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Journal of Pain and Symptom Management Jul 2022The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps... (Review)
Review
OBJECTIVE
The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps in the exploration of underlying mechanisms that produce these disparities.
BACKGROUND
Countless studies over several decades have revealed that our healthcare system in the United States consistently produces poorer quality end-of-life care for Black compared with White patients. Effective interventions to reduce these disparities are sparse and hindered by a limited understanding of the root causes of these disparities.
METHODS
We searched PubMed, CINAHL and PsychInfo for research manuscripts that tested hypotheses about causal mechanisms for disparities in end-of-life care for Black patients. These studies were categorized by domains outlined in the National Institute of Minority Health and Health Disparities (NIMHD) framework, which are biological, behavioral, physical/built environment, sociocultural and health care systems domains. Within these domains, studies were further categorized as focusing on the individual, interpersonal, community or societal level of influence.
RESULTS
The majority of the studies focused on the Healthcare System and Sociocultural domains. Within the Health Care System domain, studies were evenly distributed among the individual, interpersonal, and community level of influence, but less attention was paid to the societal level of influence. In the Sociocultural domain, most studies focused on the individual level of influence. Those focusing on the individual level of influence tended to be of poorer quality.
CONCLUSIONS
The sociocultural environment, physical/built environment, behavioral and biological domains remain understudied areas of potential causal mechanisms for racial disparities in end-of-life care. In the Healthcare System domain, social influences including healthcare policy and law are understudied. In the sociocultural domain, the majority of the studies still focused on the individual level of influence, missing key areas of research in interpersonal discrimination and local and societal structural discrimination. Studies that focus on individual factors should be better screened to ensure that they are of high quality and avoid stigmatizing Black communities.
Topics: Black or African American; Black People; Healthcare Disparities; Humans; Minority Groups; Terminal Care; United States
PubMed: 35381316
DOI: 10.1016/j.jpainsymman.2022.03.017 -
Frontiers in Public Health 2022Environmental resources are related to childhood obesity risk and altered brain development, but whether these relationships are stable or if they have sustained impact...
BACKGROUND
Environmental resources are related to childhood obesity risk and altered brain development, but whether these relationships are stable or if they have sustained impact is unknown. Here, we utilized a multidimensional index of childhood neighborhood conditions to compare the influence of various social and environmental disparities (SED) on body mass index (BMI)-brain relationships over a 2-year period in early adolescence.
METHODS
Data were gathered the Adolescent Brain Cognitive Development Study ( = 2,970, 49.8% female, 69.1% White, no siblings). Structure magnetic resonance imaging (sMRI), anthropometrics, and demographic information were collected at baseline (9/10-years-old) and the 2-year-follow-up (11/12-years-old). Region of interest (ROIs; 68 cortical, 18 subcortical) estimates of cortical thickness and subcortical volume were extracted from sMRI Tw images using the Desikan atlas. Residential addresses at baseline were used to obtain geocoded estimates of SEDs from 3 domains of childhood opportunity index (COI): healthy environment (COI), social/economic (COI), and education (COI). Nested, random-effects mixed models were conducted to evaluate relationships of BMI with (1) ROI COI and (2) ROI COI Time. Models controlled for sex, race, ethnicity, puberty, and the other two COI domains of non-interest, allowing us to estimate the unique variance explained by each domain and its interaction with ROI and time.
RESULTS
Youth living in areas with lower COI and COI scores were heavier at the 2-year follow-up than baseline and exhibited greater thinning in the bilateral occipital cortex between visits. Lower COI scores corresponded with larger volume of the bilateral caudate and greater BMI at the 2-year follow-up. COI scores showed the greatest associations ( = 20 ROIs) with brain-BMI relationships: youth living in areas with lower COI had thinner cortices in prefrontal regions and larger volumes of the left pallidum and Ventral DC. Time did not moderate the COI x ROI interaction for any brain region during the examined 2-year period. Findings were independent of family income (i.e., income-to-needs).
CONCLUSION
Collectively our findings demonstrate that neighborhood SEDs for health-promoting resources play a particularly important role in moderating relationships between brain and BMI in early adolescence regardless of family-level financial resources.
Topics: Humans; Child; Adolescent; Female; Male; Body Mass Index; Pediatric Obesity; Ethnicity; Brain; Income
PubMed: 36589997
DOI: 10.3389/fpubh.2022.1061049 -
Andes Pediatrica : Revista Chilena de... Aug 2022To describe psychomotor development (PMD) trajectories and nutrition in children fed with breastfeeding (BF) and to evaluate possible associations.
OBJECTIVE
To describe psychomotor development (PMD) trajectories and nutrition in children fed with breastfeeding (BF) and to evaluate possible associations.
SUBJECTS AND METHOD
Prospective co hort of full-term infants, without known pathologies, fed with BF. The intake of BF was evaluated with an isotopic technique at three months. At six successive ages, the nutritional status was evaluated according to the body mass index (BMI) for age and the PMD using the Ages and Stages Questionnai re (ASQ-3). Children who had at least two follow-up evaluations were included. Multivariate analysis of the trajectories by the PMD domain was performed according to BMI/A and BF, controlled by bio- socio-demographic variables.
RESULTS
53 children were included (60% male), 76 % were eutrophic, and 62% and 38% were fed exclusively or predominantly with BF, respectively. The nutritional and PMD trajectories were stable and within the normal range; there were no infants in the obesity ran ge. In the multivariate analysis, the Communication domain was significantly associated with BMI (p = 0.049) and BF (p = 0.032). Problem Solving domain was associated with BMI (p = 0.040). No significant associations were found in the trajectories of motor and socio-individual domains. Con clusion: The nutritional trajectories and each PMD domains were stable and within normal ranges. Exclusive BF was associated with a better Communication trajectory, while the BMI was associated with better Communication and Problem-Solving.
Topics: Infant; Female; Humans; Child; Male; Breast Feeding; Nutritional Status; Prospective Studies; Body Mass Index; Obesity
PubMed: 37906852
DOI: 10.32641/andespediatr.v93i4.4107 -
Social Psychiatry and Psychiatric... Jan 2024Social exclusion is a multidimensional concept referring processes which restrict the ability of individuals or groups to participate fully in society. While social...
BACKGROUND
Social exclusion is a multidimensional concept referring processes which restrict the ability of individuals or groups to participate fully in society. While social exclusion has been used to explore patterns of disadvantage, it has been difficult to measure. Thus, we aimed to use population-based data to measure social exclusion and its constituent domains and to describe its distribution in England.
METHODS
We used data from Understanding Society in 2009/2010 develop a multidimensional measurement approach, replicated in 2018/2019. We defined five domains of social exclusion from the literature and expert consultation: material, relational, political, digital, and structural. In both waves, we identified measures for each domain, then conducted principal component analysis to identify the components. We generated domain scores and an overall social exclusion score. We described the distribution of social exclusion and its domains by sex, region, age, and ethnicity.
RESULTS
We found the level of social exclusion was higher in the youngest age group and decreased by age. We found elevated levels of overall social exclusion for ethnic minoritised groups including African, Arab, and Caribbean groups compared to White British groups. We found distinct patterns within each domain.
DISCUSSION
We developed an overall measure of social exclusion with five domains, and finding distinct patterns of social exclusion by age, ethnicity, and region which varied across domain. These findings suggest that attention should be paid to the separate domains due to different population distributions. This measurement approach moves beyond conceptual discussions of social exclusion and demonstrates the utility of a quantitative measure of social exclusion for use in health and social research.
Topics: Humans; England; Ethnicity; Social Isolation; Minority Groups; Age Factors
PubMed: 37160438
DOI: 10.1007/s00127-023-02489-x -
Pediatric Neurology Apr 2023We investigated the influence of relevant demographic, clinical, neuropsychological, and psychosocial variables on the proxy-reported quality of life (QOL) of children...
BACKGROUND
We investigated the influence of relevant demographic, clinical, neuropsychological, and psychosocial variables on the proxy-reported quality of life (QOL) of children with cerebral palsy (CP).
METHODS
The proxy-reported Cerebral Palsy Quality of Life-Child questionnaire (CP QOL-Child) was completed by 58 children with CP (mean age 10.22 years, SD 1.67). Relationships between QOL scores and demographic, clinical, neuropsychological, and psychosocial variables were assessed. CP QOL scores and other variables that correlated significantly were introduced into a multiple linear regression model.
RESULTS
Executive functioning and motor functional status were explanatory variables for the CP QOL total score. Executive functions explained three specific QOL domains: Social Wellbeing and Acceptance, Feelings about Functioning, and Emotional Wellbeing and Self-esteem. Parental stress also explained Social Wellbeing and Acceptance. Motor functional status and visual perception were explanatory variables for the Access to Services domain. Finally, autism spectrum disorder (ASD) traits were an explanatory variable for the Participation and Physical Health domain.
CONCLUSION
Executive functioning and motor functional status importantly influence QOL of children with CP. Visual perception, ASD symptoms, and parental stress variables are related with specific QOL domains. These findings demonstrate that interventions targeting cognitive functions in children with CP may positively influence QOL.
Topics: Humans; Child; Quality of Life; Cerebral Palsy; Autism Spectrum Disorder; Surveys and Questionnaires; Multivariate Analysis
PubMed: 36805966
DOI: 10.1016/j.pediatrneurol.2023.01.006 -
Journal of Pediatric... 2023There are specific gaps that call for empirical research in the experiences of spiritual well-being among children 12 years old and younger with cancer. Understanding...
There are specific gaps that call for empirical research in the experiences of spiritual well-being among children 12 years old and younger with cancer. Understanding these relationships can help to develop holistic and family centered care in pediatric oncology wards. This study assessed the spiritual well-being of children with cancer in association with their general well-being, happiness, quality of life, pain intensity, and personal characteristics. The data were collected in Lithuania between June 2020 and November 2021. Children with cancer ( = 81) who were hospitalized at pediatric oncology-hematology centers participated in the study. Inclusion criteria were age (from 5 to 12 years old), diagnosis of oncologic disease for the first time, and absence of other chronic diseases. The instruments used were: Feeling Good, Living Life; Oxford Happiness Questionnaire, Short Form; Well-Being Index; PedsQL™3.0 Cancer Module, and a Wong-Baker FACES® Pain Rating Scale. Communal and personal domains of spiritual well-being had the highest scores among pediatric oncology patients while both dimensions of the transcendental domain scored lowest. Age, level of education, and family composition revealed differences in children's spiritual health, happiness, and well-being, and church attendance was significant for overall spiritual well-being and its transcendental domain on lived experience dimension. Happiness had the strongest effect on all four domains of spiritual well-being. Children emphasized the importance of spiritual aspects to feel better to a greater extent than they experienced in their lives. Despite their young age, children were familiar with family traditions, that is, religious practice and church attendance, and followed them in a particular sociocultural context.
Topics: Humans; Child; Child, Preschool; Spirituality; Quality of Life; Neoplasms; Pain; Chronic Disease
PubMed: 37306185
DOI: 10.1177/27527530231168592 -
Harm Reduction Journal Apr 2021Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients...
BACKGROUND
Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients with pharmacological opioid maintenance treatments according to different socio-demographic characteristic, health and disabilities domains and sexual difficulties.
METHODS
A total of 593 patients from the Andalusia community, 329 were undergoing methadone treatment and 264 were undergoing buprenorphine treatment. The patients were interviewed by socio-demographic and opioid-related variables, assessed by functioning, disability and health domains (WHODAS 2.0.) and for sexual problems (PRSexDQ-SALSEX).
RESULTS
We found significant differences in the socio-demographic and the opioid-related variables as the onset of opioid use, being on previous maintenance programs, opioid intravenous use, the length of previous maintenance programs, polydrug use and elevated seroprevalence rates (HCV and HIV) between the methadone group and the buprenorphine group. Regarding health and disability domains there were differences in the Understanding and communication domain, Getting around domain, Participation in society domain and in the WHODAS 2.0. simple and complex score, favoring buprenorphine-treated patients. The methadone group referred elevated sexual impairments compared with the buprenorphine group. Opioid-related variables as seroprevalence rates, other previous lifetime maintenance program, the daily opioid dosage and the daily alcohol use are the most discriminative variables between both groups. Participation in society variables and sexual problems were the most important clinical variables in distinguishing the methadone group from the buprenorphine group regarding their functional status.
CONCLUSIONS
The methadone group showed higher prevalence in opioid dependence-related variables, elevated disabilities in participation in society activities and sexual problems compared with the buprenorphine group. This study shows the importance of carry out a functional evaluation in the healthcare follow-up, especially in those areas related with social activity and with sexual problems.
Topics: Buprenorphine; Functional Status; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Seroepidemiologic Studies
PubMed: 33849574
DOI: 10.1186/s12954-021-00488-2 -
The Angle Orthodontist May 2021(1) To assess the effectiveness of the Orthognathic Quality of Life Questionnaire (OQLQ) and the Child Oral Health Impact Profile (COHIP) to detect differences in Oral...
OBJECTIVES
(1) To assess the effectiveness of the Orthognathic Quality of Life Questionnaire (OQLQ) and the Child Oral Health Impact Profile (COHIP) to detect differences in Oral Health-Related Quality of Life (OHRQoL) between pediatric patients with dentofacial deformities and controls. (2) To assess for correlations between scores from the OQLQ and COHIP domains with the type and severity of the skeletal mal-relationship. (3) To assess if the COHIP and OQLQ were identifying unique or overlapping OHRQoL concerns.
MATERIALS AND METHODS
Subjects were under age 18, presented with a dentofacial deformity, and completed both surveys. Matched controls completed the same. Severity for conditions was recorded via overjet, overbite, and ANB values and subjects were classified as skeletal Class I, II, or III.
RESULTS
Enrollment yielded 30 subjects and 31 controls. For the OQLQ, significant differences between subjects and controls were found for the Facial Esthetics domain, Oral Function domain, and total score. For the COHIP, significant differences were found for the Social/Emotional Well-Being and Self-Image domains plus total score. There were no significant correlations between the severity of the condition as measured by overjet and reported OHRQoL for any domains.
CONCLUSIONS
The OQLQ and COHIP are effective at detecting significant OHRQoL differences between pediatric patients with dentofacial deformities and controls. Although there is some overlap in the results, the instruments appear to identify different OHRQoL concerns.
Topics: Adolescent; Child; Humans; Oral Health; Quality of Life; Self Concept; Surveys and Questionnaires
PubMed: 33449101
DOI: 10.2319/051820-448.1 -
PsyCh Journal Apr 2020Schizophrenia, bipolar disorder, and related psychotic illnesses are common, serious mental disorders that are often associated with functional impairments and poor...
Schizophrenia, bipolar disorder, and related psychotic illnesses are common, serious mental disorders that are often associated with functional impairments and poor quality of life, even after clinical recovery. Cognitive dysfunction is a strong predictor of functional impairment; however, findings regarding relative impairments in functioning and cognition across diagnoses have been mixed, as have reports of the contribution of clinical symptoms and other illness features to functioning across diagnostic boundaries. We assessed 211 patients with psychotic disorders and 87 healthy controls using the MATRICS Consensus Cognitive Battery, clinical measures of state mood and psychotic symptoms, and an interview measure of community functioning. Diagnostic groups were compared on MATRICS composite and domain scores, and clinical and functional measures. We then examined cognitive, clinical, and demographic predictors of community functioning using stepwise hierarchical linear regression. All three patient groups exhibited deficits in most cognitive domains relative to controls, and significantly poorer community functioning. While scores on most cognitive domains did not differ by diagnosis, when groups did differ patients with schizophrenia performed worse than patients with bipolar disorder. Cognition was correlated with functioning across the sample. The final regression model included negative symptoms, mania, social cognition, and processing speed, and explained 47% of the variance in community functioning scores across patient groups. Residual negative symptoms, residual mania, and social cognition significantly and independently predicted community functioning. These findings indicate that, while all cognitive domains are associated with community outcomes, when considered together and with clinical symptoms, negative symptoms, mania, and social cognition are the strongest predictors across diagnoses. Development of interventions targeting negative symptoms and social cognition may be effective in improving community functioning for patients across diagnoses.
Topics: Adult; Bipolar Disorder; Cognition Disorders; Female; Humans; Independent Living; Male; Neuropsychological Tests; Psychotic Disorders; Quality of Life; Schizophrenia; Social Behavior; United States
PubMed: 32208557
DOI: 10.1002/pchj.356 -
Journal of Clinical Epidemiology May 2020The Singapore Caregiver Quality of Life Scale (SCQOLS) comprises five domains and 51 items in total. This study aimed to develop and evaluate short forms of SCQOLS. (Review)
Review
OBJECTIVES
The Singapore Caregiver Quality of Life Scale (SCQOLS) comprises five domains and 51 items in total. This study aimed to develop and evaluate short forms of SCQOLS.
STUDY DESIGN AND SETTING
Data were collected from 612 family caregivers of patients with advanced cancers in Singapore. Exploratory factor analysis and best subset regression were used to identify candidate items for each domain. The short forms were evaluated for measurement properties.
RESULTS
Inclusion of at least two items per domain in the short form gave correlation coefficients of at least 0.8 with the corresponding domain scores in the full-length version. The short forms and full-length version had similar correlation coefficients with Negative Personal Impact and Positive Personal Impact measures. Two of the five domains of the 10-item version had Cronbach's alpha ≤0.50 and test-retest reliability ≤0.65. A 15-item version of the scale with two to four items per domain performed satisfactorily in all aspects evaluated.
CONCLUSION
A 15-item short form of the SCQOLS (SCQOLS-15) is valid and reliable for the assessment of the overall and domain-specific quality of life of family caregivers. A 10-item short form (SCQOLS-10) may serve as a quick, valid and reliable assessment of the overall level of quality of life.
Topics: Activities of Daily Living; Caregivers; Economics; Family; Health Status; Humans; Mental Health; Neoplasms; Personal Satisfaction; Quality of Life; Reproducibility of Results; Singapore
PubMed: 32097714
DOI: 10.1016/j.jclinepi.2020.02.003