Symptom Categories Research Articles

Disability weight measurement for the severity of different diseases in Wuhan, China

BackgroundMeasurement of the Chinese burden of disease with disability-adjusted life-years (DALYs) requires disability weight (DW) that quantify health losses for all non-fatal consequences of disease and injury. The Global Burden of Disease (GBD) 2013 DW study indicates that it is limited by lack of geographic variation in DW data and by the current measurement methodology. We aim to estimate DW for a set of health states from major diseases in the Wuhan population.MethodsWe conducted the DW measurement study for 206 health states through a household survey with computer-assisted face-to-face interviews and a web-based survey. Based on GBD 2013 DW study, paired comparison (PC) and Population health equivalence (PHE) method was used and different PC/PHE questions were randomly assigned to each respondent. In statistical analysis, the PC data was analyzed by probit regression. The probit regression results will be anchored by results from the PHE data analyzed by interval regression on the DW scale units between 0 (no loss of health) and 1 (loss equivalent to death).ResultsA total of 2610 and 3140 individuals were included in the household and web-based survey, respectively. The results from the total pooled data showed health state “mild anemia” (DW = 0.005, 95% UI 0.000–0.027) or “allergic rhinitis (hay fever)” (0.005, 95% UI 0.000–0.029) had the lowest DW and “heroin and other opioid dependence, severe” had the highest DW (0.699, 95% UI 0.579–0.827). A high correlation coefficient (Pearson’s r = 0.876; P < 0.001) for DWs of same health states was observed between Wuhan’s survey and GBD 2013 DW survey. Health states referred to mental symptom, fatigue, and the residual category of other physical symptoms were statistically significantly associated with a lower Wuhan’s DWs than the GBD’s DWs. Health states with disfigurement and substance use symptom had a higher DW in Wuhan population than the GBD 2013 study.ConclusionsThis set of DWs could be used to calculate local diseases burden for health policy-decision in Wuhan population. The DW differences between the GBD’s survey and Wuhan’s survey suggest that there might be some contextual or culture factors influencing assessment on the severity of diseases.

Pompe disease ascertained through The Lantern Project, 2018-2021: Next-generation sequencing and enzymatic testing to overcome obstacles to diagnosis.

The Lantern Project is an ongoing complimentary diagnostic program for patients in the United States sponsored by Sanofi and implemented by PerkinElmer Genomics. It combines specific enzymatic, biomarker, and genetic testing to facilitate rapid, accurate laboratory diagnosis of Pompe disease and several other lysosomal storage diseases, and a multigene next-generation sequencing panel including Pompe disease, LGMD, and other neuromuscular disorders. This article reports data for Pompe disease collected from October 2018 through December 2021, including acid α-glucosidase (GAA) enzyme assay and GAA sequencing (standard or expedited for positive newborn screening [NBS] to rule out infantile-onset Pompe disease [IOPD]) and the Focused Neuromuscular Panel, which includes GAA. One hundred forty patients (12 received only GAA enzyme testing, 128 had GAA sequencing alone or in addition to enzyme assay) have been confirmed with Pompe disease in this project. Eight of the 140 had a variant of unknown significance, but GAA activity ≤2.10μmol/L/h, thus were confirmed with Pompe disease. Three diagnosed patients 0-2years old had cross-reactive immunologic material (CRIM)-negative GAA variants and thus IOPD. One additional infant with presumptive IOPD had a homozygous frameshift c.1846del, likely CRIM-negative; symptoms were not provided. Among the 128 patients with molecular results, the c.-32-13T>G splice variant was homozygous in 11, compound-heterozygous in 98, and absent in 19. Proximal muscle weakness (58 patients) was the most common sign reported at testing; elevated creatine kinase (29 patients) was the most common laboratory result. The most common symptom categories were muscular (73 patients), musculoskeletal (13 patients), and respiratory (23 patients). Clinical information was not available for 42 samples, and 17 infants had only "abnormal NBS" or "low GAA" reported. Cardiac symptoms in 7 included potentially age-related conditions in five c.-32-13T>G-compound-heterozygous adults (myocardial infarction, heart murmur/palpitations, congestive heart failure: 1 each; 2 with atrial fibrillation) and hypertrophic cardiomyopathy in 2 children (1 and 2years old) with presumptive IOPD. One novel GAA variant was observed in a patient with enzyme activity 0.31μmol/L/h: c.1853_1854ins49, a frameshift pathogenic variant. The Lantern Project demonstrates the combinatorial utility of enzyme assay, targeted single-gene testing, and a focused neuromuscular next-generation sequencing panel in diagnosing Pompe disease.

Pre-cluster symptoms and treatment response in cluster headache: A large cohort in Taiwanese patients (S41.005)

<h3>Objective:</h3> This study aimed to analyze the prevalence, symptomatology, and predictivity of upcoming bouts of pre-cluster symptoms (PCS). Also, we investigated the associations between different PCS and treatment responses for CH. <h3>Background:</h3> PCS are symptoms preceding the upcoming bouts. Some patients could predict the CH bout based on these symptoms and might have roles in pre-emptive treatment. This study analyzed the characteristic of PCS in a large Asian cohort. Moreover, we explored the linkage between PCS and the treatment outcome of CH. <h3>Design/Methods:</h3> We prospectively collected consecutive data from patients with CH. Each patient completed semi-structured interviews during CH bouts, which included 50 questions about CH symptomatology, severity, and PCS. After CH bout, we recorded responses to acute and preventive treatments. The thirty-five PCS were divided into six categories: localized (head &amp; neck) pain, general pain, fatigue &amp; mood changes, sleep problems, constitutional symptoms, and cranial autonomic symptoms. <h3>Results:</h3> A total of 131 CH patients (M: F= 98: 33) were recruited during the study period. The prevalence of PCS was 64.9%, with a mean (± SD) duration of 2.2 (± 3.9) days before CH bouts. Up to 64.1 % of CH patients were able to predict upcoming bouts. Among six categories of PCS, head and neck pain symptoms were most common (82.4%), and were more able to predict upcoming bouts (presence: absence= 68.5% vs. 43.5%, p=0.023, OR=2.8 [95% CI 1.1–7.1]). Moreover, PCS associated with response to CH preventive treatments: sleep alternation and restlessness before upcoming bouts are more likely responsive to verapamil (OR=2.1 [95% CI 1.0–4.3] and 2.3 [95% CI 1.1–4.6], respectively). <h3>Conclusions:</h3> About two-thirds of CH patients had PCS. Head and neck pain symptoms were the most common PCS with the highest predictivity of the upcoming bout. Certain PCS linked to better response to verapamil, which provides insights into future treatment strategies. <b>Disclosure:</b> The institution of ShuTing Chen has received research support from Ministry of Science and Technology (Taiwan). The institution of ShuTing Chen has received research support from Taipei Veterans General Hospital . Ms. Lin has nothing to disclose. Miss TSENG has nothing to disclose. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen-Idec. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for International Headache Society (IHS). The institution of Dr. Wu has received research support from Ministry of Science and Technology of Taiwan. The institution of an immediate family member of Dr. Wu has received research support from Ministry of Science and Technology of Taiwan.

P044 Prevalence and incidence of Behcets Syndrome (BS) in the Hospital Episode Statistics (HES) in England between 2011 and 2021; a retrospective validation study nested within the Birmingham Centre of Excellence for Behcets

Abstract Background/Aims Behçet’s Syndrome is considered rare in the UK. Prevalence estimates range from 0.64 to14.61 per 100 000 population. Here we explore validity of HES ICD-10 codes for BS using Birmingham Centre of excellence (BCoE) data as reference. Prevalence, incidence, clinical characteristics and mortality were compared for attendees at the three national Centres of Excellence (CoE) versus non attendees Methods We extracted all patients aged &amp;gt;18 who had a diagnosis for Behçet's Disease in HES between April 2011 and March 2019. A retrospective cross-sectional analysis of medical records (2012 to 2019) was undertaken at BCoE for MDT confirmed BS for validation. A multivariable logistic regression model examined mortality within 3 years following BS diagnosis. Kaplan Meier survival analysis was undertaken comparing CoE attenders versus non-attenders. Chi squared tests assessed significance of the relationship between CoE attendance, demography, symptom categories, infliximab use and mortality within 3 years. To determine the incidence and prevalence rates, we obtained ONS mid-year estimates of England’s adult population for each year from 2011 to 2019. Point prevalence of BS per 100,000 population was calculated per year of study while Incidence was calculated per 100,000 person years for each year of the study period Results 4452 cases of BS including 515 BCoE attendees were identified in HES between 2011 and 2019. 559 BS cases were confirmed between 2012 and 2020 in the BCoE database. BS prevalence and incidence increased from 2.2 to 3.8 and 0.7 to 0.9 per 100,000 respectively between 2011 and 2019. 65.5% of BS cases were female, 84.9% were Caucasian. BS prevalence peaked at ages 40-49 years. HES data only identified 1157/4452 patients attending one of the three national COEs. Male patients with BS were more likely to have ocular, vascular and cardiac characteristics of BS (p &amp;lt; 0.001). Caucasian ethnicity was associated with highest prevalence of genital ulceration, ocular, vascular and neurological BS. 3-year all-cause mortality was higher in the non-COE cohort (6.4%) versus COE attenders (2.6%) (p &amp;lt; 0.001). Overall BS associated mortality at 3 years follow-up was 0.83%, with higher rate noted in males (1.3%). In logistic regression analysis, mortality significantly associated with age &amp;gt;40 years, IMD and Comorbidity. Infliximab reduced risk of mortality (OR 0.51; p 0.037) Conclusion Our study strength includes use of unselected national HES data with potential coding for inpatient and outpatient episodes. Increasing prevalence of BS may be multifactorial (misclassification, improved recognition, migration effects, improved survival). Our study confirms differences in phenotype and mortality between those diagnosed with BS in the England versus endemic regions. Future work will examine primary care datasets (CPRD and linked HES) to evaluate the national prevalence, incidence, phenotype clusters and risk factors for BS and will ultimately facilitate the creation of a National BS Register Disclosure P. Chandratre: None. R. Situnayake: None. B. Coupland: None.

Patient reported symptom burden amongst immigrant and Canadian long-term resident women undergoing breast cancer surgery.

Immigrants are susceptible to marginalization due to social isolation, economic disadvantage and systemic bias. Our goal was to compare symptom burden between immigrant and long-term resident women undergoing breast cancer surgery in Ontario, Canada. A population-level retrospective cohort-study using administrative databases was conducted. Women who underwent surgery for newly diagnosed breast cancer and were treated at regional cancer centers between 2010 and 2016 were included. The primary outcome was a moderate or severe (≥ 4) symptom score on the Edmonton Symptom Assessment System Scale (ESAS). There were 12,250 (87.2%) long-term Canadian residents and 1,806(12.8%) immigrants. Immigrants were younger (mean age 53 vs. 61years); had a higher proportion residing in a lowest income quintile neighbourhood (22.2% vs 15.4%); were less often on a primary-care physician roster (83.7% vs. 90.4%); and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p < 0.01). The proportion of women with scores ≥ 4 was significantly higher amongst immigrant women for 7/9 symptom categories; with the largest differences for depression (24.9% vs. 20.2%, p < 0.01) and pain (28.0% vs. 22.4%, p < 0.01). On multivariable regression analysis, immigration status was associated with scores ≥ 4 for pain (OR 1.13, 95% CI 1.02-1.23). There was an association between moderate/severe pain and region of origin, but not length of stay in Canada or immigration class. This is the first study comparing symptom burden amongst immigrant and non-immigrant women with breast cancer at a population-level. Immigrant women with breast cancer undergoing surgery were found to have a higher burden of pain.

Integrative roles of human amygdala subdivisions: Insight from direct intracerebral stimulations via stereotactic EEG.

Substantial studies of human amygdala function have revealed its importance in processing emotional experience, autonomic regulation, and sensory information; however, the neural substrates and circuitry subserving functions have not been directly mapped at the level of the subnuclei in humans. We provide a useful overview of amygdala functional characterization by using direct electrical stimulation to various amygdala regions in 48 patients with drug-resistant epilepsy undergoing stereoelectroencephalography recordings. This stimulation extends beyond the anticipated emotional, neurovegetative, olfactory, and somatosensory responses to include visual, auditory, and vestibular sensations, which may be explained by the functional connectivity with cortical and subcortical regions due to evoked amygdala-cortical potentials. Among the physiological symptom categories for each subnucleus, the most frequently evoked neurovegetative symptoms were distributed in almost every subnucleus. Laterobasal subnuclei are mainly associated with emotional responses, somatosensory responses, and vestibular sensations. Superficial subnuclei are mainly associated with emotional responses and olfactory and visual hallucinations. Our findings contribute to a better understanding of the functional architecture of the human amygdala at the subnuclei level and as a mechanistic basis for the clinical practice of amygdala stimulation in treating patients with neuropsychiatric disorders.

5606726 IMPACT OF ALLOGENEIC STEM CELL TRANSPLANTATION ON PHYSICAL, MENTAL, AND SOCIAL HEALTH OF ADULT SICKLE CELL DISEASE PATIENTS: A MIXED-METHODS STUDY

Background: Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and recurrent painful vaso-occlusive crises, resulting in considerable physical and psychosocial disease burden and early mortality. In recent years, the application of allogeneic hematopoietic stem cell transplantation (HSCT) as a curative treatment for adult SCD patients has increased. As a result, a deeper understanding of the complex relationship between physical, mental, and social health before and after curation is needed. Aim: To explore the experiences and perspectives of adult SCD patients on the impact of HSCT on their physical, mental, and social health. Methods: A mixed methods study design, consisting of a semi-structured interview and completion of 9 Patient Reported Outcomes Measurement Information System (PROMIS®) item banks per participant was used. Adult SCD patients who underwent HSCT ≥ 1 year ago at the Amsterdam University Medical Center were eligible to take part in this study. Interviews were recorded, transcribed verbatim, and thematically analyzed using MAXQDA® software. Standardized T-scores of PROMIS® measures were evaluated and compared to reference scores of the Dutch general population. Results: Ten SCD patients with a median age of 29,5 years (range 19-49) were included in the study and interviewed between October 2021 and May 2022. Median time since HSCT was 2.7 years (range 1 - 3.5). All patients had successful engraftment. Relevant themes were (1) pain/living pain free, (2) physical wellbeing, (3) mental wellbeing, (4) perspective/outlook, (5) education and work, (6) family and friends and (7) activities and participation. Living pain free and the emergence of a future perspective were major improvements for most participants which resonated strongly in their daily lives. Nevertheless, emotional struggles with processing the impact of having had SCD on the one hand, while adjusting to the novel circumstances on the other hand, were common among participants. Before and after HSCT, participants experienced a lack of psychological help. Two patients with ongoing pain from avascular bone necrosis had mixed feelings about the success of the transplant. These two patients scored within the mild, moderate, or severe symptom category on ≥ 7 of 9 PROMIS® item banks. While mean PROMIS® T-scores of all participants fell within the reference values of the general population (Figure 1), a large variation between patients was observed which matched with our findings from the qualitative data. Conclusions: Adult SCD patients experience significant improvements in many aspects of their physical, mental, and social health after cure by HSCT. Yet, they are confronted with a new and often unfamiliar reality, which carries different challenges. Pain as a result of irreversible complications of SCD continues to have a negative impact on quality of life after HSCT. Clinicians should acknowledge these challenges and aim at creating realistic expectations in future transplant candidates. Moreover, patients expressed a need for tailored psychological care, which should be offered before and after HSCT.

Clinical Symptoms on Covid-19 Patient According to Pregnancy Status

Physiological adaptation in pregnant women may increase the risk of more severe symptoms of Covid-19 than women who are not pregnant but there was not much supporting data. Aim of this study was to compare the severity category between women who are pregnant and not pregnant with positive Covid-19. The study was conducted using a retrospective approach which obtained secondary data from patient medical records after being tested positive for COVID-19 from November 2020 to December 2021. Sample size for the study consisted of 67 women COVID-19 patients who were pregnant and 67 women who were not pregnant. Samples were taken by accidental sampling. Categorization of clinical symptoms of COVID-19 was divided into 5 categories (no symptoms, mild, moderate, severe/severe pneumonia, critical). Data were analysis with the Mann Whitney test. Results showed that there were significant differences in the categories of clinical symptoms between groups of pregnant women and groups of non-pregnant women who were exposed to Covid-19 with a value of p=0.000 (p&lt;0,05). Clinical symptoms in Covid-19 patients who are pregnant more severe than women who are not pregnant. This may be caused by increased levels of coagulation and fibrinolytic factors during pregnancy. It is hoped that the handling of Covid-19 patients, especially pregnant women, will receive more detailed attention to avoid the appearance of more severe clinical symptoms.

Cross-cultural adaptation, reliability and validity of the Cantonese-Chinese Cumberland Ankle Instability Tool (CAIT-HK)

Acute lateral ankle sprains are common amongst athletes, and screening is essential in preventing these long-term sequelae. Self-reported questionnaires, such as the Cumberland Ankle Instability Tool (CAIT), may help identify individuals with chronic ankle instability. To date, a Cantonese-Chinese version of the CAIT does not exist.A cross-cultural adaptation and validation of the CAIT were carried out: 46 individuals who were native in Cantonese completed the Cantonese-Chinese version of the CAIT and Chinese Foot and Ankle Outcome Score.For the test-retest analysis, the intraclass correlation coefficient was 0.874. Internal consistency showed a Cronbach’s ɑ value of 0.726. Construct validity against the FAOS was fair but statistically significant with a Spearman’s correlation coefficient of 0.353, 0.460, 0.303, 0.369 and 0.493 for the categories of symptoms, pain, daily function, sports function, and quality of life, respectively.A cutoff score of 20.5 was determined to differentiate healthy individuals from those with chronic ankle instability for this study population. The original English CAIT was successfully translated, cross-culturally adapted and validated into Cantonese-Chinese.

Abstract P4-03-28: Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery

Abstract Background: Disparities in breast cancer outcomes are well documented, with a burgeoning body of literature shedding light on the influence of multiple factors. Much of the literature comes from the US, with the current situation in Canada less well understood. Canada’s universal health care system may mitigate some, but unlikely all differences. First generation immigrants compromise 21.9% of the Canadian population. Differences in breast cancer screening rates and stage at diagnosis have been demonstrated between immigrant and non-immigrant Canadian women. However, breast cancer outcomes in the Canadian immigrant population have not been well studied. Patient reported outcomes are one such set of outcomes and crucial in understanding the patient experience. The purpose of this study is to compare symptom burden and trajectories between immigrant and Canadian long-term resident women with breast cancer undergoing breast cancer surgery in Ontario. Methods: A population-level retrospective cohort-study using linked Ontario administrative databases was constructed. Women &amp;gt;18 years of age with newly diagnosed breast cancer between 2010-2016 undergoing surgery at a regional cancer center were included. Baseline variables including immigration status, age, stage, comorbidity and income quintile were collected. The proportion of patients reporting moderate/severe Edmonton Symptom Assessment System Scale (ESAS) scores for each of 9 individual symptom categories over time was collected. Multivariable logistic regression models using generalized estimating equations with exchangeable correlation structure to account for repeated measures were constructed to assess the probability of a moderate/severe score for each of the individual ESAS symptom categories. Results: The cohort included 14,056 women, of which 12,250 (87.2%) were categorized as long-term Canadian residents and 1,806 (12.8%) as immigrants. Immigrant women had a younger mean age of diagnosis (53 vs. 61 years), were more likely to reside in a lowest income quintile neighbourhood (22.2% vs 15.4%), were less likely to be on a primary care physician roster within the last 2 years (83.7% vs. 90.4%) and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p&amp;lt; 0.0001). The proportion of women reporting moderate/severe scores was significantly higher amongst immigrant women for 7/9 symptom categories (anxiety, depression, drowsiness, nausea, pain, shortness of breath and well-being) with the largest difference observed for depression (13.1% vs 10.8%, p&amp;lt; 0.0001) and pain (14.8% vs. 12.0%, p&amp;lt; 0.0001). Comparing symptom trajectories, differences between groups were most pronounced within the first 12 months, though for depression and pain, statistically significant differences also existed at 36 months. On multivariable regression analysis, immigration status was persistently associated with higher proportion of moderate/severe score for pain only (OR 1.12, 95% CI 1.02-1.23). Immigration status was associated with a protective effect for anxiety (OR 0.86, 95% CI 0.78-0.94), drowsiness (OR 0.81, 95% CI 0.73-0.89) and tiredness (OR 0.86, 95% CI 0.79-0.94). Conclusions: To our knowledge, this is the first study comparing symptom burden amongst immigrant and non-immigrant Canadian women with breast cancer at a population-level. Immigrant women undergoing breast cancer surgery were found to have a higher burden of symptoms across most categories, and for depression and pain this difference was found to persist even at 3-years. However, the higher burden of symptoms in many categories seemed to be explained by factors such as younger age and more advanced disease. Adjusting for other factors, immigrant women with breast cancer reported more pain, indicating a need for better symptom management in this population. Citation Format: Elena Parvez, Megan M. Chu, David Kirkwood, Aristithes Doumouras, Jessica Bogach. Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-28.

The Urgency of Addressing the Underdiagnosis of Autism in Females

Autism is a complex condition which affects different individuals in markedly different ways. The autism spectrum is often referred to for exactly this reason, accounting for great variation in many distinct categories of symptoms of autistic people. Understanding of this broad range in how autism can present in different individuals needs to increase because, otherwise, many individuals are at risk of remaining undiagnosed. When autism is overlooked and goes undiagnosed in females, biological inevitabilities of menses and menopause, along with the possibility of pregnancy, stand to bring greater disruption to the undiagnosed individual than to the general population of females. As such, the underdiagnosis of autism in females urgently needs attention.

Does mentalizing moderate the relationship between psychopathology and quality of life?

IntroductionMost previous research focused on the association between mentalizing and specific mental disorders, while less is known about the relationship between mentalizing and quality of life among adolescents.ObjectivesThis study aimed to validate The Reflective Function Questionnaire for Youth in the Hungarian language and evaluate the moderating influence of mentalizing on the relationship between psychopathology and quality of life.MethodsA community sample of 384 youths of 12–18 years (72.7% females) completed the following questionnaires: The Reflective Function Questionnaire for Youth (RFQY), The Measure of Quality of Life for Children and Adolescents and The Strengths and Difficulties Questionnaire. First, we tested the different factor structures of the RFQY: the two-factor, the eight-item, and the five-item versions. We conducted a series of moderation analyses with quality of life as the dependent variable, higher-order symptom categories (internalizing or externalizing symptoms separately) as the independent variable, and mentalization as the moderator.ResultsThe confirmatory factor analysis supported the five-item version of the RFQY (Cronbach’s alpha .61) and resulted in a new, 10-item version of The Reflective Function Questionnaire for Youth on the Hungarian sample (Cronbach’s alpha .76). Mentalization had a moderator effect on the relationship between internalizing and externalizing symptoms and quality of life.ConclusionsOur study provides the first psychometric support for the Hungarian version of the RFQY and underlines the importance of assessing the complex relationships between mentalization, quality of life and symptomatology. Targeting mentalization to improve the quality of life among adolescents might be a key factor.Disclosure of InterestNone Declared

Examining the role of material and social assets on mental health in the context of COVID-19 among an urban public university sample.

Material and social stressors are both well-documented contributors to the onset of psychiatric symptoms. This relationship has not yet been investigated within the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic, and within low-income and racially/ethnically diverse urban student populations, who are facing increased stress. Via an online survey, this study assessed material and social stressors and symptom endorsements for depression, anxiety, and posttraumatic stress (PTS), within a public university student sample at two time points, April 8 through May 2, 2020; n = 2,925; and July 9 through July 31, 2020; n = 1,073; during the pandemic. Multivariate regression analyses assessed the relationship between each diagnostic symptom category and stressor category scores. Analyses yielded stronger associations for total social stressor score and probable anxiety (β = .695, SE = .046, p < .001 in April, β = .730, SE = .085, p < .001 in July), probable depression (β = .655, SE = .045, p < .001 in April, β = .676, SE = .080, p < .001 in July) and probable PTS (β = .587, SE = .045, p < .001 in April, β = .687, SE = .083, p < .001 in July), compared with total material stressor scores, total material and social stressor scores. Such findings highlight the burden of both stressor types, but particularly social stress, on psychological health for underresourced students, and emphasize the need for targeted interventions that increase social assets. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Self-Reported Symptoms in U.S. Marines Following Blast- and Impact-Related Concussion.

Recent research on traumatic brain injury (TBI) has suggested that the mechanism of injury (i.e., whether the TBI was caused by high-level blast [HLB] vs. direct physical impact to the head) may be an important factor in injury severity, symptomology, and recovery because of differences in physiological effects of each type of injury on the brain. However, differences in self-reported symptomology resulting from HLB- vs. impact-related TBIs have not been thoroughly examined. This study tested the hypothesis that HLB- and impact-related concussions result in different self-reported symptoms in an enlisted Marine Corps population. All records of 2008 and 2012 Post-Deployment Health Assessment (PDHA) forms completed by enlisted active duty Marines between January 2008 and January 2017 were examined for self-reported concussion, mechanism of injury, and self-reported symptoms experienced during deployment. Concussion events were categorized as either blast- or impact-related; individual symptoms were categorized as neurological, musculoskeletal, or immunological. A series of logistic regressions were performed to examine associations between self-reported symptoms experienced by healthy controls and Marines who endorsed (1) any concussion (mTBI), (2) a probable blast-related concussion (mbTBI), and (3) a probable impact-related concussion (miTBI); analyses were also stratified by PTSD. To determine if there were significant differences between odds ratios (ORs) for mbTBIs vs. miTBIs, 95% CIs were examined for overlap. Marines with a probable concussion, regardless of the mechanism of injury, were significantly more likely to report all symptoms (OR range: 1.7-19.3). Overall, mbTBIs, compared with miTBIs, resulted in higher odds of symptom reporting for eight symptoms on the 2008 PDHA (tinnitus, trouble hearing, headache, memory problems, dizziness, dim vision, trouble concentrating, and vomiting) and six symptoms on the 2012 PDHA (tinnitus, trouble hearing, headaches, memory problems, balance problems, and increased irritability), all of which were in the neurological symptom category. Conversely, odds of symptom reporting were higher for Marines experiencing miTBIs (vs. mbTBIs) for seven symptoms on the 2008 PDHA (skin diseases or rashes, chest pain, trouble breathing, persistent cough, red eyes, fever, and other) and one symptom on the 2012 PDHA (skin rash and/or lesion), all of which were in the immunological symptoms category. mbTBI (vs. miTBI) was consistently associated with greater odds of reporting tinnitus, trouble hearing, and memory problems, regardless of PTSD status. These findings support recent research suggesting that the mechanism of injury may play an important role in symptom reporting and/or physiological changes to the brain after concussion. The results of this epidemiological investigation should be used to guide further research on the physiological effects of concussion, diagnostic criteria for neurological injuries, and treatment modalities for various concussion-related symptoms.

Health Symptoms and Proximity to Active Multi-Well Unconventional Oil and Gas Development Sites in the City and County of Broomfield, Colorado.

City and County of Broomfield (CCOB) residents reported over 500 health concerns between January 2020 and December 2021. Our objective was to determine if CCOB residents living within 1 mile of multi-well unconventional oil and gas development (UOGD) sites reported more frequent health symptoms than residents living > 2 miles away. We invited 3993 randomly selected households to participate in a health survey. We applied linear regression to test associations between distance to UOGD and summed Likert scores for health symptom categories. After covariate adjustment, respondents living within 1 mile of one of CCOB's UOGD sites tended to report higher frequencies of upper respiratory, lower respiratory, gastrointestinal and acute symptoms than respondents living more than 2 miles from the sites, with the largest differences for upper respiratory and acute symptoms. For upper respiratory and acute symptoms, scores differed by 0.81 (95% CI: 0.06, 2.58) and 0.75 (95% CI: 0.004, 1.99), respectively. Scores for adults most concerned about air pollution, noise and odors trended higher within 1 mile for all symptom categories, while scores among adults least concerned trended lower. Scores trended higher for lower respiratory, gastrointestinal and acute symptoms in children living within 2 miles of UOGD, after covariate adjustment. We did not observe any difference in the frequency of symptoms reported in unadjusted results. Additional study is necessary to understand relationships between proximity to UOGD and health symptoms.

Lower Urinary Tract Symptoms (LUTS) after Aquablation for the treatment of Benign Prostatic Hyperplasia (BPH): Evaluation of symptoms category (filling versus voiding phase) prevalence rates

Lower Urinary Tract Symptoms (LUTS) after Aquablation for the treatment of Benign Prostatic Hyperplasia (BPH): Evaluation of symptoms category (filling versus voiding phase) prevalence rates

Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data.

In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals. We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web. We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons. We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10-12). This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care.

A multidisciplinary approach to screen the post-COVID-19 conditions

BackgroundPost-COronaVIrus Disease 2019 (COVID-19) conditions (PCC) include multiple symptoms afflicting different organs and systems. To evaluate the frequency and type of them, we described our multidisciplinary approach with preliminary results of the first enrolled patients.MethodsWe included patients aged ≥ 18 years with hospital admission for confirmed SARS-CoV-2 infection. Symptoms were grouped in five macro groups hereafter referred to as "Symptoms Category" (SC): respiratory SC (dyspnoea or cough), neurological SC (peripheral neuropathies, headache, impaired mobility, behavioural disorders), psychological SC (sleep disorders, mood disorders), muscular SC (arthromyalgia, asthenia), other SC (fever, alopecia, diarrhoea, weight loss, smell and taste alterations, sexual dysfunctions). SC were evaluated at discharge and at follow-up. Association between patients’ characteristics and presence of SC at follow up was estimated by a logistic multivariable regression model.ResultsFrom June 2020 to July 2021, we followed up 361 patients: 128 (35.5%) who were previously admitted to Intensive Care Unit (ICU) and 233 patients to ordinary department. The median length of hospital stay was 20 days (Inter-Quartile-Range 13–32). Most patients (317/361, 87.8%) were still symptomatic at discharge, with one third referring three or more SC. At follow up, 67.3% (243/361) of patients still complained at least one SC. Moreover, 159 patients (44%) developed at least one new involved SC during follow up: 116 (72.9%) one SC, 39 (24.5%) two SC, 4 (2.5%) three or more SC. At follow up visit 130 of 361 (36%) were still with SC developed during follow up. At multivariable analysis presence of any SC at follow-up was associated with male gender (Odds Ratio [OR] 3.23, Confidence Interval [CI] 95% 1.46–7.15), ICU admission (OR 2.78, CI 95% 1.29–5.96) and presence of SC at discharge (OR 14.39, CI 95% 6.41–32.32).ConclusionsIn our sample of patients with severe COVID-19, we found that PCC are highly variable and fluctuating over time; in particular, in about 50% of our patients new SC appear during follow up. Moreover, presence of PCC also in patients without SC at discharge and the variability of symptoms underlining the advisability of our multidisciplinary approach.Trial registration number: ClinicalTrials.gov Identifier: NCT04424992, registered on 28 February 2020 https://www.clinicaltrials.gov/ct2/results?recrs=ab&cond=&term=NCT04424992&cntry=&state=&city=&dist The current version of protocol is version 1.0 enrolling since June 2020. The enrollment is still ongoing.

Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis

BackgroundQuality of care and access to effective interventions have been widely criticised as limited for people diagnosed with ‘personality disorder’ or who have comparable needs (described in some recent papers as “Complex Emotional Needs” (CEN). It is important to identify effective interventions and the optimal context and mode of delivery for people with CEN. We aimed to investigate the effectiveness of psychosocial interventions delivered in community and outpatient settings in treating symptoms associated with ‘personality disorder’, and the moderating effects of treatment-related variables.MethodsWe systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, HMIC, ASSIA for articles published in English, from inception to November 23, 2020. We included randomized controlled trials examining interventions provided in community or outpatient settings for CEN. The primary outcome was ‘personality disorder’ symptoms, while secondary outcomes included anxiety symptoms, depressive symptoms, and global psychiatric symptoms. Random-effects meta-analysis was conducted for each outcome, and meta-regression analysis was performed to assess the moderating effects of treatment characteristics. The quality of the studies and the degree of publication bias was assessed.ResultsWe included 54 trials (n = 3716 participants) in the meta-analysis. We found a large effect size (g = 0.78, 95% CI: 0.56 to 1.01, p < 0.0001) favoring interventions for ‘borderline personality disorder’ (BPD) symptoms over Treatment as Usual or Waitlist (TAU/WL), and the efficacy was maintained at follow-up (g = 1.01, 95% CI: 0.37 to 1.65, p = 0.002). Interventions effectively reduced anxiety symptoms (g = 0.58, 95% CI: 0.21 to 0.95, p = 0.002), depressive symptoms (g = 0.57, 95% CI: 0.32 to 0.83, p < 0.0001), and global psychiatric symptoms (g = 0.50, 95% CI: 0.35 to 0.66, p < 0.0001) compared to TAU/WL. The intervention types were equally effective in treating all symptom categories assessed. Treatment duration and treatment intensity did not moderate the effectiveness of the interventions for any outcome.ConclusionsPeople with a ‘personality disorder’ diagnosis benefited from psychological and psychosocial interventions delivered in community or outpatient settings, with all therapeutic approaches showing similar effectiveness. Mental health services should provide people with CEN with specialised treatments in accordance with the availability and the patients’ preferences.

Self-Reported Symptoms at Last Febrile Illness as a Predictor of Treatment-Seeking in Western Kenya: A Cross-Sectional Study.

Timely treatment-seeking behavior can reduce morbidity and mortality due to infectious diseases. Patterns of treatment-seeking behavior can differ by access to health care, and perceptions of disease severity and symptoms. We evaluated the association between self-reported symptoms at last illness and the level of treatment-seeking behaviors. We analyzed cross-sectional data from 1,037 participants from the lowlands and highlands of Western Kenya from 2015 using logistic regression models. There was considerable heterogeneity in the symptoms and treatment-seeking behaviors reported among individuals who were febrile at their last illness. A greater number of self-reported categories of symptoms tended to be associated with a higher likelihood of treatment-seeking in both sites. Participants were significantly more likely to seek treatment if they reported fever, aches, and digestive symptoms at last illness than just fever and aches or fever alone, but the frequency of treatment-seeking for fever in combination with aches and respiratory symptoms did not follow a consistent pattern. Among those who sought treatment, most used a formal source, but the patterns were inconsistent across sites and by the number of symptoms categories. Understanding the drivers of treatment-seeking behavior after febrile illness is important to control and treat infectious diseases in Kenya.