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Intrusion symptoms are a core defining feature of posttraumatic stress disorder (PTSD). It was recently proposed that intrusions may be comprised of two distinct underlying processes: internally-cued intrusions (e.g., trauma-related memories), and externally-cued intrusions (e.g., reactivity to trauma-related cues in one's environment). This is the first study to examine the functional correlates of these two intrusion clusters. Participants included 7460 veterans discharged from 40 Veterans Affairs PTSD residential programs across the United States in fiscal years 2018 through 2020. Latent network modeling and structural equation modeling were used to assess the fit of an 8-factor model of PTSD symptoms, which were assessed using the PTSD Checklist for DSM-5 (PCL-5) PTSD symptoms at admission, and its association with symptoms of depression and generalized anxiety, and emotional and physical functioning. The 8-factor model, with separate intrusion factors, showed superior model fit to the DSM-5 4-factor, 5-factor dysphoric arousal, 6-factor anhedonia, and 7-factor hybrid models of PTSD. Internally-cued intrusions were uniquely associated with dysphoric arousal, decreased avoidance, and worse physical health functioning; whereas, externally-cued intrusions were uniquely associated with greater avoidance, anxious arousal, negative affect, increased generalized anxiety symptoms, and worse emotional functioning. Limitations include the cross-sectional design and use of self-report measures. Findings provide initial support for the clinical utility of a novel 8-factor model of PCL-5 PTSD symptoms, which distinguishes internally- and externally-cued intrusions. These separate intrusion symptom clusters may offer greater specificity and utility in informing the prognosis of and tailored interventions for PTSD. • Intrusions are a core, defining symptom cluster of PTSD. • Internally- v. externally-cued intrusions may represent distinct constructs. • Novel 8-factor model of PTSD showed superior model fit. • Internally- and externally-cued intrusions showed distinct associations with correlates. • New PTSD model with separate intrusion clusters may offer clinical utility. [ABSTRACT FROM AUTHOR]

Although insomnia is a common core symptom of major depressive disorder (MDD), the burden of moderate-to-severe insomnia symptoms in patients with MDD is not well-understood. This study quantified the clinical, patient-centric, and economic burden of adults with MDD with moderate-to-severe insomnia symptoms (MDDIS) compared to adults with MDD with no-to-mild insomnia symptoms (other-MDD) and adults without MDD. Data from 2019 US National Health and Wellness Survey identified adults self-reporting physician-diagnosed depression, stratified by insomnia status (MDDIS: Insomnia Severity Index [ISI] score ≥15; other-MDD: ISI score <15), and adults not reporting depression (non-MDD). Other-MDD and non-MDD were matched 2:1 to MDDIS on age/sex/race. Matched bivariate analyses examined differences in health-related outcomes by depression-insomnia status. Of 74,994 survey respondents, 2045 (2.7%) were classified as MDDIS, 8220 (11.0%) as other-MDD, and 59,859 (79.8%) as non-MDD. MDDIS respondents (vs other-MDD and non-MDD) reported greater depression severity, anxiety severity, daytime sleepiness, activity impairment, direct costs, and costs due to work productivity impairments, and lower mental and physical functioning (all P < 0.05). Depression diagnosis was not based on clinical/diagnostic interview; causal relationships cannot be determined due to the cross-sectional design. Among US adults with MDD, presence of moderate-to-severe insomnia symptoms is associated with additional burden and notable impairments across several health outcomes versus those with MDD but no-to-minimal insomnia symptoms and general population without MDD. This study highlights the burden of MDDIS and the need for better identification and management of moderate-to-severe insomnia symptoms in adults with MDD. • This study quantifies the burden of MDD with moderate-to-severe insomnia (MDDIS) • Higher depressive, anxiety, and daytime sleepiness symptoms in adults with MDDIS • Higher direct costs and work productivity impairment costs in adults with MDDIS • Lower mental and physical functioning in adults with MDDIS • Burden of MDDIS was significant even when controlling for other depressive symptoms [ABSTRACT FROM AUTHOR]

Background: Lumbar disc herniations (LDH) are among the most common spinal conditions. Despite increased appreciation for the importance of social determinants of health, the role that these factors play in patients with lumbar disc herniations is poorly defined.Purpose: To elucidate the association between insurance status and baseline patient reported outcome measures (PROMs) in the setting of lumbar disc herniations.Study Design/setting: Retrospective cohort study PATIENT SAMPLE: Baseline patient-reported outcome measures (PROMS) were reviewed from 924 adult patients presenting for treatment of lumbar disc herniation within our institutional healthcare system (2015-2020).Outcome Measures: The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical, and visual analogue scale (VAS) for back and leg pain were assessed.Methods: PROMIS scores at presentation were defined at the primary outcome and insurance status as the primary predictor. Differences in clinical and sociodemographic characteristics between our cohorts, stratified by insurance status, were evaluated using Wilcoxon rank-sum or chi-squared testing. We used multivariable negative binomial regression modeling to adjust for potential confounders including age, gender, race, language, ethnicity, comorbidity index, and median geospatial household income.Results: We included 924 patients, with mean age of 58.4 +/- 15.2 years and 52.6% male prevalence. Patients insured through Medicaid were more likely to be Black, Hispanic, and non-English speaking patients compared with the commercially insured. The Charlson Comorbidity index was significantly higher in the Medicare group. Following adjusted analysis, patients with Medicaid insurance had significantly worse PF10a (IRR, 0.90, 95% CI 0.85-0.96), as well as PROMIS Global-Physical score (IRR 0.88, 95% CI 0.82-0.94), and VAS low back pain (IRR 1.20, 95% CI 1.04-1.40) when compared to the commercially insured.Conclusions: We encountered worse physical function, mental, and pain-related patient-reported outcomes for those with Medicaid insurance in a population of patients presenting for evaluation of lumbar disc herniation. These findings, including worse depression, anxiety, and higher axial back pain scores, merit further investigation into potential health system asymmetries, and should be accounted for by treating providers. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine whether responses to Patient-Reported Outcomes Measurement Information System Short Form v2.0 - Physical Function 8c (PROMIS PF8c) items differed when the use of a 7-day recall period was compared with no specified recall period.Methods: Using a within-subject design, we surveyed 1810 individuals from the US general population, administering PROMIS PF8c at survey beginning and end. The order of measure presentation was randomly assigned. We calculated recall difference scores (RDSs) as no recall score minus 7-day recall score using both item response theory-based T scores and raw summed scores. We examined the distribution and created Bland-Altman plots for both RDSTscore and RDSRaw. We also calculated correlations between no recall versus 7-day recall T score and raw scores. Finally, we determined whether differences in no recall versus 7-day recall scores were associated with patient-reported PF.Results: RDSTscore and RDSRaw had means (root mean square differences) of 0.00 (5.43) and -0.04 (3.79), respectively. The vast majority (%) of RDSTscore and RDSRaw values fell between the Bland-Altman limits of agreement (-10.65 to 10.66 and -7.46 to 7.38, respectively). Pearson's correlations between no recall and 7-day recall for T scores and raw scores were 0.88 and 0.87, respectively. Effect sizes for mean RDSTscore and RDSRaw compared across level of Eastern Oncology Cooperative Group performance status, patient global impression of PF severity, and single PF items were near 0.Conclusions: We did not find any significant recall period effect on PF8c responses. Therefore, we recommend the use of the PROMIS physical function standard, with no specified recall time period. [ABSTRACT FROM AUTHOR]

Early-stage lung cancer survivors are a growing population. A comprehensive plan to address needs relevant to longer survival (e.g., psychological distress, persistent symptoms, physical function) and clinic capacity is necessary. How to deliver comprehensive survivorship care that meets national standards and results in improved patient outcomes is a challenge. Survivorship clinics staffed by advanced practice providers (APP) are an option to address these needs. In June 2019, Atrium Health Wake Forest Baptist Comprehensive Cancer Center (AHWFB-CCC) opened a dedicated survivorship clinic. Stakeholders from the lung cancer disease-oriented team developed a standard referral pathway for patients to survivorship. A standard workflow was developed in the electronic medical record. Eligible lung cancer survivors were referred to the Lung Cancer Survivorship Clinic for a survivorship orientation visit (SOV) with a lung cancer specific APP. Prior to the SOV, a welcome video, disease-specific questionnaire, and electronic patient reported outcome (ePRO) tools (i.e., PROMIS-29 and Distress Thermometer) were sent to the patients' electronic chart. At the SOV, the ePRO responses and survivorship care plan were reviewed. Patients were offered a post visit survey. A comparison of PROMIS-29 Scores to the United States (US) lung cancer survivor population was performed using a T-test. PROMIS-29 T-score responses based on treatment modality were also compared using T-test. Results: From January 2020 to March 2023, 315 lung cancer patients completed a SOV. Most patients were able to complete the pre-visit questions via the electronic chart. AHWFB-CCC survivors reported improved PROMIS-29 T-Scores compared to the average United States (US) early-stage lung cancer survivor, with meaningfully better scores (≥ 3 pts) in four of the seven health-related domains measured. PROMIS-29 T-Scores did not differ by treatment modality (all p values >0.05). Most patients found the SOV helpful and expressed better understanding of their cancer treatment and side effects after the SOV. Our model of an optimized electronic medical record pathway paired with an APP led survivorship visit is feasible and can address current challenges in providing survivorship care to early-stage lung cancer survivors. Survivors had similar ePROs regardless of treatment modality, indicating their survivorship care could be consolidated. Future evaluation is needed to establish if this care model improves outcomes over subsequent visits, minimizes the effect of health disparities, or enhances care capacity. [ABSTRACT FROM AUTHOR]

Background: About 50% of Americans and 70% of US military service members use dietary supplements (DSs).Objectives: This cross-sectional survey examined current prevalence of and factors associated with DS use in service members.Methods: A stratified random sample of 200,000 service members from the Air Force, Army, Marine Corps, and Navy was obtained from military manpower records, and these service members were asked to complete a questionnaire on their DS use and personal characteristics. Chi-square statistics and multivariable logistic regression examined differences across various strata of demographic, lifestyle, and military characteristics.Results: About 18% of successfully contacted service members (n = 26,681) completed the questionnaire between December 2018 and August 2019 (mean ± SD age: 33 ± 8 y, 86% male). Overall, 74% reported using ≥1 DS/wk. Multivitamins/multiminerals were the most commonly used DSs (45%), followed by combination products (44%), proteins/amino acids (42%), individual vitamins/minerals (31%), herbals (20%), joint health products (9%), and purported prohormones (5%). In multivariable analysis, factors independently associated with DS use included female gender [OR (female/male): 1.91; 95% CI: 1.73, 2.11], older age [OR (≥40/18-24 y): 1.25; 95% CI: 1.08, 1.44], higher education level [OR (college degree/high school or less): 1.35; 95% CI: 1.19, 1.53], higher BMI [OR (≥30/<25 kg/m2): 1.37; 95% CI: 1.25, 1.52], more weekly resistance training [OR (>300/≤45 min/wk): 5.05; 95% CI: 4.55, 5.61], smokeless tobacco use [OR (user/nonuser): 1.30; 95% CI: 1.17, 1.44], higher alcohol intake [OR (≥72/0 mL/wk): 1.41; 95% CI: 1.29, 1.54], and higher military rank [OR (senior officer/junior enlisted): 1.26; 95% CI: 1.06, 1.51].Conclusions: Compared with civilian data from the NHANES, service members were much more likely to use DSs and used different types of DSs, especially combination products and proteins/amino acids often used to purportedly enhance physical performance. Comparisons with previous military data suggest DS use has increased over time. [ABSTRACT FROM AUTHOR]

There is an increase in older-adult renal transplant recipients in United States. The objective of this study was to assess the association between physical function (PF) and patient survival in renal transplant recipients who are aged 65 years or older. Using United Network for Organ Sharing (UNOS) data from 2007 to 2016, renal transplant recipients aged 65 years or older were included. Multivariable Cox regression was used to assess associations between survival and functional status adjusted for age, sex, race, donor quality, diabetes, and dialysis vintage. The study identified 26,721 patients. Patient survival was significantly higher in recipients who needed no assistance and lowest in patients in need of total assistance (P <.0001). In deceased donor (DD) transplants, the relative risk for mortality was 2.06 (1.74-2.43) for total assistance and 1.17 (1.08-1.28) for moderate assistance compared to no assistance (P <.0001). In living donor (LD) transplants, the relative risk of mortality was 1.38 (0.78-2.42) for patients needing total assistance and 1.37 (1.14-1.65) for patients needing moderate assistance compared to patients who did not need assistance (0.003). PF is an independent predictor of post-transplant mortality. Assessment of older potential renal transplant recipients should include assessment and standardization of functional status to counsel about post-transplant survival. • There is an increase in older renal transplant recipients in the United States. • Poor physical function has an adverse association with both patient and graft survival independent of age and other adjusters such as diabetes and dialysis at listing. • This impact is seen both in recipients of deceased and living donor kidneys, although the impact is greater among the recipients of deceased donor kidneys. • Physical dysfunction should be considered a component of evaluation and counseling. [ABSTRACT FROM AUTHOR]

• Pressure ulcer prevalence remains high in nursing home residents with diabetes. • One third of residents with a pressure ulcer had an ulcer of stage 2 or greater. • The strongest risk factors included physical dependance, urinary incontinence, and bowel incontinence. Introduction: Nearly a third of US nursing home residents have diabetes mellitus. These residents have an increased risk of pressure ulcer (PU) development and progression; however, little is known about the characteristics of their PUs or the role of other risk factors. This study estimates the prevalence of PUs, describes characteristics of PUs, and quantifies associations between risk factors and PUs in nursing home residents with diabetes. Methods: We conducted a cross-sectional study of nursing home residents aged ≥50 years with diabetes mellitus using national 2016 Minimum Data Set 3.0 data. Pressure ulcers were defined as the presence of any stage PU and by subgroups of stage and tissue type. Prevalence estimates of PUs were calculated overall and by covariate subgroups. Unadjusted and adjusted odds ratios were calculated using logistic regression. Results: The prevalence of any unhealed PU was 8.1%. Of those with a PU, 19.4% had at least two ulcers and the most common subtypes were identified as unstageable and stage 2 ulcers. These were most often treated by pressure reducing devices. In our fully adjusted model, risk factors that were strongly associated with PUs were related to mobility, nutrition, incontinence, and infections. Conclusion: We observed that the prevalence of PUs remains high in nursing home residents with diabetes and that higher stage ulcers were common in this population. Our adjusted model highlights the importance of suspected risk factors in the development of PUs. Further research is needed to understand the unique needs of nursing home residents with diabetes. [ABSTRACT FROM AUTHOR]

Background: Although substance use disorder (SUD) is frequently complicated by pain, the prevalence and correlates of persistent pain and dysfunction following SUD remission have not been studied.Methods: Using a cross-sectional sample of United States (US) adults with SUD identified in the National Epidemiologic Survey on Alcohol and Related Conditions Wave III, we evaluated the prevalence of moderate/severe pain interference (PI) in subgroups with current and remitted SUD and the independent association of SUD remission and PI with self-reported psychosocial and physical function (Mental Health Composite Score [MCS] and Physical Function Score [PFS] from the Short Form 12).Results: A fifth (20.6%; 7.6 million) of estimated 36.7 million US adults with past year SUD and a slightly higher proportion (25.6%; 9.6 million) of 37.4 million with SUD remission reported PI. MCS and PFS showed independent negative associations with PI among adults with both past year SUD and SUD remission. MCS had a positive independent association with SUD remission, but a stronger negative association with PI. While PFS had no statistically significant association with SUD remission, it had a strong negative association with PI. Analysis of interaction between SUD remission and PI revealed that SUD remission had no effect on the association of PI and MCS but had significant moderating influence on the association between PI and PFS.Conclusions: Moderate to severe pain interference continues to be a significant problem among a sizable population achieving SUD remission potentially impeding recovery, and deserves focused clinical attention both active SUD and its remission. [ABSTRACT FROM AUTHOR]

Psychological traits, such as character strengths, have been already established in experimental studies as factors playing a favorable role for well-being and potentially reducing the risk of depression. Positive associations have been also reported between character strengths and physical fitness, self-reported physical and mental health. Yet, evidence with large scale, epidemiological data on the role of character strength of honesty and integrity (CSHI) in shaping subsequent health outcomes and daily functioning remains unexplored. We examined whether the character strength of honesty and integrity was prospectively associated with six physical health outcomes, two depression outcomes, and two daily functioning outcomes. We used data from the Health and Retirement Study obtained from a sample of 9813 older adults. We found that after a 4-year follow-up period, compared with individuals who scored the lowest in CSHI, participants who scored in the third tertile had a 18% lower risk of lung disease (RR = 0.824; 95% CI = 0.732; 0.927), and a 11% lower risk of depression (RR = 0.891; 95% CI = 0.806; 0.986). They also reported lower limitations in mobility (β = −0.048; 95% CI (−0.089; −0.008)] and less difficulty in instrumental activities of daily living [β = −0.088; 95% CI (−0.128; −0.047)]. These associations were independent of demographics, prior socioeconomic status, psychological factors, health conditions, and health behaviors. Policy makers and practitioners may consider the character strength of honesty and integrity as a factor for promoting healthy longevity, limiting risks of becoming physically inactive and reducing risk of physical and mental disease. • The role of character strength of honesty and integrity (CSHI) for health is examined. • CSHI is a significant predictor of subsequent physical and mental health outcomes. • CSHI is significantly associated with subsequent daily functioning outcomes. • CSHI may be a factor for promoting healthy longevity. [ABSTRACT FROM AUTHOR]

During the early 2020 COVID-19 pandemic, several US states had implemented stay-in-place orders (SIPOs) with varying degrees of stringency which resulted in inter-state differences in mobility (i.e., longer presence at home). We test whether the inter-state differences in mobility influenced changes in reported psychological distress. Our study is not on the surge in COVID-19 in the later part of 2020. To identify whether the change in state-level mobility is associated with the change in individuals' reported psychological distress during the early COVID-19 pandemic and whether the intensity of the association varies by older individuals, females, and nonwhites. We use differences in state-level mobility and change in reported psychological distress between the two dates of interviews of 5,132 individuals who participated in March and April 2020 waves of Understanding America Study (UAS). We find support for modest effects, i.e., a one standard deviation decline in mobility was associated with a 3.02% higher psychological distress [95% CI: 0.4%–5.64%], and the effects are robust to controlling for reported changes in exercise intensity, alcohol consumption, cannabis use, recreational drug use, and meditation intensity. We also find support for a stronger association for females, but not for older individuals or non-whites. Further, we do not find support for the mediation effects from change in chance of running out of money or change in chance of getting COVID-19. Our findings show that reduced mobility from lockdowns during the early COVID-19 wave in the US is associated with a modest increase in reported psychological distress, especially for females. However, these conclusions should not be construed as a small increase in psychological distress in general, as a variety of non-mobility related factors associated with COVID-19 could have exacerbated psychological distress during the early COVID-19 wave in the US. • Did reduced mobility early in 2020 COVID-19 pandemic affect psychological distress? • Used two waves of Understanding America Study individual survey for analysis. • Found that decline in mobility is associated with modest increase in distress. • Found evidence of stronger association especially among females. [ABSTRACT FROM AUTHOR]