Additional Questionnaire Research Articles

The Impact of e-Health Literacy on Risk Perception Among University Students

Background: The COVID-19 pandemic significantly increased public interest in e-health literacy, especially among university students. However, gaps remain in their ability to find and use credible online health information. Purpose: This study explores the effects of public health emergencies on e-health literacy among Chinese university students, aiming to identify influencing factors and propose solutions to improve digital health education. Methods: A structured survey using the eHEALS scale and additional questionnaires was administered to 300 students in Northern China. Statistical analysis was conducted using SPSS 25.0, focusing on literacy levels and their determinants. Results: The pandemic heightened interest in e-health, leading to modest improvements in literacy levels. However, challenges persist, including evaluating the credibility of information and addressing privacy concerns. Apps emerged as the most widely used e-health tools. Discussion: Findings highlight the importance of targeted health education programs to bridge gaps in e-health literacy and support students in effectively using digital health tools. The results emphasize integrating privacy safeguards and enhancing user trust in e-health systems. Conclusion: Enhancing e-health literacy can empower students to make informed health decisions, fostering better self-management and resilience during public health crises.

The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being-Related Outcomes in Police Officers: Longitudinal Mixed Design Study.

Wearable sensor technologies, often referred to as "wearables," have seen a rapid rise in consumer interest in recent years. Initially often seen as "activity trackers," wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being-related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals. The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being-related outcomes in police officers and (2) whether extending a basic "off-the-shelf" wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness. A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions. The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25-0.46) but consistent effect on 8 of 15 of the stress- and well-being-related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes. Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being-related outcomes. Complementing the basic "off-the-shelf" wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects.

Enhancing Sustainable Development Goals (SDGs) for Rural Tourism Communities: The Case of Mae Kampong Village, Chiang Mai, Thailan

Objective: This study proposes sustainable communities for rural tourism, using Mae Kampong Village in Chiang Mai, Thailand, as a case study. The theoretical framework: The determinants of a sustainable rural community-based tourism model include (1) cultural experiences, (2) homestay, hotel, street food, and shop experiences (services, prices, and facilities), and (3) eco-friendly practices and natural experiences. Method: The researchers utilized a meticulous approach, which involved purposive sampling, to select Mae Kampong Village. This research is a systematic review that gathers secondary data and observations for the primary data. Content analysis was employed to understand and synthesize the data. Results and Discussion: The findings indicate that sustainable rural tourism communities based on environmental awareness encompass cultural experiences, tourist experiences (services, pricing, facilities), and eco-friendly actions inside the village. Research Implications: Sustainable rural tourism should employ Mae Kampong Village as a best practice model for sustainable rural tourism regarding cultural experiences, responsible tourism practices, and environmental management to accomplish sustainable development growth (SDGs). Originality/Value: The village offers authentic encounters with Lanna culture through tourist experiences, natural experiences, and community connections. However, this qualitative observation was without respondents. Additional questionnaires and interviews are recommended for further studies to comprehensively examine the village's environmental awareness activities, such as organic farming and renewable energy. This will help tourists and locals benefit from sustainable economic growth while safeguarding the village's natural and cultural heritage. Emphasizing community-based tourism and providing inexpensive and accessible experiences will be instrumental in achieving sustainability goals.

WeChat mini-program, a preliminary applied study of the gestational blood glucose management model for pregnant women with gestational diabetes mellitus

BackgroundThe mHealth has been increasing in pregnancy. However, the WeChat mini-program based gestational glucose management model for gestational diabetes mellitus (GDM) during pregnancy has not been established. Methods56 GDM pregnant women were selected. The control group received routine pregnancy health care, and the experimental group received WeChat mini-program GDM women’s blood glucose management model, Intervention from diagnosis of GDM to delivery. PBG, self-management ability, maternal and infant outcomes, satisfaction and so on were collected, with an additional mHealth app usability questionnaire collected by the experimental group. ResultsThe WeChat mini-program GDM women’s blood glucose management model reduced PBG, the birth weight of newborns and the incidence of other complications(P < 0.05). The model also improved self-management ability and satisfaction of GDM pregnant women(P < 0.01). The mHealth app usability questionnaire score tends to be close to 1, which indicates that the WeChat mini-program has usability. ConclusionThe WeChat mini-program blood glucose management model reduces PBG and improves the self-management ability, which verifies the feasibility and effectiveness of the blood glucose management model relying on the WeChat mini-program.

Measuring implicit associations with behaviours to improve resident mood: development of implicit association tasks for nursing home care providers.

To develop and evaluate instruments for measuring implicit associations of nursing home care providers with behaviours aimed at improving resident mood. Study 1 (N = 41) followed an iterative approach to develop two implicit association tasks measuring implicit attitude (positive versus negative valence) and motivation (wanting versus not wanting) regarding mood-improving behaviours, followed by an evaluation of the content validity for target stimuli representing these behaviours. In Study 2 (N = 230), the tasks were assessed for stimulus classification ease (accuracy and speed) and internal consistency. A subsample (n = 111) completed additional questionnaires to evaluate convergent validity (with self-reported attitudes towards depression, altruism, and mood-improving behaviours), and discriminant validity (against social desirability), and repeated the tasks after 2 weeks to assess test-retest reliability. Content validity indexes for target stimuli were satisfactory. Error rates were acceptable for attribute stimuli, but exceeded the 10 % limit for target stimuli. Response times for all stimuli exceeded the 800-millisecond threshold. Both tasks demonstrated good internal consistency but poor test-retest reliability. Regarding convergent validity, both tasks significantly correlated with altruism, the implicit attitude task associated with self-reported mood-improving behaviours, and the implicit motivation task correlated with the behavioural scale of attitudes towards depression. Discriminant validity was supported as neither task was significantly associated with social desirability. The implicit association tasks show potential for measuring implicit associations with mood-improving behaviours of care providers, offering an innovative pathway for exploring processes influencing caregiving behaviours. However, limitations in psychometric properties were identified, aligning with challenges observed in similar measures.

Anterior Gastropexy for Paraesophageal Hernia Repair

Paraesophageal hernias can cause severe limitations in quality of life and life-threatening complications. Even though minimally invasive paraesophageal hernia repair (MIS-PEHR) is safe and effective, anatomic recurrence rates remain notoriously high. Retrospective data suggest that suturing the stomach to the anterior abdominal wall after repair-an anterior gastropexy-may reduce recurrence, but this adjunct is currently not the standard of care. To determine whether anterior gastropexy reduces 1-year recurrence after MIS-PEHR. This registry-based randomized clinical trial was conducted by 10 surgeons at 3 academic hospitals within the Cleveland Clinic Enterprise. Between June 26, 2019, and July 24, 2023, 348 patients were assessed for eligibility, and 240 patients were enrolled and randomized. Statistical analysis was performed from January to March 2024. Enrolled patients were randomized to and received either an anterior gastropexy (n = 119) or no anterior gastropexy (n = 121). The primary outcome was recurrence as determined by reherniation of the stomach greater than 2 cm above the diaphragm on routine imaging at 1 year or reoperation. Secondary outcomes included quality of life as measured by the Gastroesophageal Reflux Health-Related Quality of Life survey, additional foregut symptom questionnaire, and patient satisfaction at 30 days and 1 year. A total of 240 patients were randomized to either anterior gastropexy (n = 119; 104 [97%] women; median [IQR] age, 70 [64-75] years) or no anterior gastropexy (n = 121; 97 [80%] women; median [IQR] age, 68 [62-73] years) at the end of their MIS-PEHR. At 1 year, 188 patients (78%) had completed follow-up. By intention-to-treat analysis, 1-year recurrence was significantly lower in patients who received an anterior gastropexy (15% vs 36%; risk difference, 0.21 [95% CI, 0.09-0.33]), which remained significant after risk-adjusted regression analysis (hazard ratio, 0.38 [95% CI, 0.23-0.60]). Of 13 reoperations (5.4%) for recurrence in the first year, 3 (2.5%) were in the anterior gastropexy group and 10 (8.2%) were in the no-gastropexy group (P = .052). Two patients (1.7%) had their anterior gastropexy sutures removed for pain. There were no significant differences in quality-of-life outcomes at 30 days and 1 year between treatment groups. This randomized clinical trial found that the addition of an anterior gastropexy to MIS-PEHR is superior to no gastropexy in regard to reducing 1-year paraesophageal hernia recurrence. These results suggest that an anterior gastropexy should be routinely used in the context of minimally invasive paraesophageal hernia repair. ClinicalTrials.gov Identifier: NCT04007952.

Putting the ‘Uni’ into Community. A three-year mixed methods pragmatic sequential evaluation of an innovative voluntary sector collaborative partnership with a UK University.

Evidence for a triangular partnership of individual student volunteers, universities, and voluntary sector groups so multiple benefits. This paper presents a three-year mixed-method pragmatic sequential evaluation of an innovative and ambitious enterprise which aimed to bring assets of the community sector and higher education together. The researchers conducted yearly focused groups and semi-structured interviews with key individuals involved in the enterprise with additional online questionnaires with students and local voluntary sector groups. Universities around the UK increasingly build partnerships with voluntary organisations and communities, but these are not without their challenges. This evaluation has highlighted that successful partnerships are those whereby partners can exchange values and aims they deem worth striving for, and where they are urged to continually consider these intended outcomes of the partnership during the process.

The effect of SARS-CoV-2 infection and COVID-19 vaccination during pregnancy on neonatal outcomes.

This study explored the effect of SARS-CoV-2 infection and COVID-19 vaccination during pregnancy on neonatal outcomes among women from the general Dutch population. VASCO is an ongoing prospective cohort study aimed at assessing vaccine effectiveness of COVID-19 vaccination. Pregnancy status was reported at baseline and through regular follow-up questionnaires. As an extension to the main study, all female participants who reported to have been pregnant between enrolment (May-December 2021) and January 2023 were requested to complete an additional questionnaire on neonatal outcomes. Multivariable linear and logistic regression analyses were used to determine the associations between self-reported SARS-CoV-2 infection or COVID-19 vaccination during pregnancy and neonatal outcomes, adjusted for age, educational level, and presence of a medical risk condition. Infection analyses were additionally adjusted for COVID-19 vaccination before and during pregnancy, and vaccination analyses for SARS-CoV-2 infection before and during pregnancy. Of 312 eligible participants, 232 (74%) completed the questionnaire. In total, 196 COVID-19 vaccinations and 115 SARS-CoV-2 infections during pregnancy were reported. Infections were mostly first infections (86; 75%), caused by the Omicron variant (95; 83%), in women who had received ≥1 vaccination prior to infection (101; 88%). SARS-CoV-2 infection during pregnancy was not significantly associated with gestational age (β = 1.7; 95%CI: -1.6-5.0), birth weight (β = 82; -59 to 223), Apgar score <9 (odds ratio (OR): 1.3; 0.6-2.9), postpartum hospital stay (OR: 1.0; 0.6-1.8), or neonatal intensive care unit admission (OR: 0.8; 0.2-3.2). COVID-19 vaccination during pregnancy was not significantly associated with gestational age (β = -0.4; -4.0 to 3.2), birth weight (β = 88; -64 to 240), Apgar score <9 (OR: 0.9; 0.4-2.3), postpartum hospital stay (OR: 0.9; 0.5-1.7), or neonatal intensive care unit admission (OR: 1.6; 0.4-8.6). In conclusion, this study did not find an effect of SARS-CoV-2 infection or COVID-19 vaccination during pregnancy on any of the studied neonatal outcomes among a general Dutch, largely vaccinated, population. Together with data from other studies, this supports the safety of COVID-19 vaccination during pregnancy.

Self-reported dizziness, balance, and multisensory impairment following mild traumatic brain injury: an exploratory study

ABSTRACT Dizziness following mild traumatic brain injury (mTBI), or concussion, is common and can encompass multiple sensations reflecting diverse aetiologies. This exploratory study investigated the types of dizzy sensations experienced, their evolution, and relationship with other post-concussion symptoms. Thirty New Zealanders (24 female) aged 49 ± 16 years who experienced dizziness or imbalance following their injury completed the Dizziness Handicap Inventory, Visual Vertigo Analogue Scale, and the Hospital Anxiety and Depression Scale. Additional custom questionnaires probed subjective experiences of dizziness and balance, headaches, and difficulties with auditory processing and vision. Just over half the participants (56.7%) experienced a single mTBI. The median time interval since the injury was 16 months (IQR = 24 months). Participants usually reported multiple dizzy symptoms which developed within a week of the injury, although delays of up to six months were reported. Most participants (70%) felt their symptoms improved over time, while lack of improvement was associated with a history of multiple mTBI (P = 0.020). Moderate to strong correlations between questionnaire scores representing dizziness handicap, visual vertigo severity, and auditory processing difficulties (P < 0.001) suggest that dizziness and sensory impairment following mTBI are multi-modal and likely to benefit from holistic, multidisciplinary treatment.

QOL-21. PSYCHOMETRIC VALIDATION OF THE FEAR OF CANCER RECURRENCE INVENTORY FOR PRIMARY BRAIN TUMOR PATIENTS

Abstract BACKGROUND Fear of cancer recurrence and progression (FCR) is a significant concern among those living with primary brain tumor and may be distinct compared to FCR in other cancer populations due to poorer prognosis, neurologic symptoms, and often lifelong treatment. The gold-standard comprehensive assessment tool for FCR–the FCR Inventory (FCRI)–includes 42 items with seven subscales. Validation of the FCRI scale excluded those with primary brain tumors. The present study is the first examination of the psychometric properties of the full FCRI in a heterogeneous sample of patients with primary brain tumors. METHODS Adult patients with primary brain tumors (n=334) completed the FCRI, with six additional brain tumor-specific items, and psychological, medical, and demographic questionnaires. In accordance with best practices of measure development, exploratory factor analysis (EFA) was conducted on the FCRI at the subscale level. Correlations investigated construct validity. RESULTS EFA largely supported the overall psychometric properties of the original FCRI. Several subscales were unchanged: Psychological Distress, Functioning Impairments, Insight, and Reassurance. One brain tumor-specific item (researching treatments) exhibited good fit on the Coping Skills subscale. On the Severity subscale, one item (belief that the tumor will not return) did not fit with an otherwise strong one-factor model. Additionally, five new brain tumor-specific items demonstrated good fit with the Triggers subscale. The resultant FCRI-Brain includes 41 original FCRI items plus six new brain tumor-specific items. FCRI-Brain demonstrated good convergent validity with measures of depression (r=.72), anxiety (r=.75), and death anxiety (r=.80; ps&amp;lt;.05). CONCLUSIONS This is the first validation of the comprehensive FCRI in patients with primary brain tumors. Factor analysis identified a theoretically similar and brain-tumor specific seven-factor model for the FCRI-Brain. Item-level and subscale statistics will be presented, including factor iteration and construction. Future work will use the FCRI to investigate FCR intervention efficacy in neuro-oncology.

Psychiatric disorders endorsed by trauma-exposed premenopausal women enrolled in a cardiovascular research study: a 2-year report

IntroductionWomen are more likely than men to experience interpersonal trauma, with 1 in 3 women affected globally. This paper aims to give a 2-year report of the demographics, trauma history [i.e., non-interpersonal and interpersonal including adverse childhood event (ACEs)] and psychiatric disorders endorsed by premenopausal women screened for our cardiovascular research study.MethodsPremenopausal women were recruited from the Twin-Cities area using flyers. Interested participants were screened for this study via REDCap. Age, race, history of psychiatric disorders, menopausal status, contraceptives, and current medications were collected. Participants who met the eligibility criteria were enrolled and completed additional questionnaires focusing on trauma exposure and mental health.ResultsThe first 2 years our study was open to accrual, a total of 447 premenopausal women were screened. The majority (~ 71%) of our participants were between 18 and 30 years old. Among the 447 women, 35% reported a diagnosis of posttraumatic stress disorder (PTSD), while 46% reported depression and 53% an anxiety disorder, according to DSM-5. Further, we found that women between the ages of 21–25 years reported the most (23%) psychiatric disorders, mainly PTSD. The main type of trauma reported was interpersonal trauma (~ 62%), of which 76% were ACEs.ConclusionAmong the trauma-exposed women enrolled in our study, the age group between 21 and 25 years old endorsed the most psychiatric disorders, possibly stemming from ACEs. Our findings shed the light on the rising rate of psychiatric disorders in premenopausal women and support the growing public health burden of trauma exposure, particularly in childhood.

Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial.

The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health-based intervention designed to systematically facilitate thought progression would substantially alleviate depression. The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns. A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life. The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was -7.01 points (95% CI -10.72 to -3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app. The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety. ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758.

The Influence of Sex and Gender on the Level and Course of Subjective Cognitive Complaints After Percutaneous Coronary Intervention.

Cognitive complaints (e.g., health anxiety and illness disruption) are commonly experienced by patients with coronary heart disease (CHD). While it is known that sex and gender affect health, their influence on cognitive complaints remains unknown. The current study explored sex and gender differences in cognitive complaints during the first month (acute phase) and beyond, up to 2years (recovery phase) after percutaneous coronary intervention (PCI). A total of 514 (Mage = 64.2 ± 8.9, 84.2% male) completed the cognitive scale of the Health Complaints Scale (i.e., overall cognitive complaints, health worry, illness disruption) at baseline, 1, 12, and 24months post-PCI. Additional questionnaires to gauge gender identity, traits, and norms were administered in a follow-up study. General linear mixed model analyses were conducted to examine the influence of sex, gender, sex × gender, and covariates on cognitive complaints. Cognitive complaints only decreased in the first month post-PCI (all p < .01). There were no clear sex differences. However, gender generally predicted cognitive complaints in the first 2 years post-PCI: masculinity was related to less complaints, whereas feminine individuals reported higher absolute levels of complaints. The current findings reveal that gender is a valuable factor concerning health complaints and indicate the need to further elaborate on the discrepancies between sex and gender in health research.

Collection of Multiple Patient-Reported Outcome Measures (CRAM-PROMs) in orthopaedic trauma: a randomized trial to assess the impact of quantity on quality

BackgroundWe rely on sound clinical research to ensure the safety and effectiveness of medical interventions. We are nowadays experiencing an increased utilization of Patient Reported Outcome Measures (PROMs) in research, for which there is good evidence on validity and reliability. However, these measures are often validated in isolation and not in a real-life setting where they are used in conjunction with other questionnaires and measures. Our study objective was to determine if the number of PROMs questionnaires completed by fracture patients affected their reliability; more specifically, the internal consistency of the EuroQuol Five Dimension-Five Level (EQ-5D-5 L) questionnaire. HypothesisOur hypothesis was that there is a progressive decline in reliability as we increase the number of questionnaires given to participants. Patients and methodThis is a randomized study carried out in a single Level I academic trauma center. Patients presenting to the fracture clinic for follow-up were screened. Participants were randomly assigned to 4 groups: group 1 only answered the EuroQol Five Dimension–Five Level (EQ-5D-5 L) questionnaire, group 2 answered one additional questionnaire before the EQ-5D-5 L, group 3 answered two and group 4 answered three additional questionnaires before the EQ-5D-5 L. The primary outcome measured was the internal consistency of the EQ-5D-5 L as a measure of reliability. ResultsEnrolment was 115 participants. Twenty-eight participants were randomized to Group 1, 29 to Group 2, 29 to Group 3, and 29 to Group 4. There was a progressive decline of reliability as number of questionnaires increased except for a sudden rise in group 4. (Group 1: 0.83, 95% Confidence Interval (CI) 0.70 to 0.91; Group 2: 0.74, 95% CI 0.56 to 0.87; Group 3: 0.68, 95% CI 0.44 to 0.83; Group 4: 0.81, 95% CI 0.68 to 0.90). Completeness was 100% for Group 1, 98.5% for Group 2, 100% for Group 3, and 92% for Group 4. DiscussionThese results cannot strongly support our initial hypothesis. Although there is an initial decrease in Cochran’s alpha for Groups 2 and 3 consecutively, the sudden rise in group 4 limits the validity our results. Notwithstanding, researchers should consider these findings when designing their research trials to avoid potential misleading results. Hence, the number of given questionnaires in research should be limited in order for these to maintain their reliability. Level of evidenceII.

Exercise-induced cardiac troponins in long-distance walkers: a preliminary observation.

Abstract Background Elevated concentrations of cardiac troponin (cTnT and cTnI), the preferred biomarker to diagnose myocardial infarction, can be detected in other (cardiac) conditions and even post-exercise. Whether these exercise-induced elevations reflect a (patho)physiological process, as well as their clinical implications, is unknown. In this preliminary study, pre- and post-exercise high-sensitivity cTn (hs-cTnT and hs-cTnI) concentrations were investigated in long-distance walkers. Purpose Gain insight of elevated cTnT and cTnI concentrations post-exercise in long-distance walkers. Methods From 478 participants, walking 30-50 km on the first day of the 4Daagse 2023, blood-samples were collected pre- and &amp;lt;6h post-exercise. In addition, health and exercise questionnaires were conducted. Hs-cTnT (Roche) and hs-cTnI (Abbott) concentrations were determined and the unisex, female and male Upper Reference Limit (URL) were according to package inserts (Roche: 14 ng/L, 9 ng/L, 16 ng/L, Abbott: 26 ng/L, 16 ng/L, 34 ng/L). Results Participants (51% female) were 57±7.6 years (mean±SD). At baseline, median [IQR] hs-cTnT and hs-cTnI were 5.9 [4.5-8.0] and 1.7 [1.1-2.9] ng/L, which increased significantly post-exercise to 8.7 [6.4-12.4] ng/L (P&amp;lt;0.001) and 5.2 [3.1-9.5] ng/L (P&amp;lt;0.001). Pre-exercise, the unisex-URL for hs-cTnT was exceeded by 4.4% walkers and for sex-specific URLs, this resulted in 6.6% females and 3.8% males. For hs-cTnI, the unisex-URL was exceeded by 0.6%, as for sex-specific URLs, 0.8% females and 1.3 % males surpassed. Post-exercise, hs-cTnT URLs were exceeded by 18.2%, 35.1%, 16.5% and as for hs-cTnI post-exercise, 7.3%, 11.6%, 3.8% for unisex, female and male. Alternatively, the absolute median delta difference was 2.4 [0.9-4.6] ng/L for hs-cTnT and 3.0 [1.6-5.7] ng/L hs-cTnI. Conclusion Post-exercise long-distance walkers had significantly increased hs-cTnT and hs-cTnI concentrations, in particular in women when using sex-specific cutoffs. In order to understand clinical implications of these findings, status of cardiac vascular diseases, risk-factors and exercise characteristics will be analyzed in the future.

Lithium Aspartate for Long COVID Fatigue and Cognitive Dysfunction

Neurologic post-COVID-19 condition (PCC), or long COVID, symptoms of fatigue and cognitive dysfunction continue to affect millions of people who have been infected with SARS-CoV-2. There currently are no effective evidence-based therapies available for treating neurologic PCC. To assess the effects of lithium aspartate therapy on PCC fatigue and cognitive dysfunction. A randomized, double-blind, placebo-controlled trial (RCT) enrolling participants in a neurology clinic from November 28, 2022, to June 29, 2023, with 3 weeks of follow-up, was conducted. Subsequently, an open-label lithium dose-finding study with 6 weeks of follow-up was performed among the same participants enrolled in the RCT. Eligible individuals needed to report new, bothersome fatigue or cognitive dysfunction persisting for more than 4 weeks after a self-reported positive test for COVID-19, Fatigue Severity Scale-7 (FSS-7) or Brain Fog Severity Scale (BFSS) score of 28 or greater, Beck Depression Inventory-II score less than 24, and no history of a condition known to cause fatigue or cognitive dysfunction. All participants in the RCT were eligible for the dose-finding study, except for those who responded to the placebo. Intention-to-treat analysis was used. Lithium aspartate, 10 to 15 mg/d, or identically appearing placebo for 3 weeks followed by open-label lithium aspartate, 10 to 15 mg/d, for 2 weeks. In the subsequent dose-finding study, open-label lithium aspartate dosages up to 45 mg/d for 6 weeks were given. Change in sum of FSS-7 and BFSS scores. The scores for each measure range from 7 to 49, with higher scores indicating more severe symptoms. Secondary outcomes included changes from baseline in the scores of additional questionnaires. Fifty-two participants were enrolled (30 [58%] males; mean [SD] age, 58.54 [14.34] years) and 26 were randomized to treatment with lithium aspartate (10 females) and 26 to placebo (12 female). Two participants assigned to lithium aspartate were lost to follow-up and none withdrew. No adverse events were attributable to lithium therapy. There were no significant intergroup differences for the primary outcome (-3.6; 95% CI, -16.6 to 9.5; P = .59) or any secondary outcomes. Among 3 patients completing a subsequent dose-finding study, open-label lithium aspartate, 40 to 45 mg/d, was associated with numerically greater reductions in fatigue and cognitive dysfunction scores than 15 mg/d, particularly in 2 patients with serum lithium levels of 0.18 and 0.49 mEq/L compared with 1 patient with a level of 0.10 mEq/L. In this RCT, therapy with lithium aspartate, 10 to 15 mg/d, was ineffective for neurologic PCC fatigue and cognitive dysfunction. Another RCT is required to assess the potential benefits of higher lithium dosages for treating neurologic PCC. ClinicalTrials.gov Identifier: NCT05618587 and NCT06108297.

Validation of the Cholinergic Urticaria Activity Score (CholUAS)

BackgroundIn cholinergic urticaria (CholU), itchy wheal and flare-type skin reactions are triggered by sweat-inducing activities. The CholU activity score, CholUAS, is used to assess disease activity, but has not yet been validated.The aim of the study was to validate the CholUAS, develop an English version, and provide instructions for scoring. MethodsCognitive debriefing of CholUAS was performed. CholU patients (n =75) used the CholUAS on 7 consecutive days, underwent provocation testing, and completed additional anchor instrument questionnaires including global evaluation tools and established quality of life instruments. A scoring protocol for the calculation of the weekly CholUAS, the CholUAS7, was developed. The CholUAS7 was tested for validity, reliability, and influencing factors. An English version of the CholUAS was developed. ResultsThe final CholUAS contains 3 questions that are used for scoring as well as one global question. The weekly CholUAS, CholUAS7, showed excellent test-retest reliability and good correlations with anchor instruments. Statistical analysis showed no significant influence of age or duration of disease on CholUAS7 results. ConclusionThe validated CholUAS is ready for use in clinical trials and routine clinical practice.

How Do Age and Attitudes Affect the Quality of Data Collected by Young Citizen Scientists in an Ecological Research Project?

Citizen science is increasingly used to collect ecological data. Specifically, participation of school students in authentic research has been suggested as having a multitude of benefits from serving as data collection to providing science education. Nevertheless, the overall quality and quantity of data is concerning for ecologists who are using data for research. In the Helsinki Urban Rat Project, lower- and upper secondary school students (13-19-year-old) collect data on urban rat occurrence using track plates that record rat footprints. I measured the success of school-aged citizen scientists in collecting and submitting data, and I determined the accuracy of the data they submitted by comparing their results to the results from professional researchers. Furthermore, I used additional questionnaire to relate success and accuracy to student attributes, including age, attitudes about biology as a school subject, interest in the environment and disgust sensitivity toward rats. I learned that, in contrast to results from previous studies, age was not a significant variable but rather available support from a teacher and voluntary participation with rewards were associated with higher data quality. Additionally, attitudes played a part in observer quality: higher liking of biology as a school subject was associated with lower accuracy, whereas a higher interest in the environment was associated with higher accuracy. The young citizen scientists provided broadly accurate data, although false-positive observations were comparatively common. The results suggest that the quality and quantity of citizen-generated data are not straightforwardly dependent on the selected target groups. Citizen science activities should be planned by careful consideration of the context as, for example, the organization of the participation strongly shapes the participatory activities.

Use and feasibility of a Lynch Syndrome predictive model for inherited colorectal and endometrial cancer in a low-middle income country.

While universal tumor testing for Lynch Syndrome (LS) is recommended in all new diagnoses of colorectal cancer (CC) and endometrial cancer (EC), the cost and availability of this test in low-resource settings poses challenges. The PREdiction Model for gene Mutations (PREMM5) is a clinical algorithm designed to assess the risk of an individual carrying estimates one's risk of carrying a LS mutation. This study aims to assess the feasibility of using PREMM5 to screen for LS risk in Guatemala. This cross-sectional pilot study enrolled 50 patients with colorectal or endometrial cancer receiving treatment at LIGA-INCAN, a cancer hospital in Guatemala City, between June 2022-July 2022. Patients were contacted by phone and administered the PREMM5 survey, followed by an additional feasibility questionnaire. Of the 50 participants, 62% of patients had a PREMM5 predicted probability of ≥ 2.5%, the threshold above which genetic testing is recommended. Almost all patients found the survey easy to complete (98%), were able to easily recall personal (90%) and family (88%) medical history, understood its purpose (94%), and reported an interest in (96%) and ability to (98%) act on the results if applicable. Our study shows the role of the PREMM5 as a feasible tool for identifying individuals at risk of carrying mutations associated with LS in this low-resource setting. By implementing the PREMM5 model, high risk individuals can be identified early, enabling timely interventions and improving outcomes in this at-risk population.

Testing the Effectiveness of a Mobile Smartphone App Designed to Improve the Mental Health of Junior Physicians: Protocol for a Randomized Controlled Trial.

Shift (Black Dog Institute) is the first mobile health smartphone appcreated to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians. This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group. A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or(2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months.Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated. The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025. To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians. Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk. DERR1-10.2196/58288.