BACKGROUND:Monitoring trends in key quality of life (QoL) indicators is crucial for effective surveillance and guiding targeted interventions to improve well-being. Few studies have examined population-level trends among older adults with cognitive impairment, particularly across different living and care arrangements. METHODS:We used repeated cross-sectional data from the 2008-2022 Health and Retirement Study (HRS) to examine trends in five key QoL indicators among a nationally representative sample of older adults with cognitive impairment, overall and by living and care arrangements. Logistic regression was applied to estimate prevalence rates of binary outcomes, and linear regression was used to estimate mean values of continuous outcomes, adjusting for covariates. RESULTS:The analytic sample included 7469 older adults with persistent cognitive impairment. Overall trends in poorer self-rated health, elevated depressive symptoms, and loneliness remained relatively stable over time. Among community-dwelling individuals, the prevalence of high life satisfaction increased (2008: 49.7%, 95% CI: 48.9%-50.6%; 2022: 55.8%, 95% CI: 54.3%-57.4%), whereas the prevalence of high purpose in life declined (2008: 55.5%, 95% CI: 54.5%-56.4%; 2022: 49.1%, 95% CI: 47%-51.2%). QoL varied across living and care arrangements. Community-dwelling individuals without Activities of Daily Living or Instrumental Activities of Daily Living (ADL/IADL) limitations consistently reported better QoL. Among those with ADL/IADL limitations, individuals without reported caregiving support had a higher prevalence of loneliness (2022: 33.2% vs. 22.6%) and a lower prevalence of high life satisfaction (2022: 41% vs. 54.2%) compared to those with caregiving support. CONCLUSIONS:Low QoL indicators were more prevalent among community-dwelling individuals with ADL/IADL limitations. These findings emphasize the importance of increasing access to home-based care and tailored interventions to enhance psychosocial well-being in community settings.

INTRODUCTION:Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for adverse long-term outcomes. However, little is known about how ADHD medication use and social determinants of health (SDOH) relate to children's self-reported functional outcomes over time. METHODS:This observational, longitudinal cohort study used data from the Adolescent Brain Cognitive Development (ABCD) Study®. Participants were nine to ten years old at enrollment, and analyses included the first five years of follow-up. Patterns of medication use were operationalized longitudinally. Latent class growth analysis was used to identify trajectory classes of child-reported family conflict, prosocial behavior, and school experiences. Multinomial logistic regression was used to examine associations between medication use patterns, SDOH, and functional outcome trajectory class membership. RESULTS:Half of children used ADHD medication during the five-year period. Among medication users, the most common patterns included early initiation (medication use at study enrollment), stimulant-only use, and discontinuation without later reinitiation. Latent class growth analysis identified three trajectory classes across each functional domain: Resilient, Declining, and Low Improving. Social and structural factors were associated with trajectory membership, including ethnic discrimination, sex, insurance status, race and ethnicity, parental partnership and employment status, and medication type. Medication use patterns were not strongly associated with functional outcome trajectories; however, nonstimulant use (relative to stimulant-only use) was associated with less favorable outcomes. Females were more likely to demonstrate declining trajectories in family conflict and school experiences, whereas males were more likely to demonstrate low improving trajectories in prosocial behavior and school experiences. Ethnic discrimination was associated with less favorable trajectories across functional domains. CONCLUSIONS:Functional outcome trajectories in children with ADHD appear to be more strongly associated with social and structural factors than with patterns of medication use. These findings highlight the importance of addressing contextual influences when evaluating long-term functioning among children with ADHD.

Sleep disturbances, particularly insomnia, significantly impact individuals living with Alzheimer's disease and related dementias (ADRD), leading to accelerated cognitive decline, increased institutionalization rates, and faster disease progression. While pharmacological interventions exist, their potential side effects necessitate the exploration of safer, non-pharmacological alternatives. Music interventions have shown promise in addressing sleep disturbances among older adults, yet existing solutions are neither tailored to nor extensively tested in persons living with dementia (PLWD). This study presents the research protocol for CoMPoSER (Calming Music Personalized for Sleep Enhancement in PeRsons living with Dementia), a mobile application designed specifically for PLWD and their caregivers. In the first two phases, the study will involve the development of the application and in the third phase we will employ a pilot randomized controlled trial to assess preliminary effects of the intervention and explore its mechanism of action. The research objectives include developing and refining the CoMPoSER mobile application prototype, investigating its underlying mechanisms, and evaluating its impact on both PLWD and caregiver outcomes. By developing and systematically testing approaches that address sleep disturbances in PLWD, this study aims to expand the repertoire of evidence-based interventions available to PLWD and their families, ultimately contributing to improved quality of life and disease management.

Background Attention-deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity, resulting in impaired functioning in multiple settings, including home, school and in social settings. Disparities exist in ADHD care among children, with White male children experiencing increased access to diagnosis and treatment. Other children remain underdiagnosed, undertreated and subject to poorer functional outcomes. Factors that impact equitable ADHD treatment include gender, race, ethnicity and social determinants of health (SDOH), including household income, parental education, insurance status, neighbourhood deprivation and discrimination. Medication is effective, yet little is known regarding the impact of medication type and trajectories of use on functional outcomes. Aims Data from the first 6 time points of the Adolescent Brain and Cognitive Development℠ Study® (N = 11 868) will be used to address the following aims. Aim 1: identify typologies of children with distinct trajectories of medication use using multivariate latent class growth analysis. Aim 2: identify typologies of children with distinct trajectories of child-reported functional outcomes using latent class growth analysis. Aim 3: examine relationships of gender, race, ethnicity, SDOH and medication use with trajectories of functional outcomes using multinomial logistic regression. Method This study protocol describes the background and methods for an observational study seeking to better understand the impact of gender, race, ethnicity, SDOH and trajectories of medication use on child-reported functional outcome trajectories in a diverse group of US children with ADHD. Conclusions Findings will advance the understanding of effective ADHD treatment and highlight the importance of equitable treatment access.

This study evaluated a four-week virtual group gratitude intervention for adults ages 59 and older (N = 129). We randomly assigned participants to an intervention (n = 64) or a waitlist condition (n = 65). The virtual intervention was led by a team of 2–3 college students who received training and supervision in delivery of the intervention. Participants completed online surveys at pretest and posttest assessing demographic variables, gratitude (Gratitude Experience, Gratitude Expression, Gratitude Obstacles), and well-being (Sleep Problems, Depression, Loneliness, Positive Affect, Physical Health). Multilevel modeling revealed that intervention participants increased more than waitlist participants on Gratitude Experience and Positive Affect and decreased more on Gratitude Obstacles and Depression. The majority of intervention participants reported they enjoyed the intervention and planned to continue practicing gratitude exercises. These findings suggest that virtual group gratitude interventions for older adults can be beneficial and enjoyable. Study implications and suggestions for future research are discussed.

INTRODUCTION:Patients with heart failure, especially those with lower socioeconomic position, are vulnerable to adverse outcomes of care fragmentation. Care coordination mitigates care fragmentation; however, a comprehensive assessment of relationships among all relevant clinicians that enable it is lacking. This explanatory sequential mixed-methods study explores how patients' clinician network characteristics relate to their social context and clinical outcomes following heart failure care transitions. METHODS:We conducted a bipartite social network analysis to describe clinician networks for 1269 patients first hospitalized with heart failure in a southeastern US health system. Networks were constructed using electronic health record notes 1 year before, during, and 1 year after the index hospitalization (January 2015-February 2020). We then used stratified purposive sampling to select 11 adults with diverse socioeconomic positions but similar illness severity and comorbidity. For these patients, we conducted qualitative chart reviews of their clinical notes. Each patient's clinician network size, density, and centrality were integrated with qualitative findings to explore clinician networks' relationship to patients' social context and outcomes. RESULTS:Patients with higher socioeconomic positions used fewer acute care services and lived longer. Their clinicians, particularly outpatient clinicians, tended to have denser and more centrally located team networks before the index hospitalization that persisted after the index hospitalization. Their telephone notes indicated more regular and reciprocal communication patterns between patients and clinicians. CONCLUSIONS:Early involvement and better communication among clinician networks with greater density and centrality may help to explain better care transition outcomes observed among patients with higher socioeconomic positions.

BACKGROUND:Self-citation plays a dual role in scientific communication: it may reflect legitimate scholarly continuity, but excessive self-referencing can distort citation-based metrics used in research evaluation. As citation indicators increasingly influence faculty promotion, institutional benchmarking, and the global visibility of nursing schools, understanding typical self-citation patterns within nursing has become important. PURPOSE:To examine the distribution of self-citation among highly cited nursing researchers and to establish empirical thresholds for identifying unusually high self-citation patterns. METHODS:This bibliometric analysis used the publicly available Scopus-based standardized author-level citation database developed by Ioannidis (2024). The sample included 1,375 career-long (1996-2024) and 1,403 single-year (2024) highly cited nursing researchers. Self-citation rates were computed following Scopus definitions, encompassing citations from both authors and coauthors. Thresholds for excessive self-citation were identified using an interquartile range (IQR)-based outlier approach (strict = Q3 + 1.5 × IQR; liberal = Q3 + 3 × IQR). DISCUSSION:The mean self-citation rate was 9.27% (median = 8.65%) in the career-long dataset and 7.88% (median = 6.41%) in the 2024 dataset, with both distributions showing right-skewed patterns. Using strict and liberal IQR-based thresholds, 2.1% and 0.2% of career-long nursing researchers, respectively, and 3.2% and 0.4% of single-year researchers exceeded the thresholds for unusually high self-citation. CONCLUSION:Self-citation among highly cited nursing researchers is generally concentrated at relatively low levels, with higher values confined to a small minority of authors. The empirical benchmarks derived in this study provide a discipline-specific reference for interpreting self-citation patterns in nursing research. These thresholds should be viewed as analytical reference points that may help contextualize citation-based evaluation rather than as indicators of unethical citation behavior.

Cancer constitutes a persistent global health challenge, and immunocyte therapy has emerged as one approach in oncological care. This narrative review aimed to systematically analyze, synthesize, and critically interpret the therapeutic characteristics, advantages, market landscape, and current access barriers of cancer immunocyte therapy, based on thematic clustering and cross‑study integration of clinical evidence, market data, and industry reports. Immunocyte therapy exhibits distinctive features including personalization, long‑term immune memory, and observed efficacy in refractory malignancies, yet its clinical accessibility is limited by high costs, low public and physician awareness, and unsuitable traditional marketing models. Through thematic synthesis and pattern identification across included studies, this review identified core strategic directions including precise hierarchical positioning, academic and digital medical education, innovative payment models, industrial-chain integration, data‑driven dynamic optimization, policy leverage, and differentiated product‑service strategies. Each strategy is supplemented with comprehensive implementation feasibility analysis, covering regulatory constraints, infrastructure limitations, cost implications, stakeholder barriers, and context‑dependent variability to enhance practicality and credibility. These tailored marketing approaches are associated with improved market penetration, expanded patient access, and potential support for the clinical and commercial value of immunocyte therapy. This review provides evidence‑based, analytically integrated strategic insights for enterprises, medical institutions, and policymakers to promote the rational commercialization and equitable access of cancer immunocyte therapy.

Importance:Sickle cell disease (SCD) is a complex hemoglobinopathy. Vaso-occlusive episodes are the primary cause of emergency department (ED) utilization among individuals with SCD. Literature lacks a standardized definition for high ED utilization. Objective:To explore ED utilization, redefine high ED utilization, and describe factors associated with super-high ED utilization among individuals with SCD. Design, Setting, and Participants:This retrospective cohort study analyzed the North Carolina Hospital Discharge Datasets (2013-2019). Participants were included if they had SCD, defined as at least 3 SCD visits (ED, inpatient, or outpatient surgery) in a rolling 5-year period. All age groups, sexes, and payers, regardless of state of residence, were included. Data were analyzed from July 2023 to August 2024. Exposures:Variables included sex, race, ethnicity, age, age at death, distance (in miles) to the closest SCD center, number of annual ED visits, and social vulnerability index (SVI). Main Outcomes and Measures:To determine ED utilization categories, first the distribution of people based on the number of annual ED visits was examined, then the categories across years were identified to determine the data-informed cutoff for each category. Univariate analysis determined differences between participants based on the ED utilization category using χ2 tests of independence or analysis of variance, as applicable. Descriptive statistics were conducted to describe characteristics of utilization in the sample and by ED utilization group. A parsimonious multinomial regression was conducted using significant factors from the univariate analysis. Results:The cohort included 9964 unique patients (5364 [53.83%] female; mean [SD] age, 24.49 [17.54] years), including 9355 Black patients (93.89%), with 100 188 total ED visits from 2013 to 2019. ED visits were categorized into 4 levels: low (0-1 visits per year), moderate (2-9 visits per year), high (10-32 visits per year), and super high (≥33 visits per year). A small subset (178 patients [1.79%]) exhibited super-high ED utilization, contributing disproportionately to the total number of ED visits. Older age, younger age for in-facility deaths, and higher SVI were significantly associated with higher ED utilization. Patients with high utilization were more likely to die, die younger (eg, median [IQR] age at death, 33.0 [30.0-44.0] years in the super-high utilization group vs 50 [38.0-61.0] years in the moderate utilization group), use multiple EDs (eg, 93.8% of participants in the super-high utilization group vs 40.08% of participants in the moderate utilization group), and reside in counties more disadvantaged on socioeconomic and transportation characteristics. Conclusions and Relevance:This cohort study of 7 years of North Carolina Hospital Discharge Data described 4 new categories of ED utilization in SCD. These categories could be used to reframe how high ED use is determined.

Background and Purpose: The proliferation of short-form video content on social media platforms has led to increased user engagement but also raised concerns about potential addictive behaviors and cognitive consequences, particularly among youth. This study explored the prevalence of short-form video addiction (SVA) among Jordanian youth, its correlates, and its impact on attention and memory function, with an emphasis on understanding the mediating and moderating role of attention in the relationship between SVA and memory. Methods: Utilizing a cross-sectional survey design, data were collected from 1029 university students across 25 higher-education institutions in Jordan. Results: Half of the participants exhibited moderate to high levels of SVA. The findings indicated a significant increase in SVA scores among female students (p = 0.003), those of a younger age (p = 0.045), those with lower GPAs (p = 0.013), and those who dedicated fewer hours to study (p = 0.006). Notably, there was a significant and large correlation between SVA scores and students’ perceptions of user-generated content (p < 0.001). Attention partially mediated the relationship between SVA and memory function with excellent model fit indices (χ2(12) = 14.11, p = 0.05, RMSEA = 0.03, GFI = 0.99, IFI = 0.99, TLI = 0.98, CFI = 0.99). However, attention did not moderate this relationship, suggesting that the impact of SVA on memory is consistent across varying levels of attention. Discussion: The findings underscore the significant engagement of Jordanian youth with short-form video content and the potential cognitive risks associated with SVA. Interventions to manage attention could mitigate the adverse effects of SVA on cognitive functions. This study calls for a comprehensive approach to address SVA among youth, including the development of digital literacy programs, mental health support services, and policy interventions that promote a balanced digital ecosystem and responsible media consumption.

Hepatocellular carcinoma (HCC) is a highly fatal form of malignancy that seriously threatens patient survival. The global 5-year survival rate for HCC patients ranges from 15% to 19%, and nearly 80% of patients are diagnosed at an advanced stage. Therefore, exploring the mechanism of HCC development and identifying biomarkers and therapeutic targets for HCC are vital. MicroRNAs (miRNAs), a class of noncoding single-stranded RNAs, are 20-24 nucleotides (nt) long. They play pivotal roles in modulating the progression of diverse diseases. The specific role of miR-32-5p in the development of HCC remains unclear. In this study, qRT-PCR is utilized to precisely determine the downregulated expression levels of miR-32-5p in HCC. Subsequently, functional analysis reveals the suppressive role of miR-32-5p in modulating the proliferative and migratory capabilities of HCC cells. Glycogen synthase kinase 3β (GSK3β) has emerged as a potential target of miR-32-5p, which is confirmed through a dual-luciferase reporter assay. Notably, the expression of GSK3β in HCC tissue specimens is negatively correlated with the abundance of miR-32-5p, and patients with high GSK3β expression have shorter survival time. Furthermore, the targeted downregulation of GSK3β remarkably impedes the proliferation and migration of tumor cells. This study suggests that miR-32-5p inhibits the proliferation and migration of HCC through regulating the GSK3β/NF-κB signaling pathway. Therefore, this study reveals that miR-32-5p exerts its suppressive effect on HCC progression, suggesting that it is a promising target for both diagnostic and targeted therapeutic interventions against HCC.

The aim of this study was to create a tool capable of measuring parents’ experiences of discrimination when obtaining healthcare for their children, capturing their parental identities and perceptions of discrimination in the healthcare setting. Discrimination experiences, including racial, ethnic, and healthcare discrimination, have negative health effects across the lifespan. Parents have an essential role in pediatric healthcare, which is distinct from the role of other caregivers in pediatric and non-pediatric healthcare settings. Though measures of discrimination in healthcare settings exist, few psychometrically valid tools evaluating parents’ experiences of healthcare discrimination are readily available. A measure of parental racial/ethnic discrimination in healthcare was developed. Items were generated with theoretical and empirical literature followed by expert panel review. Items were tested among a population of US-based adult parents via online survey using exploratory factor analysis. Reliability, construct, and criterion validity were assessed. Item generation resulted in an acceptable pool of test items based on relevance and clarity (mean CVI = 0.94 and 0.70, respectively). Exploratory factor analysis resulted in a two-factor solution, one of which was related to discrimination experiences and demonstrated reliability ( α α = 0.90) and construct and criterion validity (r = 0.52–0.74) with existing scales. The final six-item scale measuring parental discrimination experiences offers a way to better understand discrimination experiences unique to parents in the pediatric healthcare setting. Further validation with larger samples utilizing more traditional recruitment practices is recommended.

HIV-related stigma impedes HIV prevention and treatment and affects the health and quality of life of people living with HIV. Evidence-based internalized stigma reduction interventions are an identified gap in the response to HIV stigma. Our protocol article describes the methods and procedures for a randomized controlled trial in Tanzania to test the preliminary efficacy of the Labda Siku Moja (Maybe Someday) internalized stigma reduction intervention for women living with HIV on the proximal outcomes of internalized stigma, coping self-efficacy, self-esteem, and resilience, which we hypothesize are the mechanisms of change through which the intervention would work to improve distal clinical and behavioral outcomes. In addition, our study will provide data on implementation feasibility. If this preliminary efficacy trial demonstrates intervention effect on the proximal outcomes, it will signal that a larger trial testing the effect on downstream distal clinical and behavioral outcomes is warranted. Our study will add to the nascent literature on rigorously evaluated internalized HIV stigma interventions.

Prostate cancer (PCa) is one of the most common malignancies for male individuals globally. Androgen deprivation therapy (ADT) initially demonstrated significant efficacy in treating PCa; however, most cases of PCa eventually progress to castration-resistant prostate cancer (CRPC), which becomes increasingly challenging to manage. Notably, the loss or disruption of primary cilia in PCa cells may play a critical role in the progression of the disease, and there are no reports on the role of circular RNAs in ciliogenesis. Thus, this warrants further investigation.In this study, key circular RNAs linked to prostate cancer progression, and enzalutamide resistance is identified. Specifically, it is found that hsa_circ_0005185 interacts with OTUB1 and RAB8A, serving as a molecular scaffold. Hsa_circ_0005185 mediates the binding of the deubiquitinase OTUB1 to RAB8A, resulting in the deubiquitination of RAB8A. Consequently, the stable expression of RAB8A promotes the regeneration of primary cilia and enhances the production of GLI3R, an inhibitory factor in the Hedgehog signaling pathway, thereby suppressing AR activity and slowing the progression of CRPC.

AIM:To describe nurses' roles in transitional care planning during intensive care unit (ICU) family meetings for patients with prolonged mechanical ventilation (PMV). DESIGN:A qualitative descriptive study. METHODS:Using secondary data from a trial of a decision aid about PMV, transcripts from 19 unstructured ICU family meetings were purposively sampled and analysed using directed content analysis. FINDINGS:Among 76 recorded ICU family meetings where nurses engaged and spoke at length beyond introduction, nurses spoke at length in 19 (25%) of them. These 19 family meetings were analysed in depth. Three themes were identified describing the roles nurses served: (1) Transitional care liaisons (e.g., introducing next levels of care, identifying/engaging family members, providing patient/family education, managing medications, planning for discharge, assessing patient/family needs, coordinating care, setting goals, providing care continuity, offering provider guidance and referring to resources); (2) information and communication facilitators (e.g., moderating family meetings, facilitating family understanding and serving as communication intermediaries) and (3) family support providers (e.g., providing emotional support, describing expectations and advocating for patients/families). CONCLUSION:Although nurses play a central role in patient care, they engage in only a minority of ICU family meetings addressing transitional care planning. Increased nursing involvement in these discussions may enhance care coordination and better support families navigating complex care transitions. IMPLICATIONS FOR CLINICAL PRACTICE:Findings suggest that more consistent engagement of nurses in ICU family meetings has the potential to support transitional care planning and family-centred care for patients with PMV and their families. IMPACT:This work adds to a growing body of knowledge about nurses' role in ICU transitional care planning. These findings provide valuable guidance for future research and development of transitional care standards to guide nurses in ICU transitional care planning. REPORTING METHOD:The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ). PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

OBJECTIVES:To examine how accurately ICU clinicians perceived family-reported prognostic expectations (FPEs) for patients with prolonged mechanical ventilation (PMV). DESIGN:A cross-sectional, exploratory design using secondary analysis. SETTING:Thirteen ICUs across five hospitals in the United States. SUBJECTS:Family members of patients with PMV and ICU clinicians, including physicians and nurses. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Latent profile analysis was used to identify profiles of accuracy in clinician perception of FPE, followed by bivariate analyses and multinomial logistic regression to examine associations between patient, family, and clinician characteristics and profile membership. A total of 554 participants (239 family members, 150 physicians, and 165 nurses) were included. Five distinct latent profiles of accuracy in clinician perception of FPE were identified: 1) clinician underestimation of FPE; 2) clinician overestimation of FPE; 3) accurate perception: low prognosis; 4) accurate perception: moderate prognosis; and 5) accurate perception: high prognosis. Families in profile 1 (clinician underestimation of FPE) were more likely to be spouses/partners of patients and reported higher levels of hope and optimism, whereas those in profile 2 (clinician overestimation of FPE) reported lower levels. Patient characteristics, including age, employment status, admission to medical ICU, and pulmonary-related hospital diagnosis, were statistically significantly associated with the profile membership. CONCLUSIONS:Understanding how accurately clinicians perceive FPE is vital to improving shared decision-making and developing goal-concordant care for patients with PMV. Further research examining strategies for clinicians to accurately perceive what families believe about prognosis is needed to identify potential misalignment, initiate timely and empathetic conversations, and build toward shared decision-making and goal-concordant care.

INTRODUCTION:Tobacco use remains the leading cause of preventable death in the U.S., with hookah smoking particularly popular among young adults. While stress, anxiety, and depression may influence susceptibility to HTS, their role in predicting this risk has not been extensively studied, despite their potential as triggers for smoking. This study explores the impact of perceived stress, anxiety, and depression on susceptibility to HTS among individuals who have never smoked. METHODS:Two web-based pilot studies were conducted (April 2021 - October 2023) with young adults aged 18-32. Study 1 focused exclusively on those who have never smoked hookah, while Study 2 included both those who currently smoke and those who have never smoked hookah. Participants, recruited via an online platform, completed surveys assessing demographics, perceived stress, susceptibility to HTS, anxiety, and depression. RESULTS:In Study 1 (N = 117), susceptible individuals reported significantly higher perceived stress (M = 23.87) compared to non-susceptible peers (M = 20.21, p = 0.0038). Logistic regression confirmed perceived stress as a significant predictor of susceptibility. Study 2 (N = 216) revealed strong correlations among perceived stress, anxiety, and depression, but no individual predictors reached statistical significance in the multivariable context. CONCLUSION:This study identifies perceived stress as a correlate of HTS susceptibility among young adults. Stress, anxiety, and depression are interconnected in ways that require further investigation to understand how they collectively influence tobacco use behaviors.

OBJECTIVE:People living with HIV (PLWH) face greatly elevated risk of mental health challenges, including suicide. In Tanzania, there is a critical shortage of providers and interventions to address suicide risk. The 3-session IDEAS for Hope intervention is delivered by telehealth, combining universal suicide screening in HIV care, adherence strategies, HIV-related stigma reduction, and problem solving. METHODS:We identified 60 PLWH experiencing suicidal ideation at 2 HIV clinics in Kilimanjaro, Tanzania, and randomized them 1:1 to receive an evidence-based safety planning intervention or IDEAS for Hope. Participants completed surveys at baseline and 3-month follow-up with mixed-methods assessments of feasibility, acceptability, and preliminary efficacy to reduce suicidal ideation and improve HIV care engagement. RESULTS:Session attendance was high at 88% and intervention fidelity, quality, and counseling skills exceeded pre-established thresholds in 94% of sessions. Participants were very satisfied with the counselors and helpfulness of the intervention to reduce suicide risk and improve care engagement. Participants in both trial arms achieved near-total recovery in suicidal thoughts (Cramer V = 0.07, P = 0.617). Between-arm differences in HIV treatment adherence were nonsignificant but showed moderate effects in favor of the intervention (Cramer V = 0.18, P = 0.760). In qualitative feedback, participants described improvements in coping, social support, and problem solving for economic empowerment, which fostered a renewed sense of hope. CONCLUSIONS:IDEAS for Hope is a feasible and acceptable intervention that reduced suicide risk and improved HIV care engagement in this cohort. A larger clinical trial will be powered to determine comparative effectiveness, evaluate mechanisms of change, and inform future implementation strategies.

Background: We aimed to identify health-related quality of life (HRQOL) profiles among breast cancer survivors and factors associated with each profile. Methods: Breast cancer survivors diagnosed 6-13 months earlier completed surveys assessing sociodemographic, clinical, and HRQOL variables (NIH PROMIS short forms). Using latent profile analysis (LPA), we grouped survivors into HRQOL profiles of PROMIS scores based on model fit and clinical interpretability. We used multinomial logistic regression models to determine clinical, psy- chosocial, and demographic factors associated with each HRQOL profile. Results: Among 1,638 breast cancer survivors, we identified four HRQOL profiles: high (20.3% of survivors), average (34.5%), low (33.1%), and very low (12.1%). Membership in the low or very low versus high HRQOL profile was associated with:(sic) high school versus college/graduate (low OR-2.98 (1.29, 6.85); very low OR-4.51 (1.53, 13.33)]; not working [low OR = 2.20 (1.41, 3.43); very low OR-4.32 (2.33, 8.00)]; lack of consistent companionship (low OR = 3.67 (1.85, 7.25); very low OR-6.22 (2.78, 13.92)]; and history of: lung condition [low OR = 2.42 (1.34, 4.36); very low OR 4.28 (2.09, 8.77)]; anxiety/depression [low OR = 2.76 (1.71, 4.46); very low OR -8.86 (4.74, 16.56)]; sleep disturbance [low OR = 2.97 (1.25, 7.06); very low OR 6.21 (2.40, 16.08)]; and chemotherapy [low OR-3.29 (2.13, 5.08); very low OR-7.34 (3.75, 14.37)]. Protective factors associated with reduced likelihood of low/very low HRQOL profile membership included higher: financial well-being (low OR 0.82 (0.74, 0.90); very low OR = 0.78 (0.68, 0.89)] and spirituality (low OR = 0.63 (0.56, 0.71); very low OR-0.53 (0.45, 0.62)]. Conclusion: About 45% of early-phase breast cancer survivors in the present sample experienced low or very low HRQOL; early identificatic and targeted interventions can be used to improve HRQOL over time.