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IntroductionGratitude has been identified as a key factor in a number of positive health-related outcomes; however, the mechanisms whereby gratitude is associated with well-being among older adults with chronic pain are poorly understood. Using the Positive Psychological Well-Being Model as a theoretical framework, the objective of the present study was to examine the serial mediating effects of social support, stress, sleep, and tumor necrosis factor-alpha (TNF-α) on the relationship between gratitude and depressive symptoms.MethodsA total sample of 60 community-dwelling older adults with chronic low back pain (cLBP) provided blood samples for high-sensitivity TNF-α and completed the Gratitude Questionnaire, Perceived Stress Scale, and the PROMIS Emotional Support, Sleep Disturbance, and Depression forms. Descriptive statistics, correlation analyses, and serial mediation analyses were performed.ResultsGratitude was negatively associated with perceived stress, sleep disturbance, and depression, and was positively associated with social support. No significant association was observed between gratitude and TNF-α. After controlling for age and marital status, analyses revealed that perceived stress and sleep disturbance sequentially mediated the association between gratitude and depressive symptoms.ConclusionPerceived stress and sleep disturbance may be potential mechanistic pathways by which gratitude impacts negative well-being. Targeting gratitude as a protective resource may be a potential therapeutic tool to improve psychological and behavioral outcomes in older adults with cLBP.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): University Review Board of the American University of Beirut Background Heart Failure [HF] affects 64.3 million individuals globally and despite its decreasing global burden it remains dramatically high in countries of the Eastern Mediterranean Region. Self-care is highly recommended to improve HF patient outcomes and an integral aspect for effective HF self-care is symptom perception. This involves body listening, symptom recognition and monitoring, and interpreting and labeling the meaning of these symptoms. Purpose To identify factors related to HF symptom burden as perceived by patients living with HF and using the Heart Failure Somatic Perception [HFSP] scale. Methods This was a secondary analysis of a cross-sectional correlational study that recruited dyads living with HF. Patients were assessed for symptom burden measured by the HFSP scale, depression measured using the Patient Health Questionnaire [PHQ-9], perceived control measured using the Control Attitudes Scale [CAS], and quality of life measured using the Minnesota Living with HF [MLWHF] questionnaire. Independent t-Test and Pearson correlation were used for analysis. Results A total of 109 HF patients [mean age 63.24 ± 10.77 years, 69.7% males] were included. The mean score of HFSP scale was 27.96 ± 19.43. Symptomatic HF patients [New York Functional Class (NYHA) I and II] had significantly higher HFSP than asymptomatic patients [NYHA III and IV] indicating higher symptom burden [32.90 ± 19.65 versus 23.16 ± 17.79; p = 0.11]. Likely, higher symptom burden was associated with lower total quality of life [higher MLWHF score; r = .802; p <.001], lower physical quality of life [r = .802; p <.001], lower emotional quality of life [r = .384; p <.001], more depression [higher PHQ-9 score; r = .464; p <.001], and lower perceived control over symptoms and disease process [lower CAS score; r = -.506; p <.001]. Predictors were retained in the regression model if they contributed significantly to the model or were conceptually relevant and did not negatively affect the variance. Worse quality of life and lower perceived control explained about 60% of the variance in symptom burden [F = 49.189; p = 0.001]. Conclusion Results of this secondary analysis suggest that patients’ somatic perception of their illness has an independent and substantial relationship to their functionality, quality of life, and perceived control over illness. Illness perceptions are amenable to change, and healthcare providers are tasked with developing and testing targeted interventions aimed to modify these as this may be helpful for improving quality of life and control over disease process.

Objectives Chronic pain results in significant impairment in older adults, yet some individuals maintain adaptive functioning. Limited research has considered the role of positive resources in promoting resilience among older adults. Likewise, these factors have largely been examined independently. We aimed to identify resilience domains based upon biopsychosocial factors and explore whether resilience phenotypes vary across sleep disturbance, fatigue, and cognitive function. Methods Sixty adults (ages 60+) with chronic low back pain (cLBP) completed measures of psychological, health, and social functioning. Based on previously published analyses, principal components analysis was conducted to create composite domains for these measures, followed by cluster analysis to identify phenotypes. Results Four profiles emerged: Cluster 1 (high levels of psychosocial and health-related functioning); Cluster 2 (high health and low psychosocial functioning); Cluster 3 (high psychosocial functioning, poorer health); and Cluster 4 (low levels of functioning across all domains). Significant differences across cluster membership emerged for sleep disturbance (ηp2=0.29), fatigue (ηp2=0.29), and cognitive abilities (ηp2=0.47). Individuals with the highest levels of resilience demonstrated more optimal outcomes in sleep and fatigue (p’s ≤ 0.001), when compared to individuals with a less resilient phenotype. Further, the High Resilience and High Psychosocial/Low Health clusters had lower cognitive impairment than the High Health/Low Psychosocial and Low Resilience groups (p’s ≤ 0.009). Conclusions A higher array of protective resources may buffer against the negative sequelae associated with cLBP. These exploratory findings support the multidimensional nature of resilience and suggest that targeting resilience from a multisystem perspective may optimize interventions for older adults with chronic pain.

Introduction: Substance use among adolescents is on the rise globally. Adolescents rarely seek help for problematic substance use and healthcare professionals can easily fail to identify adolescents with risky substance use. There is therefore a significant global need for substance use screening by healthcare professionals followed by appropriate intervention. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that enables clinicians to determine adolescents’ risk for substance use and intervene accordingly. However, little effort has been placed on empowering primary care clinicians to use it in Lebanon. We explored the attitudes, perceptions, and practices of primary care nurses and physicians regarding adolescent SBIRT use. Methods: The study used a cross-sectional multisite survey design targeting urban and rural areas in Lebanon. A national sample of 140 physicians and nurses was recruited using random sampling stratified by governorate. Participants completed mailed or online surveys addressing their practices, attitudes, role perceptions, and self-efficacy regarding SBIRT use. Results: This study revealed that 57.8% of healthcare professionals were not familiar with the SBIRT model and that 76.2% did not practice SBIRT in their setting. The majority addressed the problem of substance use through educating and counseling adolescents about the dangers of substance use (84.2%) and encouraged them to stop (82%) but only 2% reported using standardized instruments for substance use screening. Most participants (88.1%) reported their willingness to use SBIRT in their clinical practice and 92.4% expressed an interest in receiving SBIRT training. Overall, the results showed positive attitudes ( M = 4.38, SD = 0.89) and role responsibility ( M = 4.47, SD = 1.62) toward addressing substance use in adolescents, in addition to a high level of perceived self-efficacy in addressing substance use ( M = 4.04, SD = 0.92). Our results showed minimal differences between nurses’ and physicians’ perceptions and self-efficacy regarding SBIRT use. Conclusions: Our study confirms the lack of a standardized approach toward adolescent substance use screening and intervention by primary healthcare providers in Lebanon but revealed the readiness and willingness to receive training and proper support to adopt an evidence-based approach such as SBIRT.