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The impact of co-occurring chronic pain and mental health symptoms on adolescent functioning, a cross-sectional survey
(2024-11-06) Bateman, Sharon; Jordan, Abbie; Noel, Melanie; Loades, Maria; Caes, Line
Abstract Adolescents who experience poor mental health may develop chronic pain. Similarly, those with chronic pain may develop mental health symptoms. Little is known concerning how these co-occurring symptoms are associated with adolescent functioning. Our online cross-sectional quantitative study compared the specific nature of challenges to psychosocial functioning, across 4 groups: (1) adolescents with co-occurring chronic pain and mental health symptoms; (2) adolescents who only experience chronic pain symptoms; (3) adolescents who only experience mental health symptoms, and (4) adolescents who do not report either symptom. Participants completed self-report questionnaires assessing pain experiences, mental health symptoms and psychosocial functioning. After controlling for pain intensity, findings revealed significant differences, in physical, social, and family functioning across all groups. Significantly worse physical functioning was reported by adolescents with co-occurring pain and mental health symptoms and those with pain-only symptoms compared with adolescents with mental health-only symptoms and those without symptoms. Social functioning was significantly worse for adolescents who experienced co-occurring chronic pain and mental health symptoms compared with adolescents who experienced pain-only symptoms, and those with no symptoms. Significantly worse family functioning was reported by adolescents with mental health-only symptoms compared with adolescents reporting pain-only symptoms and no symptoms. Results suggest the combined impact of pain and mental health symptoms mainly influences adolescent social functioning. Future research is needed to develop standardised assessment and treatment plans to facilitate a thorough understanding of symptoms presented by adolescents who experience co-occurring pain and mental health symptoms. This study identifies that the combined impact of pain and mental health symptoms influences adolescent social functioning when compared to adolescents who experience pain-only or those without symptoms. Research is needed to develop standardised assessment and treatment plans to fully understand the symptoms presented by adolescents with co-occurring symptoms.
Exploring patient perspectives on the impact of resuming cost sharing: a qualitative analysis
(2024-11-09) Tran, Sophia H. N.; Fletcher, Jane M.; McSweeney, Breanna; Saunders-Smith, Terry; Manns, Braden J.; Campbell, David J. T.
Abstract Introduction The ACCESS trial showed that those who received a copayment elimination benefit had a modest improvement in their adherence to medications, but no improvement in clinical outcomes. This is consistent with other studies that have demonstrated that time-limited copayment elimination was welcomed by participants. However, the removal of such benefits can be problematic, as participants may have become accustomed to receiving the benefit, and made changes to their spending that would need to be reconsidered. We aimed to explore participants’ experience with resuming cost sharing for their medications at the end of the ACCESS trial and if this experience influenced their willingness to participate in future trials like ACCESS. Methods We conducted semi-structured interviews with 21 former participants of the ACCESS trial who were receiving the copayment elimination intervention, with discussions focused on the loss of the copayment elimination. The interviews were recorded, transcribed, and analyzed in duplicate using thematic analysis. Results Four primary themes emerged from the analysis, including emotionality regarding loss of benefits; notification of benefit termination, describing tangible losses from coverage ending, but resistance to acknowledging negative impacts; and acceptability of receiving a temporary financial benefit. Many participants described negative emotions around the loss of coverage and concern about affording care for their chronic diseases. Despite negative emotions about the end of their study benefit, participants generally had a positive view of the study and would participate again in a future study of this nature. Conclusion The positive tangible and emotional benefits of the copayment elimination over 3 years outweighed the negative emotions and impacts associated with having to become reaccustomed to life without it. Patient and public contribution Within the ACCESS trial, participants were involved in the design, modification, and implementation of the program using multiple focus groups. The current study aimed to engage patients to provide input on their experience and engagement with the copayment elimination program.
Developing a question prompt tool to prevent and manage early cardiovascular disease after hypertensive pregnancy: qualitative interviews with women and clinicians
(2024-11-07) Theodorlis, Madeline; Edmonds, Jessica; Sino, Sara; Lyons, Mavis S.; Ramlakhan, Jessica U.; Nerenberg, Kara; Gagliardi, Anna R.
Abstract Background Persons (henceforth, women) who have hypertensive disorders of pregnancy (HDP) are at risk of premature cardiovascular disease (CVD). While largely preventable through lifestyle management, many women and clinicians are unaware of the risk. Based on prior research, we developed a question prompt tool (QPT) on preventing and managing CVD after HDP. The purpose of this study was to refine QPT design. Methods We recruited Canadian women who had HDP and clinicians who might care for them using multiple strategies, conducted telephone interviews with consenting participants, and used qualitative description and inductive content analysis to derive themes. Results We interviewed 21 women who varied in HDP type, CVD status, years since HDP pregnancy, age, geography and ethno-cultural group; and 21 clinicians who varied in specialty (midwife, nurse practitioner, family physician, internist, obstetrician, cardiologist), geography and years in practice. Participating women and clinicians agreed on needed improvements: more instructions, lay and gender-neutral language, links to additional information, more space for answers, graphic appeal, and both print and electronic format. Both groups identified similar barriers: clinicians lack time/willingness, and low language/health literacy and access to technology among women; enablers: translated, credible source/endorser, culturally relevant, organized by health trajectory stages; and likely benefits: raise awareness, empower women, encourage them to adopt healthy lifestyle. Women desired exposure to the QPT before or during pregnancy, while clinicians recommended waiting until postpartum to avoid overwhelming women. Similarly, most women said the QPT should be available through multiple avenues to empower them for health self-advocacy, while clinicians thought they should introduce the QPT to women, and decide when and which questions to address. To mitigate reluctance, clinicians recommended self-directed educational materials accompany the QPT. Conclusions We will use this information to refine QPT design and plan for future evaluation. If found to be effective and widely disseminated, the QPT could improve awareness and communication about this issue, and may reduce CVD risk in many women who have hypertensive pregnancies. Ongoing research is needed to more fully understand how QPTs support patient-clinician communication, and how to alert and prime both patients and clinicians to use QPTs.
Maternal Metabolism and Pregnancy: Predicting Pregnancy Outcomes Using Metabolomic Assessment
(2024-10-31) Han, Ying Chieh; Shearer, Jane; Slater, Donna; Manske, Sarah; Duggan, Gavin
Despite the significant health risks preterm birth poses to both mothers and babies, assessing the risk remains challenging due to its heterogeneous nature. Common risk factors, such as personal health history or lifestyle habits, have had some success in identifying at-risk mothers. However, their effectiveness is limited in asymptomatic and niche populations that lack distinct, identifiable preterm traits. Recent efforts have shifted toward exploring metabolic biomarkers for preterm prediction, aiming to capture the metabolic changes occurring during gestation. Nevertheless, most targeted compounds in these studies have been chosen based on their association with other underlying conditions, such as obesity or uterine disorders. With advancements in computational methods, particularly in machine learning, prediction models based on high-dimensional data have emerged as a promising new approach. This project aims to explore metabolic signatures associated with preterm birth by leveraging machine learning and untargeted metabolomics. We analyzed third-trimester serum samples from primigravid participants—first-time mothers—enrolled in the All Our Families (AOF) Cohort. Significant reductions in acylcarnitines and amino acid derivatives were identified, with various acylcarnitines, particularly butenylcarnitine, notably reduced in preterm mothers. These metabolites proved effective in predicting preterm birth, as shown by receiver operating characteristic (ROC) analysis. Next, we compared the performance of six different machine learning models in predicting preterm birth across a broader population from the AOF cohort, using Shapley Additive Explanations (SHAP) analysis to evaluate feature importance. We also assessed the impact of resampling techniques, such as bootstrapping. Linear models, including PLS-DA and linear logistic regression, demonstrated moderate predictive performance, while non-linear models like XGBoost and artificial neural networks (ANN) showed a slight advantage. Bootstrapping improved model accuracy and predictive strength, with varying degrees of enhancement across different models. Among the models tested, the bootstrap-resampled XGBoost model was the top performer in predicting preterm birth. SHAP analysis consistently identified acylcarnitines as the most significant class of metabolites in preterm prediction, with kynurenic acid also emerging as a contributing metabolite in several models following bootstrapping. The observed alterations in acylcarnitines suggest possible disruptions in lipid transport and energy metabolism in preterm mothers. The modeling results underscored the complexity of preterm prediction, while resampling techniques proved effective in mitigating the overtraining and low-variance challenges posed by the small sample size. This project introduces a novel approach to predicting preterm birth based on a combination of metabolites. As preterm birth continues to present significant risks to fetal health, the development of newer and more effective prediction models could improve maternal and fetal outcomes.
A Weighted Multilevel Monte Carlo Method
(2024-11-07) Li, Yu; Ware, Antony; Qiu, Jinniao; Swishchuk, Anatoliy
This thesis begins by introducing the Weighted Multilevel Monte Carlo (WMLMC) method in a one-dimensional context, expanding upon the established Multilevel Monte Carlo (MLMC) method. The focus is on demonstrating that the WMLMC method provides even greater computational savings compared to the traditional MLMC method, which has already shown superior efficiency over the standard Monte Carlo (MC) approach under similar conditions. In the second part, we apply a mixed Partial Differential Equation (PDE)/Weighted Multilevel Monte Carlo (WMLMC) method to the pricing of Double-No-Touch options. We compare these results with those obtained using a mixed PDE/Multilevel Monte Carlo (MLMC) method. The analysis reveals a significant reduction in total computational costs when substituting the MLMC method with the more efficient WMLMC method. This finding prompts us to explore the broader applicability of the WMLMC method as a superior alternative to the MLMC method across various domains, anticipating substantial cost savings in computational tasks traditionally dominated by the MLMC approach. The adoption of the WMLMC method is expected to optimize resource utilization and enhance computational performance, making it a promising avenue for future research and application in diverse fields beyond options pricing. The third part integrates the WMLMC method with one-step Richardson Extrapolation
(RE), resulting in a considerable boost in efficiency from a convergence standpoint. A comparative analysis highlights this computational advantage, demonstrating that the WMLMC method with one-step RE achieves the greatest reduction in computational cost. This approach could potentially be extended to combine WMLMC with multi-step RE for even greater efficiency. In the final section, we present the Weighted Multi-Index Multilevel Monte Carlo (WMIMLMC) method designed for a multi-dimensional setting, building on the Multi-Index Monte Carlo (MIMC) method. By utilizing high-order mixed differences instead of first-order differences, the WMIMLMC method significantly reduces the variance of hierarchical differences while adhering to similar assumptions as its predecessors. We provide a 2-dimensional example to showcase the computational advantages of the WMIMLMC method.