Daily Symptoms Research Articles

Abstract 4136911: Daily Dyadic Symptom Appraisal Dynamics During Care Transitions in Persons with Heart Failure and Their Care Partners

Background: Symptom monitoring after heart failure (HF) hospitalization is a central aspect of patient education. However, appraising symptoms can be difficult for persons with HF (PWHFs), and studies suggest family care partners (CPs) play a key supportive role. The purpose of this study is to examine dyadic HF symptom appraisal dynamics in PWHF-CP dyads during hospital-to-home transitions. Methods: We conducted a daily diary study of dyadic symptom appraisal in which PWHFs and CPs were enrolled during a HF hospitalization. Over 5 weeks, both completed daily assessments of the PWHF’s symptoms (HF Somatic Perception Scale, PROMIS Fatigue 4a). Each dyad’s appraisal dynamics were quantified using a set of N of 1 dyadic autoregressive time series models examining total symptoms, hallmark symptoms (dyspnea, edema) and nonspecific symptoms (early/subtle cluster, fatigue). Models were examined for within-dyad dynamics (within-dyad associations on the same day or on a 1-day lag). Patterns in significant dynamics across dyads were narratively described. Results: This analysis includes n=14 cohabitating dyads, all partnered. On average, PWHFs and CPs were 69.6±5.4 and 67.4±8.0 years of age. The sample was relatively gender balanced (43% of PWHFs and 64% of CPs identified as female), and primarily identified as non-Hispanic (86% of PWHFs, 93% of CPs) and White (93% of PWHFs, 86% of CPs). Most PWHFs had non-ischemic cardiomyopathy (64%) and were NYHA Class III/IV (86%), with 57% HFrEF (mean EF 37%±17%). Symptom appraisals were highly variable within and across dyads (Fig 1). Most (n=11, 79%) had significant dyadic dynamics, but dynamics across dyads varied by symptom type and time structure (Fig 2). Conclusions: The types of symptoms that HF care dyads are able to appraise together and the time structure of appraisals are variable during care transitions. Precision approaches tailored to individual dyads are needed to optimize inclusion of CPs in symptom monitoring interventions.

Short-course subcutaneous treatment with birch pollen allergoids greatly improves symptom and medication scores in birch allergy.

Subcutaneous immunotherapy has emerged as an effective option for treating allergic diseases. Here, we assessed the clinical impact of the mannan-conjugated birch pollen polymerized allergoid T502 in birch pollen-induced allergic rhinoconjunctivitis. In this prospective, randomized, double-blind placebo-controlled phase III trial, 298 birch pollen-allergic adult patients were treated across 28 trial sites in Germany. Patients received either placebo or 23,000 mTU T502 subcutaneously over five pre-seasonal visits. Efficacy was assessed by comparing the combined symptom and medication score (CSMS) between placebo and T502 during the peak birch pollen season 2022. Safety, tolerability and immunologic effects were also analyzed. During the peak birch pollen season, the median CSMS of the T502 group was reduced by 33% (p = 0.002) compared to placebo. The median daily symptom score and daily medication score were reduced by 30.4% (p < 0.001) and 56.3% (p = 0.045), respectively. Health related quality of life improved as reflected by reduction of RQLQ values by 31.5% (p < 0.0001). Production of Bet v 1 sIgG4 and Bet v 1 sIgG increased up to 6.2-fold and 3-fold respectively in the T502 group (p < 0.0001). The sIgE/sIgG4 ratio was strongly reduced in the T502 group at V7 (-62.9%, p < 0.0001). No fatalities nor serious adverse events were reported. In total, 16 systemic allergic reactions occurred (Grade I/II). Treatment with T502 significantly reduced symptoms and medication need in rhinoconjunctivitis patients. The treatment is well tolerated and safe.

The SQ tree sublingual immunotherapy tablet is effective and well tolerated in children-A pivotal phase III trial.

Allergic rhinitis and/or conjunctivitis (AR/C) induced by tree pollen is common and negatively impacts quality of life in children and adolescents. This phase III trial investigated the efficacy and safety of the SQ tree SLIT-tablet in a paediatric population (5-17 years) with moderate-to-severe AR/C induced by pollen from birch and trees in the birch homologous group. Nine hundred and fifty-two subjects were randomized (1:1) to daily treatment with SQ tree SLIT-tablet or placebo for up to 52 weeks and had free access to AR/C symptom-relieving medications. The primary endpoint was the average total combined score (TCS); sum of average daily symptom score (DSS) and average daily medication score (DMS) during the birch pollen season (BPS). Key secondary endpoints included average DSS and DMS during BPS and average TCS, DSS and DMS during tree pollen season (TPS). SQ tree SLIT-tablet demonstrated a statistically significant and clinically relevant treatment effect compared with placebo for the TCS during BPS with an absolute treatment difference of 1.29 (95% CI: 0.58, 2.00; p = .0004) and a relative reduction of 21.9% (95% CI: 10.6, 31.9). Results were substantiated by reductions in both DSS and DMS versus placebo during the BPS and in DSS, DMS and TCS during the TPS. Treatment was generally well tolerated. Most treatment-related adverse events were mild or moderate local administration site reactions. This is the first paediatric trial to provide robust evidence of efficacy and safety of the SQ tree SLIT-tablet in tree pollen-induced AR/C in a paediatric population (5-17 years).

Randomised controlled trial of HOYA One-day Multifocal Contact Lenses: – the HOMCL trial

Trial designDouble-masked crossover RCT (Research Registry: #8136) comparison of a new HOYA one-day disposable multifocal contact lens (HOMCL) with Alcon DAILIES TOTAL1® Multifocal (ADT1). MethodsSixty presbyopic participants from three countries attended for baseline measurements and fitting of both lens types and then for a fortnight completed daily diaries of symptoms with habitual optical correction, and VF-14 questionnaire. Participants collected either HOMCL or ADT1, when the vision was measured again, and they wore this product for a fortnight, completing daily diaries and VF-14. Participants then collected the other type and had vision and symptoms recorded in the same way. ResultsThere were no serious adverse events. Primary outcomes were no significant differences between the lens types in willingness to purchase nor stated preference; no significant differences in the daily symptom ratings of comfort; statistically significant findings with the daily symptom ratings and VF-14 of better near vision with HOMCL and better distance vision with ADT1. Secondary outcomes were better high contrast distance visual acuity with ADT1 (<1 line), better low contrast distance visual acuity with ADT1; faster Wilkins rate of reading test with HOMCL; no significant differences in near visual acuity, wearing time, or number of lenses during fitting process. Exploratory analyses were better handling scores with ADT1; and some, but not all of the dry eye data indicating better acceptance of HOMCL by patients with relatively dry eyes. For all measures, there were some participants who preferred/performed better with each lens type. ConclusionsThe differences between the performance of the two products were small. There was a trend in some clinical measurements and the daily diary data and VF-14 questionnaire, for HOMCL to outperform ADT1 for near vision and vice versa for distance vision.

Exploring the Potential of Electronic Patient-Generated Health Data for Evaluating Treatment Response to Intramuscular Steroids in Rheumatoid Arthritis: Case Series.

Mobile health devices are increasingly available, presenting exciting opportunities to remotely collect high-frequency, electronic patient-generated health data (ePGHD). This novel data type may provide detailed insights into disease activity outside usual clinical settings. Assessing treatment responses, which can be hampered by the infrequency of appointments and recall bias, is a promising, novel application of ePGHD. Drugs with short treatment effects, such as intramuscular steroid injections, illustrate the challenge, as patients are unlikely to accurately recall treatment responses at follow-ups, which often occur several months later. Retrospective assessment means that responses may be over- or underestimated. High-frequency ePGHD, such as daily, app-collected, patient-reported symptoms between clinic appointments, may bridge this gap. However, the potential of ePGHD remains untapped due to the absence of established definitions for treatment response using ePGHD or established methodological approaches for analyzing this type of data. This study aims to explore the feasibility of evaluating treatment responses to intramuscular steroid therapy in a case series of patients with rheumatoid arthritis tracking daily symptoms using a smartphone app. We report a case series of patients who collected ePGHD through the REmote Monitoring Of Rheumatoid Arthritis (REMORA) smartphone app for daily remote symptom tracking. Symptoms were tracked on a 0-10 scale. We described the patients' longitudinal pain scores before and after intramuscular steroid injections. The baseline pain score was calculated as the mean pain score in the 10 days prior to the injection. This was compared to the pain scores in the days following the injection. "Response" was defined as any improvement from the baseline score on the first day following the injection. The response end time was defined as the first date when the pain score exceeded the pre-steroid baseline. We included 6 patients who, between them, received 9 steroid injections. Average pre-injection pain scores ranged from 3.3 to 9.3. Using our definitions, 7 injections demonstrated a response. Among the responders, the duration of response ranged from 1 to 54 days (median 9, IQR 7-41), average pain score improvement ranged from 0.1 to 5.3 (median 3.3, IQR 2.2-4.0), and maximum pain score improvement ranged from 0.1 to 7.0 (median 4.3, IQR 1.7 to 6.0). This case series demonstrates the feasibility of using ePGHD to evaluate treatment response and is an important exploratory step toward developing more robust methodological approaches for analysis of this novel data type. Issues highlighted by our analysis include the importance of accounting for one-off data points, varying response start times, and confounders such as other medications. Future analysis of ePGHD across a larger population is required to address issues highlighted by our analysis and to develop meaningful consensus definitions for treatment response in time-series data.

A smartphone app for preschool wheezing and reliability of medical history collection

BackgroundThe use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews.MethodsChildren with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app.ResultsWe enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ‘’simple and intuitive’’ at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21–25) for the control group (42 patients) and 23 (21–24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24–25) and 24 (24–25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable.ConclusionsThe smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit.

Symptom management in isocitrate dehydrogenase mutant glioma

Abstract According to the 2021 World Health Organization classification of CNS tumors, gliomas harboring a mutation in isocitrate dehydrogenase (mIDH) are considered a distinct disease entity, typically presenting in adult patients before the age of 50 years. Given their multiyear survival, patients with mIDH glioma are affected by tumor and treatment-related symptoms that can have a large impact on the daily life of both patients and their caregivers for an extended period of time. Selective oral inhibitors of mIDH enzymes have recently joined existing anticancer treatments, including resection, radiotherapy, and chemotherapy, as an additional targeted treatment modality. With new treatments that improve progression-free and possibly overall survival, preventing and addressing daily symptoms becomes even more clinically relevant. In this review we discuss the management of the most prevalent symptoms, including tumor-related epilepsy, cognitive dysfunction, mood disorders, and fatigue, in patients with mIDH glioma, and issues regarding patient’s health-related quality of life and caregiver needs in the era of mIDH inhibitors. We provide recommendations for practicing healthcare professionals caring for patients who are eligible for treatment with mIDH inhibitors.

From sleep to sip? Examining a daily model of sleep and trauma-related drinking among sexual violence survivors.

Alcohol misuse is common among women who have experienced sexual violence and is often attributed to the self-medication model of alcohol use to alleviate posttraumatic stress disorder (PTSD) symptoms. Despite the proximal theorized role of PTSD symptoms, less attention has been given to daily associations between PTSD symptoms, trauma-related drinking to cope (TRD) motives, and ensuing alcohol use by survivors. Moreover, despite indications that poor sleep impacts affective functioning and may exacerbate daily PTSD symptoms, the role of sleep duration and quality in drinking to cope with PTSD symptoms is not well understood. This study examined an integrated model testing whether shorter sleep duration and poorer sleep quality predict greater daily PTSD symptoms and, in turn, greater alcohol use later that day through TRD motives. Participants were 82 cisgender women (Mage = 22.8, 73.2% White, 13.4% Hispanic/Latina, 56.1% heterosexual, 30.5% bisexual) who had experienced sexual violence. Participants completed ecological momentary assessment measures and wore actigraphs for 3 weeks. Contrary to hypotheses, shorter-than-usual sleep duration did not predict greater alcohol use quantity via daily PTSD symptoms and TRD motives. However, poorer-than-usual sleep quality predicted greater PTSD symptoms that day, which in turn predicted greater same-day TRD motives. Findings underscore the importance of sleep quality in heightened PTSD symptoms but suggest survivors did not drink more to alleviate trauma-related distress. Future research should examine other drinking motives among survivors to inform proximal interventions to prevent alcohol misuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study.

COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6. Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded. RR2-10.2196/resprot.6636.

Fixed Airflow Obstruction in Asthma Can Be Identified Early by Low FEF25-75% and is Associated with Environmental Exposure.

This study aimed to identify environmental risk factors associated with asthmatic fixed airflow obstruction (FAO) and assess the relationship between small airway abnormalities defined by forced expiratory flow at 25-75% (FEF25-75%) and FAO. We analyzed data from 312han Chinese patients with stable asthma on standard treatment. Low FEF25-75% was defined as post-bronchodilator FEF25-75% z-score <-0.8435, and FAO as post-bronchodilator FEV1/FVC z-score <-1.645. Exposure levels were retrospectively analyzed in relation to FAO risk in asthmatics. Asthmatics were grouped by low FEF25-75% and FAO, and lung function, environmental exposure, daily symptoms, and exacerbations in the previous year were compared cross-sectionally across groups. In retrospective analyses, pack-years of smoking in male patients (adjusted odd ratio [95% confidence interval] 1.05 [1.03-1.07], P<0.001), biomass exposure for >20 years (2.65 [1.13-6.43], P=0.027), occupational exposure for >10 years (2.01 [1.06-3.86], P=0.035) and occupational exposure for >20 years (2.67 [1.24-5.91], P=0.013) were associated with asthmatic FAO. In cross-sectional analyses, compared with the normal FEF25-75%/ asthmatics without FAO (NON-FAO) group, the low FEF25-75%/ asthmatics with FAO (FAO) group had lower FEV1 z-scores and FEV1/FVC z-scores, more pack-years and years of biomass and occupational exposure, higher Asthma Control Questionnaire-5 and Chronic Obstructive Pulmonary Disease Assessment Test scores, and more frequent exacerbations. The low FEF25-75%/NON-FAO group showed the same trend, but to a lesser extent. Chronic airway inflammation is not the only driver of asthmatic FAO, and management and treatment targeting environmental risk factors (smoking and biomass and occupational exposures) may slow FAO progression in asthmatics. The FEF25-75% determined by the z-score is a reliable marker of small airway abnormalities, and patients with low FEF25-75% are at greater risk for FAO, requiring more frequent follow-up.

Precision Health Approach To Daily Activities And Symptom Severity In Generalized Myasthenia Gravis

Precision Health Approach To Daily Activities And Symptom Severity In Generalized Myasthenia Gravis

Diurnal and Daily Symptom Variation in Patients with ESKD.

Diurnal and Daily Symptom Variation in Patients with ESKD.

Subsyndromes and symptom clusters: Multilevel factor analysis of behavioral and psychological symptoms of dementia with intensive longitudinal data.

Behavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. We applied a multilevel framework to identify subsyndromes (between-person factors) that represent clinically relevant profiles of BPSD and identify symptom clusters (within-person factors) that represent contextually driven daily symptom experiences. This study used an intensive longitudinal design in which 68 co-residing family caregivers to persons living with dementia were recruited to proxy report on their care recipient's daily symptom experiences of 23 different BPSD for eight consecutive days (n=443 diaries). A multilevel exploratory/confirmatory factor analysis was used to account for nested data and separate within-person variances from between-level factor estimates. Exploratory factor analysis identified a 4-between 3-within factor structure based on fit statistics and clinical interpretability. This study offers major methodological and conceptual advancements for management of BPSD within Alzheimer's disease and related dementias by introducing two related but distinct concepts of subsyndromes and symptom clusters. Because behavioral and psychological symptoms of dementia (BPSD) are dynamic temporal phenomenon, this introduces measurement error into aggregate group-level estimates when trying to create subsyndromes. We propose a multilevel analysis to provide a more valid and reliable estimation by separating out variance due to within-person daily fluctuations. Using a multilevel exploratory factor analysis with intensive longitudinal data, we identified distinct and meaningful groups of BPSD. The four factors at the between-person level represented subsyndromes that are based on how BPSD co-occurred among persons with Alzheimer's disease (AD). These subsyndromes are clinically relevant because they share features of established clinical phenomena and may have similar neurobiological etiologies. We also found three within-person factors representing distinct symptom clusters. They are based on how BPSD clustered together on a given day for an individual with AD and related dementias. These clusters may have shared environmental triggers.

Influence of Preexisting Conditions and Concussion History on Postconcussion Symptom Severity and Recovery Time in Collegiate Athletes.

Mental health conditions and concussion history reported by a collegiate athlete may contribute to prolonged recovery and symptom severity after concussion. This work examined the potential associations among concussion history, preexisting conditions, and sex relative to initial symptom severity and recovery duration following sport-related concussion (SRC) in a cohort of Division 1 National Collegiate Athletic Association athletes. This prospective cohort study analyzed symptom severity, recovery, and return-to-play (RTP) times reported post-SRC using data collected as part of the Pac-12 Concussion Assessment, Research and Education Affiliated Program and Health Analytics Program. Health history questionnaires that included self-reported history of preexisting conditions were completed at baseline. When consented athletes were diagnosed with a concussion, daily postconcussion symptom scores were evaluated until an athlete was clinically determined to be asymptomatic. Generalized linear and Cox proportional hazards models were used to determine associations between preexisting conditions and recovery and RTP times. Ninety-two concussions met inclusion criteria. Notable differences in initial symptom severity existed between females and males who had mood disorders (effect size [d] = 0.51) and attention-deficit hyperactivity disorder (ADHD; d = 0.93). The number of previous concussions was a strong predictor of athletes reporting preexisting mood disorders, depression, anxiety, and ADHD (p = 0.008-0.04). Females with ≥2 previous concussions required more days to RTP than males (d = 0.31-0.72). Weekly recovery and RTP probabilities substantially differed between athletes who did or did not have learning disorders (LDs; hazard ratio [HR]Recovery = 0.32, HRRTP = 0.22, d = 1.96-2.30) and ADHD (HRRecovery = 3.38, HRRTP = 2.74, d = 1.71-4.14). Although no association existed between concussion history and acute symptom severity, collegiate athletes with a history of concussion had higher probabilities of reporting depression, mood disorders, anxiety, and ADHD. Having ADHD or LDs likely strongly affects time to recovery and RTP for collegiate athletes.

Gender matters for daily depression: Symptom fluctuations and links to self-expression

BackgroundDepression is a global health burden, disproportionately affecting women. A lack of contextual, real-life assessments considering the oft-gendered context (e.g., expression) of daily symptom fluctuations may contribute to this disparity. The current study examines: a) gender differences in daily depressive symptoms – and fluctuations; and b) daily links between self-perceived gender expression and depressive symptoms. MethodsEstablished adults (N = 96; Mage = 28.19, SDage = 8.43) participated in an ecologically-valid multi-wave 100-day intensive longitudinal study. They reported daily on their depressive symptoms, and on their self-expression in the final study wave. Gender differences in daily symptoms fluctuations (intraindividual standard deviations) and their links to gender expression (person-specific residualized correlations) were examined. ResultsWomen experienced greater day-to-day symptom fluctuations than men, after accounting for the gender difference in baseline symptoms (b = -0.05; 95 % CI: [-0.093, -0.012]). Results from a subsample (n = 28) showed that daily links between gender expression and depressive symptoms were heterogeneous: For 38.5 % of men and 53.3 % of women, daily increases in congruent gender expressions (i.e., masculine for men and feminine for women) corresponded with daily symptom decreases, but many individuals (46.4 %) did not show meaningful relations. ConclusionsResults highlight the utility of intensive longitudinal approaches for the study of depression and, for some people, the daily psychological relations with gender self-perceptions. Results also emphasize heterogeneity in depression etiology and the need for personalized basic and applied science. LimitationsFuture research on individuals with varying gender identities and clinical experiences is needed.

Dynamic links between daily anxiety symptoms and young adults’ daily well-being

ABSTRACT Background Anxiety disorders are prevalent among youth and adults. Increasing studies examined the dynamic associations between momentary fluctuations of anxiety and well-being, primarily focusing on the severity of general anxiety. Scant research has explored the co-fluctuations between different anxiety symptoms and mental health outcomes. Method The current study evaluated the multi-level factor structure and assessed the subclinical symptoms of generalized anxiety disorder (GAD), social phobia (SP), and panic disorder (PD) in a sample of non-clinical young adults (N = 271, Mage = 18 years, 72% female, 68% non-White) who participated in a 30-day daily diary study. Results Between persons, GAD, SP, and PD were positively correlated with depressive symptoms, stress, as well as emotional and peer problems. Within persons, both SP and PD were positively associated with stress, peer and emotional problems on the same day. Across days, there was positive reciprocal relation between PD and stress, whereas negative reciprocal link was observed between SP and emotional problems. Conclusions Current findings showed dynamic and distinct patterns in the associations between different anxiety symptoms and several mental health outcomes, which emphasizes the need to disentangle between- and within-person variation of anxiety symptoms with intensive longitudinal designs.

The Impact of Ambient Air Pollution on Allergic Rhinitis Symptoms: A Prospective Follow-Up Study.

Air pollution has become a serious public health problem and there is evidence that air pollution affects the incidence of allergic rhinitis. To further investigate the effect of ambient air pollutants on the severity of allergic rhinitis symptoms, a prospective follow-up study in patients with allergic rhinitis was conducted. A total of 167 allergic rhinitis patients with a mean age of 35.4 years, who were visiting the hospital, were enrolled. The daily symptom severity of allergic rhinitis and the concentrations of six air pollutants, including PM2.5, PM10, SO2, CO, O3 and NO2, were collected through follow-up investigations. The impact of ambient air pollutants on symptom severity was assessed via multi-pollutant models. Among several typical ambient air pollutants, we observed correlations of allergic rhinitis symptoms with PM2.5, PM10, CO, SO2 and NO2, whereas O3 showed no such correlation. Specifically, PM2.5 and PM10 were significantly associated with sneezing and nasal blockage. NO2 was significantly correlated with symptoms of rhinorrhea, itchy nose and itchy eyes. CO was significantly linked to sneezing and nasal blockage symptoms. These air pollutants not only had a direct impact on allergic rhinitis symptoms but also exhibited a lagging effect. This study indicates that short-term exposure to air pollutants is associated with exacerbation of nasal symptoms in patients with allergic rhinitis, leading to a decline in their quality of life.

Associations between Daily Stressors, Health, and Affective Responses among Older Adults: The Moderating Effect of Age

Introduction: Reactivity to daily stressors may change as a function of stressor type and age. However, prior research often excludes older adults or compares them to younger age groups (e.g., younger and middle-aged adults). Recognizing older adults as a heterogeneous population with shifting motivations, this study focused on individuals aged ≥65 years and tested age differences in associations between different types of daily stressors, affect, and physical symptoms. Methods: A total of 108 older adults aged 65–92 years (M = 73.11, SD = 5.92; 58% women) completed daily dairy questionnaires on daily stressors, positive and negative affect, and physical symptoms for 14 consecutive days. Multilevel models were employed, adjusting for sex, age, education, living situation, and day-in-study. Results: Findings revealed age-dependent variations in the associations between daily stressors and affect and physical symptoms. Specifically, external stressors (e.g., finance and traffic stressors) and health stressors were more strongly associated with daily affective states and with overall physical symptoms (respectively) among older age adults. Age did not moderate associations between social stressors and affect or physical symptoms. Conclusion: These findings underscore the heterogeneous nature of older adults’ responses to daily stressors based on stressor type and age. Specifically, the oldest-old might benefit from personalized support for dealing with challenges such as health and financial stressors.

Using mHealth Technology to Evaluate Daily Symptom Burden among Adult Survivors of Childhood Cancer: A Feasibility Study.

Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL). This prospective study used an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after the symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. These surveys comprised a PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models were used to analyze total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression was used to analyze the association between daily symptom burden in the first month and HRQOL in the third month, adjusted for covariates. Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL in each study week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95% CI: 4.10-9.02), depression (6.32; 95% CI: 3.18-9.47), fatigue (7.93; 95% CI: 5.11-10.80), sleep (6.07; 95% CI: 3.43-8.70), pain (5.16; 95% CI: 2.11-8.22), and cognitive function (-6.89; 95% CI: -10.00 to -3.79) in the third month. Daily assessment revealed fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability.

Adherence to CPAP Therapy in Obstructive Sleep Apnea: A Prospective Study on Quality of Life and Determinants of Use.

Obstructive sleep apnea (OSA) often goes unrecognized despite common symptoms, such as excessive daytime sleepiness, fatigue, and impaired quality of life (QoL). Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA, but optimal daily usage and time needed for observable effects remain unclear. This study aimed to investigate the short-term effects of CPAP on daytime sleepiness and QoL in patients with severe OSA. Medical records were collected from 87 patients with severe OSA who initiated CPAP therapy. Also, validated questionnaires were used before and after one month of CPAP to analyze QoL-the Calgary Sleep Apnea Quality of Life Index (SAQLI), the Cues to CPAP Use Questionnaire (CCUQ), and daytime sleepiness-the Epworth Sleepiness Scale (ESS). Multiple regression analysis was conducted to identify predictors of CPAP usage. Of the total participants aged 55.6 ± 12.5, 77% were males, and 62% were CPAP adherent. Reductions in daytime sleepiness (ESS) were noted, as well as improvements in both overall QoL (SAQLI) and specifically in the domains of daily functioning, social interactions, emotional well-being, and symptom perception. Important cues for CPAP usage recognized by patients were physicians' instructions and physicians' concern regarding their patients' condition. Furthermore, multiple regression revealed higher SAQLI scores and lower ESS scores as positive predictors of CPAP usage, along with lower AHI after one month of CPAP being associated with sufficient adherence.