Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: A cohort study

Context: The short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated. Objectives: The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers. Methods: A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = 301). Sociodemographic, mental health, and bereavement-related data were collected from the caregiver upon the patient\u27s admission to palliative care (T1). Further data addressing circumstances around the death and psychological health were collected at six (T2, n = 167), 13 (T3, n = 143), and 37 months (T4, n = 85) after bereavement. Results: At T4, 5% and 14% of bereaved caregivers met criteria for PGD and subthreshold PGD, respectively. Applying the total PGD score at T4, linear regression analysis found preloss anticipatory grief measured at T1 and self-reported coping measured at T2 were highly statistically significant predictors (both p \u3c 0.0001) of PGD in the longer term. Conclusion: For almost 20% of caregivers, the symptoms of PGD appear to persist at least three years post bereavement. These findings support the importance of screening caregivers upon the patient\u27s admission to palliative care and at six months after bereavement to ascertain their current mental health. Ideally, caregivers at risk of developing PGD can be identified and treated before PGD becomes entrenched

Imputation strategies when a continuous outcome is to be dichotomized for responder analysis: a simulation study

Background: In many clinical trials continuous outcomes are dichotomized to compare proportions of patients who respond. A common and recommended approach to handling missing data in responder analysis is to impute as non-responders, despite known biases. Multiple imputation is another natural choice but when a continuous outcome is ultimately dichotomized, the specifications of the imputation model come into question. Practitioners can either impute the missing outcome before dichotomizing or dichotomize then impute. In this study we compared multiple imputation of the continuous and dichotomous forms of the outcome, and imputing responder status as non-response in responder analysis.MethodsWe simulated four response profiles representing a two-arm randomized controlled trial with a continuous outcome at four time points. We omitted data using six missing at random mechanisms, and imputed missing observations three ways: 1) replacing as non-responder; 2) multiply imputing before dichotomizing; and 3) multiply imputing the dichotomized response. Imputation models included the continuous response at all timepoints, and additional auxiliary variables for some scenarios. We assessed bias, power, coverage of the 95% confidence interval, and type 1 error. Finally, we applied these methods to a longitudinal trial for patients with major depressive disorder. Results: Both forms of multiple imputation performed better than non-response imputation in terms of bias and type 1 error. When approximately 30% of responses were missing, bias was less than 7.3% for multiple imputation scenarios but when 50% of responses were missing, imputing before dichotomizing generally had lower bias compared to dichotomizing before imputing. Non-response imputation resulted in biased estimates, both underestimates and overestimates. In the example trial data, non-response imputation estimated a smaller difference in proportions than multiply imputed approaches. Conclusions: With moderate amounts of missing data, multiply imputing the continuous outcome variable prior to dichotomizing performed similar to multiply imputing the binary responder status. With higher rates of missingness, multiply imputing the continuous variable was less biased and had well-controlled coverage probabilities of the 95% confidence interval compared to imputing the dichotomous response. In general, multiple imputation using the longitudinally measured continuous outcome in the imputation model performed better than imputing missing observations as non-responders.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Alcohol involvement in aggression between intimate partners in New Zealand: a national cross-sectional study

Objectives: To examine the role of alcohol at the time of aggressive incidents between intimate partners in the general population by gender, by estimating (1) prevalence and severity of aggression, and drinking at the time, (2) associations of drinking at the time of the aggression with reported severity, anger and fear, and (3) association of usual drinking patterns with partner aggression. Design: A national survey of 18-70-year-olds using an electoral roll sample obtained self-reported alcohol consumption, partner’s alcohol consumption and details of the most severe partner aggression by the respondent and towards the respondent in the past 2 years. The mean scores for associated severity, anger and fear were analysed by gender and alcohol involvement. Multinomial models estimated associations of drinking patterns with aggression to and from the respondent. Results: The response rate was 49% (n=1925). Men and women reported similar prevalence of victimisation and perpetration of aggression (11-15%). Alcohol was involved in more than 25% of incidents, and reported more by women than by men, particularly male-only drinking when the respondent was the victim. Women reported greater severity, anger and fear with victimisation than men, and drinking was associated with greater reported severity. Heavy episodic drinking by respondents was associated with a threefold increase in victimisation and doubling of perpetration of aggression involving alcohol. Heavy episodic drinking by either partner was also associated with drinking being involved in reported aggression. Conclusions: The experience of intimate-partner aggression in a cross-section of households differs by gender and the involvement of alcohol, and ‘counts’ of aggressive acts in a population-based survey do not reflect the reality of gender differences. Heavy episodic drinking patterns are associated with more aggression involving alcohol within relationships, and alcohol involvement is associated with increased severity

Assessing the Influence of Living and Working Conditions on Alcohol Consumption in Migrant Farmworkers in Mexico

Background and Purpose: Inadequate working and living conditions are associated with alcohol consumption in farmworkers in the U.S. However, the influence of these factors on alcohol consumption patterns in migrant farmworkers in Mexico remains unclear. The purpose of this analysis was to assess the influence of housing and working conditions on alcohol use in migrant farmworkers in Mexico. Methods: We used logistic and ordinal logistic regression to examine the association of living and working conditions on alcohol consumption and frequency in 3,132 farmworkers in Mexico with data from a Mexican national farmworker’s survey. Results: Living in inadequately built homes (OR=0.84; 95% CI=0.72, 0.98; p<0.05) and limited access to luxury items (OR=0.69; 95% CI=0.52, 0.94; p<0.01), were associated with a decreased likelihood to consume alcohol compared to living in better conditions. In contrast, living in employer provided housing (OR=1.79; 95% CI=1.40, 2.31; p<0.0001) and experiencing hazards related to safety (OR= 1.69; 95% CI= 1.35, 2.12; p<0.0001), work organization (OR= 1.29; CI= 1.03, 1.63; p<0.05), and ergonomics (OR= 2.04; CI= 1.18, 3.52; p<0.05) increased the likelihood of consuming alcohol. Conclusion: Living and working conditions of farmworkers may affect alcohol consumption. However, these findings require replication and specific mechanisms, which may influence these results warrants investigation

Handling missing items in the Hospital Anxiety and Depression Scale (HADS): a simulation study

Additional file 1: Appendix S1. Individual results

Self-reported hearing difficulty and its association with general, cognitive, and psychosocial health in the state of Arizona, 2015

BackgroundHearing loss is among the leading causes of disability in persons 65years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health.MethodsA self-report question on hearing was added to the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based survey among community-dwelling adults aged >18years (n=6462). Logistic and linear regression were used to estimate the associations between self-reported hearing loss and health outcomes.ResultsApproximately 1 in 4 adults reported trouble hearing (23.2, 95% confidence interval: 21.8, 24.5%), with responses ranging from a little trouble hearing to being deaf. Adults reporting any trouble hearing were at nearly four times higher odds of reporting increased confusion and memory loss (OR 3.92, 95% CI: 2.94, 5.24) and decreased odds of reporting good general health (OR=0.50, 95% CI: 0.40, 0.64) as compared to participants reporting no hearing difficulty. Those reporting any trouble hearing also reported an average 2.5 more days of poor psychosocial health per month (beta=2.52, 95% CI: 1.64, 3.41). After adjusting for sex, age, questionnaire language, race/ethnicity, and income category the association between diabetes and hearing loss was no longer significant.ConclusionsSelf-reported hearing difficulty was associated with report of increased confusion and memory lossand poorer general and psychosocial health among Arizona adults. These findings support the feasibility and utility of assessing self-reported hearing ability on the BRFSS. Results highlight the need for greater inclusion of the full range of hearing disability in the planning process for public health surveillance, programs, and services at state and local levels.National Institute on Deafness and Other Communication Disorders of the National Institutes of Health [R21/R33 DC013681]; James S. and Dyan Pignatelli/UniSource Clinical Chair in Audiologic Rehabilitation for AdultsOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Resistant starch consumption promotes lipid oxidation

BACKGROUND: Although the effects of resistant starch (RS) on postprandial glycemia and insulinemia have been extensively studied, little is known about the impact of RS on fat metabolism. This study examines the relationship between the RS content of a meal and postprandial/post-absorbative fat oxidation. RESULTS: 12 subjects consumed meals containing 0%, 2.7%, 5.4%, and 10.7% RS (as a percentage of total carbohydrate). Blood samples were taken and analyzed for glucose, insulin, triacylglycerol (TAG) and free fatty acid (FFA) concentrations. Respiratory quotient was measured hourly. The 0%, 5.4%, and 10.7% meals contained 50 μCi [1-(14)C]-triolein with breath samples collected hourly following the meal, and gluteal fat biopsies obtained at 0 and 24 h. RS, regardless of dose, had no effect on fasting or postprandial insulin, glucose, FFA or TAG concentration, nor on meal fat storage. However, data from indirect calorimetry and oxidation of [1-(14)C]-triolein to (14)CO(2 )showed that addition of 5.4% RS to the diet significantly increased fat oxidation. In fact, postprandial oxidation of [1-(14)C]-triolein was 23% greater with the 5.4% RS meal than the 0% meal (p = 0.0062). CONCLUSIONS: These data indicate that replacement of 5.4% of total dietary carbohydrate with RS significantly increased post-prandial lipid oxidation and therefore could decrease fat accumulation in the long-term

Women\u27s preferences for selective estrogen reuptake modulators: an investigation using the time trade off technique

PurposeSelective Estrogen Receptor Modulators (SERMs) reduce the risk of breast cancer for women at increased risk by 38%. However, uptake is extremely low and the reasons for this are not completely understood. The aims of this study were to utilize time trade-off methods to determine the degree of risk reduction required to make taking SERMs worthwhile to women, and the factors associated with requiring greater risk reduction to take SERMs. MethodsWomen at increased risk of breast cancer (N = 107) were recruited from two familial cancer clinics in Australia. Participants completed a questionnaire either online or in pen and paper format. Hierarchical multiple linear regression analysis was used to analyze the data. ResultsOverall, there was considerable heterogeneity in the degree of risk reduction required to make taking SERMs worthwhile. Women with higher perceived breast cancer risk and those with stronger intentions to undergo (or who had undergone) an oophorectomy required a smaller degree of risk reduction to consider taking SERMs worthwhile. ConclusionWomen at increased familial risk appear motivated to consider SERMs for prevention. A tailored approach to communicating about medical prevention is essential. Health professionals could usefully highlight the absolute (rather than relative) probability of side effects and take into account an individual’s perceived (rather than objective) risk of breast cancer

Lexical deconstruction—review of Giegerich, H., Lexical structures: Compounding and the modules of grammar, Edinburgh Studies in Theoretical Linguistics, vol. 1

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