Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review

Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social re-integration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: “trajectory curves” or “trajectory models” and “clinic” or “clinical.” Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.

Quantifying Nature Positive

To become mainstream, Nature Positive development needs positive messaging, measures and metrics to guide, plan and assess urban outcomes. With accelerating climate crisis and negative messages getting the upper-hand, it is important to avoid paralysis by bad news. Whilst striving for a nature positive world, more effort should be on moving beyond zero to qualify and quantify benefits, gains and regenerative outcomes instead of around damage and loss sticking points. Life Cycle Benefit Assessment (LCBA) methods measure gains in accelerating regeneration and climate security that enables a good news focus. Its reach beyond negative quantifies and shows positive gain beyond zero loss outcomes. The aims are to clarify concepts, challenges and quantitative methods then review real-world 3rd party Certified nature positive case studies. Climate security, human wellness and resource viability gains inside safe operating space within planetary boundaries are quantified as positive benefits. contrary to conventional Life Impact Cycle Impact Assessment LCBA assigns damage losses as negatives debts and benefit gains as positive savings. It concludes that LCBA remains under development with more research needed to model economic outcomes.

Item Pool Development for the School-Aged Life Impact Burn Recovery Evaluation (SA- LIBRE5-12) Profile Computerized Adaptive Test (CAT): An Observer-Reported Outcome Assessment Measuring the Impact of Burn Injuries in School-Aged Children

Introduction The transition from early childhood to teen years (5-12) is a critical time of development, which can be made particularly challenging by a burn injury. Assessing post-burn recovery during these years is important for improving pediatric survivors’ development and health outcomes. Few validated burn-specific measures exist for this age group. The purpose of this study was to generate item pools that will be used to create a future computerized adaptive test (CAT) assessing post-burn recovery in school-aged children. Methods Item pool development was guided by the previously developed School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Conceptual Framework. The item pool development process involved a systematic literature review, extraction of candidate items from existing legacy measures, iterative item review during expert consensus meetings, and parent cognitive interviews. Results The iterative item review with experts consisted of six rounds. A total of 10 parent cognitive interviews were conducted. The three broad themes of concern were items that needed 1) clarification, needed context or were vague, 2) age dependence and relevance, and 3) word choice. The cognitive interviews indicated that survey instructions, recall period, item stem, and response choices were interpretable by respondents. Final item pool based on parental feedback consist of 57, 81, and 60 items in Physical, Psychological, and Family and Social Functioning respectively. Conclusion Developed item pools (n=198) in three domains are consistent with the existing conceptual framework. The next step involves field-testing the item pool and calibration using item response theory to develop and validate the SA-LIBRE5-12 CAT Profile.

Development of Social Life Impact for Mother (SLIM) Scale At First Trimester to Identify Mothers Who Need Social Support During Postpartum: A Hospital-Based Prospective Study in Japan

Background: Postpartum social problems, such as postpartum depression and bonding disorders, are important risk factors for child maltreatment. Mothers with such problems are known to need social support. The aim of this study was to develop and validate the Social Life Impact for Mother (SLIM) scale to identify mothers in Japan who need social support during postpartum.Methods: Hospital-based prospective study was implemented covering nation-wide area of Japan. A total of 7462 pregnant women completed the SLIM scale at first trimester, and postpartum social problems (postpartum depression and bonding disorders) were assessed at one month after delivery (N=5768, follow-up rate: 77.3%). Multivariate logistic regression was applied to investigate the association between SLIM scale and postpartum social problems.Results: The SLIM scale predicted postpartum social problems in moderate accuracy (AUC=0.63, 95% confidence interval: 0.60-0.65). Further stratification by local clinic and tertiary hospital did not affect the estimates.Conclusion: The SLIM scale at prenatal checkup may be useful for obstetricians to detect mothers with postpartum social problems. Further intervention study using SLIM score is warranted.

Aging in the Aftermath of Adversity: Later-Life Impact of Institutional Child Abuse and Disclosure

Until the 1990’s in Ireland, many children in institutional care experienced abuse and neglect, with lasting negative effects, including trauma symptoms and psychopathology. While trauma disclosure can be important for recovery, findings are inconsistent and often lack consideration of wider social and interpersonal contexts. As survivors of this historical adversity enter later-life stages, research is needed on the long-term impact and to clarify the role of disclosure. Therefore, this study aimed to examine the later-life impact of institutional child abuse on health and well-being, and the role of trauma disclosure and socio-interpersonal contexts in an older adult sample. Qualitative semi-structured interviews (60-120 minutes) were conducted with 17 Irish older adults, aged 50-77 years (mean age=60.7 years), who experienced childhood institutional abuse. Audio-recorded interviews were transcribed and analysed using Framework Analysis. Themes for ‘childhood and related later-life adversity’ included detrimental perceptions and interactions, re-exposure and reminders, failure of system and society, and cycle of abuse. Disclosure themes included successful, unsuccessful, and non-disclosure, as well as evidence of socio-interpersonal interactions (e.g., non-disclosure influenced by shame or fear, compounded by socio-cultural values, (lack of) social acknowledgment, or the power of the church in society). Results suggest that childhood institutional abuse can have long-term negative impacts into later life, including social, psychological, physical health, and socio-economic aspects. Disclosure results emphasize the need to consider the complex social, cultural, and interpersonal contexts within which an individual is embedded. This may enhance understanding and facilitate targeted health and social care services for this older adult population.

Reliability and Validity of the Mental Health Quotient (MHQ)

Background: The MHQ is an assessment of mental health and wellbeing that comprehensively covers symptoms across 10 major psychiatric disorders as defined by the DSM-5, in addition to constructs defined by RDoC and positive dimensions of mental function using a novel life-impact scale. An overall measure of mental wellbeing, the Mental Health Quotient or MHQ, is computed based on these elements using a nonlinear transformation of the scale followed by a rescaling. The MHQ has been deployed as part of the Mental Health Million Project as a freely available anonymous online assessment that, on completion, provides a score to the individual that places them on a spectrum from Distressed to Thriving along with a personal report spanning their various dimensions of mental wellbeing with strategies for improvement. Since its launch in April 2020 over 200,000 people have taken the MHQ. Here we provide various demonstrations of the reliability and validity of the MHQ.Objective: This paper outlines the reliability and validity of the Mental Health Quotient (MHQ), including construct validity of the life impact scale, sample and test-retest reliability of the assessment and criterion validation of the MHQ with respect to productivity loss and clinical burden.Methods: To assess sample reliability, random demographically matched samples of 11,033 people were compared from within the same 6-month period. Test retest reliability was determined using the subset of individuals who had taken the assessment twice at least 3 days apart (N=1907). In addition, a subset of respondents (N=4,247 or 7,625) were asked additional questions (along with the standard MHQ questions) on symptom frequency and severity for an example symptom (Feelings of Sadness, Distress or Hopelessness), days of work missed in the past month, and days with reduced productivity. In addition, elements with high negative life impact considered to meet the threshold to be considered a ‘symptom’ were mapped to the criteria for each of 10 major DSM-5 based mental health disorders to calculate the clinical burden (N=174,618).Results: Distinct samples collected during the same period had indistinguishable MHQ distributions and average ratings for each of the 47 elements, demonstrating the reliability of the assessment and MHQ scores were correlated with r=0.84 between retakes. The life impact rating was correlated with both frequency and severity of symptoms and mean values had a clear linear relationship with an R2>0.99. Furthermore, aggregate MHQ scores were systematically related to both productivity and clinical burden. At one end of the scale, those in the Distressed category had an average productivity loss of 15.2±0.5 days per month with 89.08% (8,986/10,087) mapping to 1 or more DSM-5 based clinical disorders. In contrast those at the other end of the scale, in the Thriving category, had an average productivity loss of 1.3±0.1 and 0.00% (1/24,365) had any DSM-5 based clinical disorder.Conclusions: The MHQ is a valid and reliable assessment of mental wellbeing when delivered anonymously online

The Quality of Life Impact Refractive Correction (QIRC) questionnaire: validation of the Malay-translated version of the QIRC using Rasch analysis

Background The Quality of Life Impact Refractive Correction (QIRC) questionnaire is a Rasch-validated instrument to assess the quality of life of ametropes with refractive correction. The original QIRC was validated in the United Kingdom. This study aimed to validate the Malay version of the QIRC among refractive correction wearers in Malaysia using Rasch analysis. Methods The original 20-item QIRC was forward-backward translated into Malay in preparation for the Pilot Malay QIRC. The pilot version was pre-tested on 105 spectacle/contact lens-corrected myopes, and the results were reviewed and cross-culturally adapted to produce the Final Malay QIRC. The final version was self-administered to a new sample of 304 participants. A Rasch analysis was conducted to evaluate the items and response categories of the Pilot and the Final Malay QIRC. Test-retest reliability was also analysed on the Final Malay QIRC. Results Based on the pre-test findings, Rasch analysis revealed a multidimensional scale (functional scale [Items 1 to 13] and emotional scale [Items 14 to 20], which were separated in subsequent analysis), unordered response categories for the functional scale (Category 3 was collapsed into Category 2), one misfit item (Item 3 was removed) and six items required modification (Items 4, 6 to 9, and 12 were reworded and cross-culturally adapted). In the Final Malay QIRC, both the functional and emotional scales had ordered response categories, good person reliability (functional, 0.80; emotional, 0.81) and separation index (functional, 2.01; emotional, 2.06), well-targeted items (targeting precision: functional, 0.28 logits; emotional, 0.08 logits), and satisfactory fit statistics (infit and outfit mean square were less than 1.50 for all items). A noticeable differential item functioning (DIF) between genders was found in Item 18 (DIF contrast, 0.40 logits; p = 0.04). Test-retest reliability analysis demonstrated a high intraclass correlation coefficient (0.94) and Cronbach’s alpha (0.97) with a coefficient of repeatability of ±8.14 units. Conclusions The Malay-translated version of the QIRC has good psychometric characteristics for assessing the quality of life of refractive correction wearers in Malaysia. This translated and cross-culturally adapted Malay QIRC is a valid and reliable instrument that can be used in routine clinical practice.

How frequent are acute reactions to COVID-19 vaccination and who is at risk?

Introduction: Our objective was to describe and compare self-reported side effects of COVID-19 vaccines in the USA. Methods: A web-based registry enrolled volunteers who received a COVID-19 vaccine between March 19 and July 15, 2021. We collected self-reported short-term side effects, medical consultation, hospitalization, and quality of life impact following completed vaccination regimens (Pfizer, Moderna, J&J). Results: We recruited 6,966 volunteers who completed their full course of vaccination (median age 48 years, IQR 35.0-62.0; 83.6% female): Pfizer 3,486; Moderna 2,857; J&J 623. Few (3.1%) sought medical care for post-vaccination side effects. Hospitalization (n=17; 0.3%) and severe allergic reactions (n=39; 0.6%) also were rare. Those with autoimmune disease or lung disease were approximately twice as likely to seek medical care (adjusted odds ratio (aOR) 2.01 [95% CI: 1.39;2.92] and 1.70 [95% CI: 1.12;2.58] respectively). 92.4% of participants reported >1 side effect (median 3), with injection site reactions (78.9%), fatigue (70.3%), headache (49.0%) reported most frequently. More side effects were reported after the second dose of two-dose vaccines (medians: 1 vs. 2 for Pfizer and 1 vs. 3 for Moderna for first and second doses respectively) versus 3 for J&J's single-dose vaccine. For the employed, the median number of workdays missed was one. Diabetics and those vaccinated against influenza were substantially less likely to report >3 symptoms (aOR 0.68, 95% CI 0.56,0.82 and aOR 0.82, 95% CI 0.73,0.93, respectively.) Discussion: The total side effect burden was, not unexpectedly, greater with two-dose regimens but all three vaccines appear relatively safe. Very few subjects reported side effects serious enough to warrant medical care or reported post-vaccination hospitalization. While these findings do not address possible long-term effects, they do inform on their short-term safety and tolerability and will hopefully provide some reassurance and positively inform the benefit-risk and pharmacoeconomic assessment for all three vaccines. Clinicaltrials.gov NCT04368065