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Although both groups improved over time on several measures (e.g., decreases in psychological distress, stress, and emotion-oriented coping), these changes could not be attributed to the psychotherapeutic intervention. Thus, evidence does not support the referral of these patients to this type of intervention.

Objective To determine whether skin score changes are associated with changes in overall disease severity, function and quality of life in early dcSSc patients. Methods A total of 154 and 128 dcSSc patients from the Canadian Scleroderma Research Group database with 1 and 2 year follow-up and a disease duration ⩽5 years without end-stage organ damage and/or significant comorbidity at the initial visit were included. Skin was assessed using the modified Rodnan skin score (mRSS) and disease severity by the summed Medsger disease severity score (DSS) (without skin domain), physician and patient global assessments, function [HAQ disability index (HAQ-DI)] and quality of life [36-item Short Form Health Survey (SF-36) physical component summary (PCS)]. Analyses were repeated in patients with a disease duration ⩽3 years. Results At 2 years, 64 (50%) patients had improved skin (mRSS decrease of ⩾5 points and/or ⩾25%). Skin improvers had improved summed DSS (P = 0.002); better physician global assessments of disease activity, severity and damage (all P ⩽ 0.003); better HAQ-DI (P = 0.001) and SF-36 PCS (P = 0.005). Changes in the mRSS were positively correlated with changes in summed DSS (P = 0.006) and other disease outcomes. In the 26 (20.3%) patients with worsened skin (mRSS increase of ⩾5 points and/or ⩾25%), the summed DSS and physician global assessments were worse (P = 0.01 and P ⩽ 0.009, respectively). In the subgroup with a disease duration ⩽3 years, similar associations were found. Conclusion At 1 and 2 years, overall disease improvement parallels skin improvement in early dcSSc. This is important for prognosis and reflects the value of mRSS as an outcome measure in trials with these patients.

Scholars and social commentators have noted the escalating rates of loneliness among global societies for more than a decade. The need to quarantine, self-isolate, and physically distance during the COVID-19 pandemic negatively affected the way we interacted with each otherexacerbating feelings of loneliness. A sense of belonging and loneliness are sometimes used interchangeably and the research on their shared and distinct aspects is limited. One shared demographic vulnerability in the belonging and loneliness research is the focus on adolescents and young adults. This paper brings together research on the association between the two constructs as a way to explore the utility of belonging-focused perspectives and approaches for addressing loneliness at multiple socio-ecological levels. A proposed conceptual Dual Continuum Model of Belonging and Loneliness presents a multifaceted categorisation of the conjoint loneliness and belonging relationship. This paper highlights the role of belonging in addressing loneliness, which has critical implications for ongoing research and intervention. KEY POINTS What is already known about this topic:(1) Loneliness is considered to arise from a universal human need to belong.(2) Loneliness and belonging are important constructs for social wellbeing.(3) A sense of belonging and loneliness are terms that are often used interchangeably. What this topic adds:(1) The loneliness and belonging research have similarities but are also distinct.(2) Loneliness and belonging could be conceptualised within a dual continuum model.(3) The proposed dual model demonstrates that there is much more to understand about these constructs-theoretically, conceptually and empirically.

Objective. This study was undertaken to assess the effects of a web-based program, MyLupusGuide, developed to facilitate self-management in systemic lupus erythematosus (SLE).Methods. In this randomized controlled online study, participants received either immediate access to the MyLupusGuide site or delayed access starting on month 3. The primary outcome was the patient activation measure (PAM) score. Secondary outcomes included measurements of health status, self-efficacy, coping, perceived patientphysician relationship, and medication adherence. Outcomes were measured at the baseline visit and at the 3-month and 6-month follow-up visits. We used linear mixed modeling to compare PAM scores between the 2 groups at months 3 and 6.Results. There were 541 participants included in this study. The mean ± SE age was 50 ± 14 years; 93% were female and 74% were White. The mean ± SE disease duration was 17 ± 12 years, and 56% visited MyLupusGuide at least once. The baseline mean ± SE PAM score was 61.2 ± 13, with 36% scoring low for perceived self-management skills. After 3 months of exposure to MyLupusGuide, there were no differences in terms of PAM scores between groups. In exploratory analyses, we found significant improvement in PAM scores in those who had low PAM scores at baseline and in male individuals. We observed significant improvements in self-efficacy before and after access to MyLupusGuide and delayed improvements at month 6 compared to month 3 in terms of mental health and emotional coping.Conclusion. MyLupusGuide increases self-efficacy but not patient activation. A total of 56% of participants visited the MyLupusGuide site during the study period. Individuals with lupus need support to become activated toward self-management behaviors.ClinicalTrials.gov identifier: NCT02950714.