Objective: Loneliness and physical activity are important targets for research into the impact of COVID-19 because they have established links with mental health, could be exacerbated by social distancing policies and are potentially modifiable. In this study we aimed to identify whether loneliness and physical activity were associated with worse mental health during a period of mandatory social distancing in the UK. Design: Population-based observation cohort study. Setting: Mental health data collected online during COVID-19 from an existing sample of adults aged 50 and over taking part in a longitudinal study of ageing. All had comparable annual data collected between 2015 and 2019. Participants: 3,281 participants aged 50 and over. Measurements: Trajectories of depression (measured by PHQ-9) and anxiety (measured by GAD-7) between 2015 and 2020 were analyzed with respect to loneliness, physical activity levels and a number of socioeconomic and demographic characteristics using zero-inflated negative binomial regression. Results: In 2020, PHQ-9 score for loneliness, adjusted for covariates, was 3.23 (95% CI: 3.01-3.44), an increase of around one point on all previous years in this group and 2 points higher than people not rated lonely, whose score did not change in 2020 (1.22, 95% CI: 1.12-1.32). PHQ-9 was 2.60, 95% CI: 2.43-2.78 in people with decreased physical activity, an increase of 0.5 on previous years. In contrast, PHQ-9 in 2020 for people whose physical activity had not decreased was 1.66, 95% CI: 1.56-1.75, similar to previous years. A similar relationship was observed for GAD-7 though the absolute burden of symptoms lower. Conclusion: After accounting for pre-COVID-19 trends, we show that experiencing loneliness and decreased physical activity are risk factors for worsening mental health during the pandemic. Our findings highlight the need to examine policies which target these potentially modifiable risk factors.
The efficacy of tests of differential item functioning (measurement invariance) has been well established. It is clear that when properly implemented, these tests can successfully identify differentially functioning (DF) items when they exist. However, an assumption of these analyses is that the metric for different groups is linked using anchor items that are invariant. In practice, however, it is impossible to be certain which items are DF and which are invariant. This problem of anchor items, or referent indicators, has long plagued invariance research, and a multitude of suggested approaches have been put forth. Unfortunately, the relative efficacy of these approaches has not been tested. This study compares 11 variations on 5 qualitatively different approaches from recent literature for selecting optimal anchor items. A large-scale simulation study indicates that for nearly all conditions, an easily implemented 2-stage procedure recently put forth by Lopez Rivas, Stark, and Chernyshenko (2009) provided optimal power while maintaining nominal Type I error. With this approach, appropriate anchor items can be easily and quickly located, resulting in more efficacious invariance tests. Recommendations for invariance testing are illustrated using a pedagogical example of employee responses to an organizational culture measure.
Dermatomyositis is an uncommon autoimmune disorder with distinctive cutaneous manifestations that are frequently challenging to manage. Although a number of therapies including hydroxychloroquine, methotrexate, mycophenolate mofetil, and intravenous immunoglobulin have demonstrated efficacy, few alternative treatments are available when these agents fail. Recently, tofacitinib, an oral Janus kinase (JAK)-1/3 inhibitor, was approved for use in rheumatoid arthritis and has demonstrated efficacy for treating inflammatory skin diseases including psoriasis, alopecia areata, vitiligo, and atopic dermatitis. 1,2 Studies suggest that tofacitinib suppresses interferon signaling, 3 a pathway that has been found to be abnormally upregulated in dermatomyositis. 4 With this context in mind, we sought to evaluate the utility of tofacitinib for treating cutaneous dermatomyositis.
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