusions Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis

Services utilization for mental health problems in Portugal during the economic crisis: Preliminary results of the national mental health survey follow-up

IntroductionDuring economic crises additional mental health risks emerge and social inequalities in health can widen. In order to ensure universal coverage of mental health care and to reduce the impact of the crisis, it is crucial to assess the needs of the population to be able to reorganize mental health care accordingly.ObjectivesTo analyse the use of services for mental health problems in Portugal during the economic crisis.MethodsIn this follow-up epidemiological study, a probability sub-sample of respondents to the 2008 national mental health survey (n = 911) was re-interviewed in 2015. Socio-demographic variables and treatment patterns were assessed using a structured interview, and psychological distress was measured using the Kessler-10 Scale. Descriptive analysis was conducted to characterize the use of services for mental health problems.ResultsIn total, 27.9% of the respondents sought treatment for mental health problems in the previous 5 years, and GPs were the most contacted professionals. Only 57.7% (n = 119) of the respondents with moderate or severe psychological distress (n = 197) reported recognizing they needed treatment. Among people with moderate or severe psychological distress who recognized their need for treatment, most received treatment (80.5%, n = 105), which was minimally adequate for 74.4% (n = 81). Low perceived need and structural barriers were the main obstacles for access to care.ConclusionsUnder-treatment, low continuity of care and low adequacy of treatment are problems that the Portuguese health system must address in order to meet the mental health challenges of the economic crisis.FundingEEA Grants: Programa Iniciativas em Saúde Pública.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Financial difficulties, economic hardship and psychological distress during the economic recession in Portugal

IntroductionPortugal is one of the European countries most affected by the Great Economic Recession. Mental health outcomes are likely to deteriorate during this period, with greater proportional impact among those more socially disadvantaged. Self-reported measures of financial difficulties and economic hardship are likely to be associated with psychological distress during this period.ObjectivesTo characterize the relationship between psychological distress and self-reported measures of financial difficulties and type of material deprivation during the Economic Recession in Portugal.MethodsA follow-up epidemiological survey was conducted in 2015, with a probability sub-sample of 911 respondents of the 2008 World Mental Health Survey Initiative Portugal. Psychological distress was evaluated by the Kessler-10 scale. Financial difficulties were assessed by asking the responds if they had enough money for their daily activities. Type of material deprivation considered difficulties in acquiring essential goods, paying debts or buying other goods (clothes or leisure activities). Chi-square analysis were used to evaluate the association between psychological distress, financial difficulties and type of material deprivation.ResultsA statistically significant association (P &lt; 0.05) between psychological distress and financial difficulties was found. Among the respondents that reported not having enough money, 22% reported psychological distress. Regarding the type of material deprivation, a statistically significant association was only found for essential goods.ConclusionsDuring the economic crisis, financial difficulties and material deprivation in essential goods were associated with increased levels of psychological distress, potentially widening social and health inequalities across the Portuguese population.FundingEEA Grants, Programa Iniciativas em Saúde Pública.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

MH Crisis Impact

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Economic Recession and Mental Health Distress: Does Age Matter?

IntroductionThe association between economic crises and mental health problems can be attributed to a number of factors. Among these, age seems to be an important determinant.ObjectivesThe aim of this study was to assess whether mental health of the Portuguese population following the onset of the 2008 recession, differs by age groups.MethodsA follow-up study (2015) on the population aged 18 to &gt; 65 years old, using the National Mental Health Survey (n = 911). The age-group prevalence of mental health distress assessed by the ten-item Kessler's Psychological Distress Scale (K10) was calculated using Chi2 statistics and mental distress as a categorical variable (P &lt; 0.05).ResultsMean mental distress score differed significantly according to age group, χ2(3) = 10.684, P &lt; = 0.05. The results showed that the older groups (50–64 and 65 = years old) were more frequently under mental distress (17–19%) compared to younger people (18–49 = years old), which were less likely to report being distressed (8–12%).ConclusionsAge seems to be an important determinant of distress levels during the economic crisis in Portugal. Older adults reported to be more distressed compared to younger individuals. There are several hypotheses for a differential expression of psychological distress between age groups such as working status and retirement, which can express differential access to coping resources under such contextual negative pressure of economic recession. Further research on age groups is thus needed to better understand how recession generates adverse effects on mental well-being.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec