Clinicaltrials.gov, NCT02754895.

Background: Optimism, or positive expectations about the future, is associated with better health. It is commonly assessed as a trait, but it may change over time and circumstance. Accordingly, we developed a measure of state optimism. Methods: An initial 29-item pool was generated based on literature reviews and expert consultations. It was administered to three samples: sample 1 was a general healthy population (n=136), sample 2 was people with cardiac disease (n=96), and sample 3 was persons recovering from problematic substance use (n=265). Exploratory factor analysis and item-level descriptive statistics were used to select items to form a unidimensional state optimism measure (SOM). Confirmatory factor analysis (CFA) was performed to test fit. Results: The selected seven SOM items demonstrated acceptable to high factor loadings on a single dominant factor (loadings: .64-.93). There was high internal reliability across samples (Cronbach's alphas: .92-.96), and strong convergent validity correlations in hypothesized directions. The SOM's correlations with other optimism measures indicate preliminary construct validity. CFA statistics indicated acceptable fit of the SOM model. Conclusions: We developed a psychometrically-sound measure of state optimism that can be used in various settings. Predictive and criterion validity will be tested in future studies.

Poor psychological health (e.g., depression and anxiety) is prospectively associated with adverse cardiac outcomes. In contrast, there is increasing evidence that positive psychological constructs like happiness, optimism and gratitude are independently and prospectively linked to better health behaviors and superior cardiac prognosis in people with and without heart disease. However, a critical question is whether such positive states and traits are modifiable. Recent studies of systematic positive psychology interventions designed to promote well-being have shown promise in patients with heart disease, and more data are needed to learn whether these interventions are effective and whether they can be broadly applied to impact public health.

Adherence to physical activity in patients with serious heart disease is critical to recovery and survival. In-person programs to promote activity in cardiac patients have been poorly attended, and increasingly patients are focused on mobile, self-management-based approaches to health. Accordingly, we completed a one-arm trial of a novel one-way 14-day text message intervention among 40 patients with a prior acute coronary syndrome (ACS). The two-pronged psychologicalbehavioral intervention alternated daily messages focused on promoting psychological well-being with messages providing specific education/advice regarding physical activity. All messages were successfully transmitted, and nearly all participants found the intervention to be helpful (n=37; 92.5%) and performed at least one specific health-related action in response to a text message (n=35; 87.5%). Post-intervention, participants had improvements in happiness (Cohen's d=0.25), determination (d=0.37), depression (d=-0.01), and anxiety (d=-0.13), though not optimism. Moreover, participants reported an increase in moderate physical activity of 105 minutes/week (baseline: 261 [SD 265] minutes/week, follow-up: 366 [SD 519]; d=0.25). These improvements were largely maintained two weeks later, with further increases in physical activity (414 [SD 570] minutes/week). Text messaging focused on well-being and physical activity was well-accepted and associated with improvements in activity and mental health in this high-risk clinical population.

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Background The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.

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Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one’s health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β=340.9; 95% confidence interval=53.4–628.4; p=.020). Gratitude for one’s life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β=.60; 95% confidence interval=.16–1.04; p=.008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity.