Category: Nevin Manimala

JMIR Med Educ. 2024 Feb 15;10:e48566. doi: 10.2196/48566.

ABSTRACT

BACKGROUND: Immersive virtual reality (IVR)-assisted experiential learning has the potential to foster empathy among undergraduate health care students toward older adults with cognitive impairment by facilitating a sense of embodiment. However, the extent of its effectiveness, including enhancing students’ learning experiences and achieving intended learning outcomes, remains underexplored.

OBJECTIVE: This study aims to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment as the primary outcome (objective 1) and on their learning experience (objective 2) and their attainment of learning outcomes as the secondary outcomes (objective 3).

METHODS: A multiple-methods design was used, which included surveys, focus groups, and a review of the students’ group assignments. Survey data were summarized using descriptive statistics, whereas paired 2-tailed t tests were used to evaluate differences in empathy scores before and after the 2-hour IVR tutorial (objective 1). Focus groups were conducted to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment (objective 1). Descriptive statistics obtained from surveys and thematic analyses of focus groups were used to explore the students’ learning experiences (objective 2). Thematic analysis of group assignments was conducted to identify learning outcomes (objective 3).

RESULTS: A total of 367 undergraduate nursing and occupational therapy students were recruited via convenience sampling. There was a significant increase in the students’ empathy scores, measured using the Kiersma-Chen Empathy Scale, from 78.06 (SD 7.72) before to 81.17 (SD 8.93) after (P<.001). Students expressed high satisfaction with the IVR learning innovation, with a high satisfaction mean score of 20.68 (SD 2.55) and a high self-confidence mean score of 32.04 (SD 3.52) on the Student Satisfaction and Self-Confidence scale. Students exhibited a good sense of presence in the IVR learning environment, as reflected in the scores for adaptation (41.30, SD 6.03), interface quality (11.36, SD 3.70), involvement (62.00, SD 9.47), and sensory fidelity (31.47, SD 5.23) on the Presence Questionnaire version 2.0. In total, 3 major themes were identified from the focus groups, which involved 23 nursing students: enhanced sympathy toward older adults with cognitive impairment, improved engagement in IVR learning, and confidence in understanding the key concepts through the learning process. These themes supplement and align with the survey results. The analysis of the written assignments revealed that students attained the learning outcomes of understanding the challenges faced by older adults with cognitive impairment, the importance of providing person-centered care, and the need for an age-friendly society.

CONCLUSIONS: IVR-assisted experiential learning enhances students’ knowledge and empathy in caring for older adults with cognitive impairment. These findings suggest that IVR can be a valuable tool in professional health care education.

PMID:38358800 | DOI:10.2196/48566

Interact J Med Res. 2024 Feb 15;13:e50064. doi: 10.2196/50064.

ABSTRACT

BACKGROUND: Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions.

OBJECTIVE: In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic.

METHODS: We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE).

RESULTS: Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively.

CONCLUSIONS: Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention.

PMID:38358785 | DOI:10.2196/50064

JAMA Otolaryngol Head Neck Surg. 2024 Feb 15. doi: 10.1001/jamaoto.2023.4694. Online ahead of print.

ABSTRACT

IMPORTANCE: There is limited literature on the exact causes and ways of death in patients with head and neck cancer. To provide optimal care, especially in the palliative phase, more information on this is needed.

OBJECTIVE: To provide insights into the causes and ways of death among patients with head and neck cancer.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a consecutive population of patients who received a diagnosis of primary squamous cell carcinoma of the head and neck between January 2006 and December 2013 who were treated in the Erasmus MC. Patient data were merged with nonpublic microdata from Statistics Netherlands. Follow-up time was specified as the date of diagnosis until death or December 3, 2019, whichever came first. The data were checked and reanalyzed in November 2023.

MAIN OUTCOMES AND MEASURES: Causes (eg, head and neck cancer, other cancer) and ways (eg, natural death, suicide) of death.

RESULTS: A total of 1291 patients (59.2%; 342 women [26.5%]) died during follow-up (median [IQR] follow-up, 2.7 [1.2-5.6] years). The main cause of death was head and neck cancer (557 [43.1%]), followed by the competing cause of other cancers (344 [26.6%]). In total, 240 patients (18.6%) received palliative sedation and 70 patients (5.4%) euthanasia. Compared with patients with head and neck cancer as the underlying cause of death, lower odds ratios (ORs) were observed for receiving palliative sedation (OR, 0.32 vs 0.07; 95% CI, 0.22-0.46 vs 0.03-0.12) and euthanasia (OR, 0.22 vs 0.01; 95% CI, 0.11-0.41 vs 0-0.107) in patients with other causes of death. Patients with a middle and high income had higher ORs for receiving palliative sedation (OR, 1.46 vs 1.86; 95% CI, 1.05-2.04 vs 1.22-2.85) or euthanasia (OR, 2.25 vs 3.37; 95% CI, 1.18-4.3, 1.6-7.12) compared with low-income patients. Retired patients had lower ORs for receiving palliative sedation or euthanasia compared with employed patients (OR, 0.56 vs 0.44; 95% CI, 0.39-0.8 vs 0.24-0.82).

CONCLUSION AND RELEVANCE: The results of this cohort study suggest that more than half of the patients died of competing causes and palliative sedation and euthanasia were more common in patients with head and neck cancer as the underlying cause of death. Patients with a higher socioeconomic status had higher odds of receiving palliative sedation and euthanasia. These insights may support health care professionals in providing patient-centered care, especially for patients in the palliative phase.

PMID:38358760 | DOI:10.1001/jamaoto.2023.4694

JAMA Netw Open. 2024 Feb 5;7(2):e2354588. doi: 10.1001/jamanetworkopen.2023.54588.

ABSTRACT

IMPORTANCE: While brain cancer is rare, it has a very poor prognosis and few established risk factors. To date, epidemiologic work examining the potential association of traumatic brain injury (TBI) with the subsequent risk of brain cancer is conflicting. Further data may be useful.

OBJECTIVE: To examine whether a history of TBI exposure is associated with the subsequent development of brain cancer.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted from October 1, 2004, to September 20, 2019, and data analysis was performed between January 1 and June 26, 2023. The median follow-up for the cohort was 7.2 (IQR, 4.1-10.1) years. Veterans Affairs (VA) and Department of Defense (DoD) administrative data on 1 919 740 veterans from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium were included.

EXPOSURE: The main exposure of interest was TBI severity (categorized as mild, moderate or severe [moderate/severe], and penetrating).

MAIN OUTCOMES AND MEASURES: The outcome of interest was the development of brain cancer based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes in either the DoD/VA medical records or from the National Death Index.

RESULTS: After 611 107 exclusions (predominately for no encounter during the study period), a cohort including 1 919 740 veterans was included, most of whom were male (80.25%) and non-Hispanic White (63.11%). Median age at index date was 31 (IQR, 25-42) years. The cohort included 449 880 individuals with TBI (mild, 385 848; moderate/severe, 46 859; and penetrating, 17 173). Brain cancer occurred in 318 individuals without TBI (0.02%), 80 with mild TBI (0.02%), 17 with moderate/severe TBI (0.04%), and 10 or fewer with penetrating TBI (≤0.06%). After adjustment, moderate/severe TBI (adjusted hazard ratio [AHR], 1.90; 95% CI, 1.16-3.12) and penetrating TBI (AHR, 3.33; 95% CI, 1.71-6.49), but not mild TBI (AHR, 1.14; 95% CI, 0.88-1.47), were associated with the subsequent development of brain cancer.

CONCLUSIONS AND RELEVANCE: In this cohort study of veterans of the Iraq and Afghanistan wars, moderate/severe TBI and penetrating TBI, but not mild TBI, were associated with the subsequent development of brain cancer.

PMID:38358743 | DOI:10.1001/jamanetworkopen.2023.54588

Psychol Trauma. 2024 Feb 15. doi: 10.1037/tra0001638. Online ahead of print.

ABSTRACT

BACKGROUND: There are two primary competing diagnostic criteria for posttraumatic stress disorder (PTSD); the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). These systems differ in terms of the number and nature of PTSD symptoms, the implied latent structure of the disorder, and associated posttraumatic diagnostic classifications.

OBJECTIVE: To investigate the prevalence and concordance of ICD-11th Revision (ICD-11) and DSM-Fifth Edition (DSM-5) PTSD, complex-PTSD (C-PTSD), and dissociative subtype of PTSD (D-PTSD) criteria in a sample of Northern Irish military veterans.

METHODOLOGY: Data were collected from a community sample of military veterans living in Northern Ireland (NI). Prevalence rates of ICD-11 PTSD and C-PTSD and DSM-5 PTSD and D-PTSD were estimated using validated self-report measures for each system. Concordance of caseness determined by diagnostic criteria was compared using Cohen’s kappa.

RESULTS: The DSM-5 algorithm criteria produced significantly higher prevalence estimates of PTSD (39.26%) relative to the ICD-11 algorithm criteria (32.09%). Both C-PTSD and D-PTSD were identified for subgroups within the sample (24.66% and 27.96%, respectively). There was moderate agreement between the diagnostic systems regarding PTSD caseness, and between C-PTSD and D-PTSD caseness.

CONCLUSIONS: These findings have implications regarding the measurement of PTSD and associated diagnostic groupings for the wider literature, suggesting that the choice of diagnostic screening framework may influence classification. Both C-PTSD and D-PTSD may be relevant diagnostic considerations for the NI military veteran group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38358723 | DOI:10.1037/tra0001638

Rehabil Psychol. 2024 Feb 15. doi: 10.1037/rep0000549. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: The fear-avoidance model is a well-established framework for understanding the transition from acute to chronic pain. However, its applicability to concussions is not yet well understood. Here, we conduct the first mixed methods analysis of the fear-avoidance model in young adults with a recent concussion and co-occurring anxiety and assess the model’s alignment with their lived experience.

RESEARCH METHOD/DESIGN: We conducted a mixed methods analysis using a cross-sectional parallel design. Seventeen participants completed questionnaires corresponding with the elements in the fear-avoidance model (e.g., pain catastrophizing, avoidance, disability, anxiety, depression, etc.) and participated in semistructured interviews probing their experiences following their concussion between March 2021 and February 2022. We calculated bivariate correlations for quantitative data and analyzed the qualitative data using hybrid inductive-deductive thematic analysis.

RESULTS: Quantitative results demonstrated strong and medium-sized correlations among theorized relationships within the fear-avoidance model (rs = .40-.85) with the majority being statistically significant. Qualitative results provided substantial convergent and complementary support (e.g., bi-directionality of some relationships, associations between nonadjacent model components, centrality of anxiety in symptom persistence) for the application of the fear-avoidance model to concussions. Findings highlighted additional factors (social factors and post-injury endurance patterns) relevant to this population.

CONCLUSION/IMPLICATIONS: The fear-avoidance model is a useful lens for understanding the lived experience of young adults with a recent concussion and co-occurring anxiety. Psychosocial treatment for this population would benefit from focusing on the interplay of concussion symptoms, anxiety, depression, disability, and pain-related fear, offering adaptive confrontation strategies, and addressing the interpersonal impact of concussion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38358710 | DOI:10.1037/rep0000549

J Consult Clin Psychol. 2024 Mar;92(3):150-164. doi: 10.1037/ccp0000873.

ABSTRACT

OBJECTIVE: This is a randomized controlled trial (NCT03056157) of an enhanced adaptive disclosure (AD) psychotherapy compared to present-centered therapy (PCT; each 12 sessions) in 174 veterans with posttraumatic stress disorder (PTSD) related to traumatic loss (TL) and moral injury (MI). AD employs different strategies for different trauma types. AD-Enhanced (AD-E) uses letter writing (e.g., to the deceased), loving-kindness meditation, and bolstered homework to facilitate improved functioning to repair TL and MI-related trauma.

METHOD: The primary outcomes were the Sheehan Disability Scale (SDS), evaluated at baseline, throughout treatment, and at 3- and 6-month follow-ups (Brief Inventory of Psychosocial Functioning was also administered), the Clinician-Administered PTSD Scale (CAPS-5), the Dimensions of Anger Reactions, the Revised Conflict Tactics Scale, and the Quick Drinking Screen.

RESULTS: There were statistically significant between-group differences on two outcomes: The intent-to-treat (ITT) mixed-model analysis of SDS scores indicated greater improvement from baseline to posttreatment in the AD-E group (d = 2.97) compared to the PCT group, d = 1.86; -2.36, 95% CI [-3.92, -0.77], t(1,510) = -2.92, p < .001, d = 0.15. Twenty-one percent more AD-E cases made clinically significant changes on the SDS than PCT cases. From baseline to posttreatment, AD-E was also more efficacious on the CAPS-5 (d = 0.39). These differential effects did not persist at follow-up intervals.

CONCLUSION: This was the first psychotherapy of veterans with TL/MI-related PTSD to show superiority relative to PCT with respect to functioning and PTSD, although the differential effect sizes were small to medium and not maintained at follow-up. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38358703 | DOI:10.1037/ccp0000873

Emotion. 2024 Feb 15. doi: 10.1037/emo0001344. Online ahead of print.

ABSTRACT

Emotion regulation (ER) variability refers to how individuals vary their use of ER strategies across time. It helps individuals to meet contextual needs, underscoring its importance in well-being. The theoretical foundation of ER variability recognizes two constituent processes: strategy switching (e.g., moving from distraction to social sharing) and endorsement change (e.g., decreasing the intensity of both distraction and social sharing). ER variability is commonly operationalized as the SD between strategies per observation (between-strategy SD) or within a strategy across time (within-strategy SD). In this article, we show that these SD-based approaches cannot sufficiently capture strategy switching and endorsement change, leading to ER variability indices with poor validity. We propose Bray-Curtis dissimilarity, a measure used in ecology to quantify biodiversity variability, as a theory-informed ER variability index. First, we demonstrate how Bray-Curtis dissimilarity is more sensitive than SD-based approaches in detecting ER variability through two simulation studies. Second, assuming that higher ER variability is adaptive in daily life, we test the relation between ER variability and negative affect in three experience sampling method data sets (total N = [70, 95, 200], number of moment-level observations = [5,040, 6,329, 14,098]). At both the moment level and person level, higher Bray-Curtis dissimilarity predicted lower negative affect more consistently than SD-based indices. We conclude that Bray-Curtis dissimilarity may better capture moment-level within-person ER variability and could have implications for studying variability in other multivariate dynamic processes. The article is accompanied by an R tutorial and practical recommendations for using Bray-Curtis dissimilarity with experience sampling method data. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38358696 | DOI:10.1037/emo0001344

Psychol Methods. 2024 Feb 15. doi: 10.1037/met0000643. Online ahead of print.

ABSTRACT

The linear mixed model (LMM) and latent growth model (LGM) are frequently applied to within-subject two-group comparison studies to investigate group differences in the time effect, supposedly due to differential group treatments. Yet, research about LMM and LGM in the presence of outliers (defined as observations with a very low probability of occurrence if assumed from a given distribution) is scarce. Moreover, when such research exists, it focuses on estimation properties (bias and efficiency), neglecting inferential characteristics (e.g., power and type-I error). We study power and type-I error rates of Wald-type and bootstrap confidence intervals (CIs), as well as coverage and length of CIs and mean absolute error (MAE) of estimates, associated with classical and robust estimations of LMM and LGM, applied to a within-subject two-group comparison design. We conduct a Monte Carlo simulation experiment to compare CIs and MAEs under different conditions: data (a) without contamination, (b) contaminated by within-subject outliers, (c) contaminated by between-subject outliers, and (d) both contaminated by within- and between-subject outliers. Results show that without contamination, methods perform similarly, except CIs based on S, a robust LMM estimator, which are slightly less close to nominal values in their coverage. However, in the presence of both within- and between-subject outliers, CIs based on robust estimators, especially S, performed better than those of classical methods. In particular, the percentile CI with the wild bootstrap applied to the robust LMM estimators outperformed all other methods, especially with between-subject outliers, when we found the classical Wald-type CI based on the t statistic with Satterthwaite approximation for LMM to be highly misleading. We provide R code to compute all methods presented here. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38358679 | DOI:10.1037/met0000643

Neotrop Entomol. 2024 Feb 15. doi: 10.1007/s13744-024-01136-7. Online ahead of print.

ABSTRACT

Co-occurrence a correlation profiles are driven by different factors (exogenous and endogenous) and drawing a profile of association between species based on co-occurrence, without assessing how these species vary in terms of ecological niche can lead to wrong conclusions. The objective was to determine the co-occurrence and correlation patterns of phytophagous insects in canola crop and to evaluate how these patterns varied according to the crop stage (phenology-biotic) and sowing times (agricultural practice-abiotic). We found that the patterns of co-occurrence and correlation between species were reflections of population variations due to the phenology and sowing times of canola. Variations in the multi-species abundance matrix were influenced by mean air temperature and accumulated rainfall. The main species associated with canola in southern Brazil, in terms of abundance, were P. xylostella, D. speciosa, and N. viridula. These species were mostly negatively associated. When evaluating their population variations, we found that they explore different temporal niches, whether in terms of phenology or sowing times. Finally, we demonstrate empirically that despite being important, association patterns based on co-occurrence and correlation should be interpreted in light of the understanding of patterns of niche exploitation and temporal variation of species.

PMID:38358647 | DOI:10.1007/s13744-024-01136-7