Differences In Individual Symptoms Research Articles

Health symptoms in individuals with and without post-covid in the Dutch general population

Abstract Background Health symptoms, often non-specific in nature such as headache and sleep problems, are more prevalent in the aftermath of disasters. Relatively little research focused on non-specific symptoms in the context of the COVID-19 pandemic, including those with post-covid conditions. The aim of this study was to assess the symptomatic profile of people with post-covid conditions, and to assess differences in health symptoms between non-infected individuals, infected individuals, and individuals with post-covid. Methods A nation-wide cross-sectional health survey performed in 2022 was combined with routine primary care electronic health records (EHRs). Prevalence of individual symptoms was analyzed, as well as symptom scores for number, duration, and severity of symptoms. The total survey sample consisted of 315,586 individuals. The EHR sample consisted of 29,797 individuals with matched survey data. Both samples were divided into three groups: non-infected, infected, and post-covid. Results Survey participants with post-covid experienced significantly (CI 99%) more (incidence risk ratio (IRR) 1.55), longer lasting (IRR 1.87), and more severe self-reported symptoms (IRR 1.95) compared to non-infected individuals. For infected compared to non-infected survey participants, there were hardly differences in symptom scores. The most distinct differences in individual symptoms were observed for loss of smell or taste, fatigue, and respiratory problems. Based on EHR data, the post-covid group is at significantly higher risk of experiencing fatigue, shortness of breath, headache, sleep problems, and dizziness. Conclusions Individuals suffering from post-covid are at the highest risk of experiencing health symptoms, both based on self-reported symptoms as well as based on EHRs. The infected group generally experienced more self-reported symptoms than the non-infected, but on average, they experienced them at a shorter duration, and they also reported them to be less severe. Key messages • Health symptom prevalence is higher in individuals with post-covid in the Netherlands. • This effect is confirmed in self-reported health surveys as well as in primary care registries.

Adversarial Learning Based Node-Edge Graph Attention Networks for Autism Spectrum Disorder Identification.

Graph neural networks (GNNs) have received increasing interest in the medical imaging field given their powerful graph embedding ability to characterize the non-Euclidean structure of brain networks based on magnetic resonance imaging (MRI) data. However, previous studies are largely node-centralized and ignore edge features for graph classification tasks, resulting in moderate performance of graph classification accuracy. Moreover, the generalizability of GNN model is still far from satisfactory in brain disorder [e.g., autism spectrum disorder (ASD)] identification due to considerable individual differences in symptoms among patients as well as data heterogeneity among different sites. In order to address the above limitations, this study proposes a novel adversarial learning-based node-edge graph attention network (AL-NEGAT) for ASD identification based on multimodal MRI data. First, both node and edge features are modeled based on structural and functional MRI data to leverage complementary brain information and preserved in the constructed weighted adjacent matrix for individuals through the attention mechanism in the proposed NEGAT. Second, two AL methods are employed to improve the generalizability of NEGAT. Finally, a gradient-based saliency map strategy is utilized for model interpretation to identify important brain regions and connections contributing to the classification. Experimental results based on the public Autism Brain Imaging Data Exchange I (ABIDE I) data demonstrate that the proposed framework achieves a classification accuracy of 74.7% between ASD and typical developing (TD) groups based on 1007 subjects across 17 different sites and outperforms the state-of-the-art methods, indicating satisfying classification ability and generalizability of the proposed AL-NEGAT model. Our work provides a powerful tool for brain disorder identification.

Postoperative atrial fibrillation burden and progression patterns after cardiac surgery during 2.5 years of continuous rhythm monitoring

Abstract Background Early postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, with an incidence of up to 50%.(1, 2) The clinical presentation of early-POAF, however, might be highly diverse, showing great individual differences in symptoms, as well as POAF-specific characteristics such as the number of episodes, duration of episodes, and the percentage of time spent in POAF (POAF-burden). It is currently unknown how these early-POAF characteristics, particularly POAF-burden, are related to the risk of developing late-POAF recurrences. Purpose To establish the association between early-POAF characteristics, in particular POAF-burden, and late-POAF occurrence and burden. Methods Patients with and without a history of AF undergoing cardiac surgery were included. Preoperatively, all patients underwent echocardiography, electrocardiography, and blood biomarker analysis. Intraoperatively, all patients received an implantable loop recorder for a period of 2.5 years. POAF was defined as an AF episode lasting at least 2 minutes, detected by the ILR algorithm, and all episodes were manually checked by the investigators. POAF-burden was calculated as the percentage of time in AF for different time intervals (early: 0-3 months, late: 3-30 months). Classification of burden was performed based on cut-off values for tertiles. Also, associations between early-POAF characteristics, such as episode duration, and the incidence of late-POAF were analyzed. Results The study population consisted of 98 patients undergoing cardiac surgery (71 without preoperative AF history and 27 with preoperative AF history), out of which 53 developed POAF. Early-POAF occurred in 46 patients, and late-POAF in 36 patients. Early-POAF was associated with an increased occurrence of late POAF after adjusting for age, sex, PAF-history, and persistent AF-history (adjusted hazard ratio [aHR] = 4.62, 95% CI: 1.93-11.05, p<0.001) (Figure 1A). Multiple regression analysis, adjusted for age, sex, PAF-history, and persistent AF-history, revealed a gradual increase in late-POAF hazard between the early-POAF burden tertiles compared to patients without early-POAF (p<0.001) (Figure 1B). Similarly, the longest individual early-POAF episode and the number of early-POAF episodes were both associated with an increased late-POAF hazard (p<0.001 and p<0.001, respectively) (Figure 1C-D). The highest POAF-burden was observed in the early postoperative phase, with a significant reduction in the late phase (p=0.007) (Figure 2A). Overall, 84 patients had no late-POAF or a reduction in POAF burden, while 14 patients showed an increase in POAF-burden compared to the early postoperative phase (Figure 2B). Conclusion Early-POAF characteristics, such as POAF-burden, are strongly associated with an increased occurrence of late-POAF. The highest POAF-burden is present in the early postoperative phase, and only a minority of patients experience an increase in late-POAF burden.Figure 1Figure 2

Explaining the influence of non-shared environment (NSE) on symptoms of behaviour problems from preschool to adulthood: mind the missing NSE gap.

Individual differences in symptoms of behaviour problems in childhood and adolescence are not primarily due to nature or nurture - another substantial source of variance is non-shared environment (NSE). However, few specific environmental factors have been found to account for these NSE estimates. This creates a 'missing NSE' gap analogous to the 'missing heritability' gap, which refers to the shortfall in identifying DNA differences responsible for heritability. We assessed the extent to which variance in behaviour problem symptoms during the first two decades of life can be accounted for by measured NSE effects after controlling for genetics and shared environment. The sample included 4,039 pairs of twins in the Twins Early Development Study whose environments and symptoms of behaviour problems were assessed in preschool, childhood, adolescence and early adulthood via parent, teacher and self-reports. Twin-specific environments were assessed via parent-reports, including early life adversity, parental feelings, parental discipline and classroom environment. Multivariate longitudinal twin model-fitting was employed to estimate the variance in behaviour problem symptoms at each age that could be predicted by environmental measures at the previous age. On average across childhood, adolescence and adulthood, parent-rated NSE composite measures accounted for 3.4% of the reliable NSE variance (1.0% of the total variance) in parent-rated, symptoms of behaviour problems, 0.5% (0.1%) in teacher-rated symptoms and 0.9% (0.5%) in self-rated symptoms after controlling for genetics, shared environment and error of measurement. Cumulatively across development, our parent-rated NSE measures in preschool, childhood and adolescence predicted 4.7% of the NSE variance (2.0% of the total variance) in parent-rated and 0.3% (0.2%) in self-rated behaviour problem symptoms in adulthood. The missing NSE gap between variance explained by measured environments and total NSE variance is large. Home and classroom environments are more likely to influence behaviour problem symptoms via genetics than via NSE.

8571 Prevalence of Baseline Lower Urinary Tract Symptoms in Women Planning to Undergo Hysterectomy for Uterine Fibroids

Study Objective Compare the prevalence of baseline lower urinary tract symptoms (LUTS) in women planning to undergo hysterectomy for fibroids versus abnormal uterine bleeding (AUB) and examine their association with fibroid characteristics Design This is a retrospective cohort study of 202 women planning to undergo hysterectomy for fibroids vs. AUB. The aim was to compare LUTS in those with vs without fibroids. Baseline demographics, fibroid characteristics, and urinary symptoms were collected. Urinary symptoms included stress and urge incontinence, dysuria, frequent bladder infections, hematuria, nocturia, incomplete emptying, urgency, and frequency. Fibroid characteristics included dominant fibroid size, location, and total uterine volume. A priori power analysis determined 97 participants were needed per group (194 total) to assess for a 20% difference in LUTS, with alpha = 0.05 and power = 0.8. 202 participants were included to account for missing data upon chart review. Setting N/A. Patients or Participants Participants were identified from a surgical database. They were eligible for inclusion if they were planning to undergo hysterectomy for fibroids or AUB from 2014-2019. Interventions N/A. Measurements and Main Results When assessing baseline LUTS in women planning to undergo hysterectomy for fibroids vs. AUB, there were no differences in individual symptoms (all p>0.05) or in prevalence of ‘any urinary symptom’ as a single variable (42.6 vs 45.5%, p=0.67). Dominant fibroid size >6cm was correlated with greater prevalence of ‘any urinary symptom’ (64.9% vs 40.4%, p=0.02), as well as difficulty passing urine (p=0.02), nocturia (p=0.04), and urinary frequency (p=0.04). When controlling for age, BMI, parity, chronic pelvic pain, and diabetes, fibroids >6cm remained significantly associated with the presence of lower urinary tract symptoms (OR 3.1, 95% CI 1.2-8.3). Conclusion Lower urinary tract symptoms are prevalent in women planning to undergo hysterectomy for fibroids, particularly in those with fibroids >6 cm. Future studies should evaluate how urinary symptoms change following hysterectomy. Compare the prevalence of baseline lower urinary tract symptoms (LUTS) in women planning to undergo hysterectomy for fibroids versus abnormal uterine bleeding (AUB) and examine their association with fibroid characteristics This is a retrospective cohort study of 202 women planning to undergo hysterectomy for fibroids vs. AUB. The aim was to compare LUTS in those with vs without fibroids. Baseline demographics, fibroid characteristics, and urinary symptoms were collected. Urinary symptoms included stress and urge incontinence, dysuria, frequent bladder infections, hematuria, nocturia, incomplete emptying, urgency, and frequency. Fibroid characteristics included dominant fibroid size, location, and total uterine volume. A priori power analysis determined 97 participants were needed per group (194 total) to assess for a 20% difference in LUTS, with alpha = 0.05 and power = 0.8. 202 participants were included to account for missing data upon chart review. N/A. Participants were identified from a surgical database. They were eligible for inclusion if they were planning to undergo hysterectomy for fibroids or AUB from 2014-2019. N/A. When assessing baseline LUTS in women planning to undergo hysterectomy for fibroids vs. AUB, there were no differences in individual symptoms (all p>0.05) or in prevalence of ‘any urinary symptom’ as a single variable (42.6 vs 45.5%, p=0.67). Dominant fibroid size >6cm was correlated with greater prevalence of ‘any urinary symptom’ (64.9% vs 40.4%, p=0.02), as well as difficulty passing urine (p=0.02), nocturia (p=0.04), and urinary frequency (p=0.04). When controlling for age, BMI, parity, chronic pelvic pain, and diabetes, fibroids >6cm remained significantly associated with the presence of lower urinary tract symptoms (OR 3.1, 95% CI 1.2-8.3). Lower urinary tract symptoms are prevalent in women planning to undergo hysterectomy for fibroids, particularly in those with fibroids >6 cm. Future studies should evaluate how urinary symptoms change following hysterectomy.

Individual differences in symptoms of maternal depression and associations with parenting behavior.

Links between global levels of maternal depressive symptoms and parenting behavior in early childhood are well established. However, depression is a heterogeneous disorder and little is known about how individual differences in depression symptoms may be differentially associated with different types of parenting behavior. We aimed to uncover nuance in the relationship between depression and parenting behavior by examining individual differences in symptoms of maternal depression and associations with parenting behavior with 2- and 3-year-old children. Participants included 714 diverse, low-income mothers and their 2-year-old children. Maternal depression symptoms were self-reported at child age 2. Three domains of parenting behavior (harsh, positive, and disengaged) were coded from mother-child interactions at ages 2 and 3. Individual differences in maternal depressive symptoms at child age 2 comprised five profiles: low, interpersonal rejection, moderate, high depressed affect and physical, and severe. Women with the high depressed affect and physical profile demonstrated the greatest risk for parenting challenges with higher levels of harsh parenting at child age 2 compared to all other profiles and higher levels of disengaged parenting at child age 3 compared to the low, moderate, and severe profiles. Unexpectedly, positive parenting did not differ by maternal depression profile at either age. There is wide heterogeneity in symptoms of depression among mothers of 2-year-old children that is clinically relevant for different dimensions of parenting. Physical and depressed affect symptoms in particular may present risk for harsh parenting. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Contrastive machine learning reveals the structure of neuroanatomical variation within autism.

Autism spectrum disorder (ASD) is highly heterogeneous. Identifying systematic individual differences in neuroanatomy could inform diagnosis and personalized interventions. The challenge is that these differences are entangled with variation because of other causes: individual differences unrelated to ASD and measurement artifacts. We used contrastive deep learning to disentangle ASD-specific neuroanatomical variation from variation shared with typical control participants. ASD-specific variation correlated with individual differences in symptoms. The structure of this ASD-specific variation also addresses a long-standing debate about the nature of ASD: At least in terms of neuroanatomy, individuals do not cluster into distinct subtypes; instead, they are organized along continuous dimensions that affect distinct sets of regions.

The longitudinal association between symptoms of posttraumatic stress and complicated grief: A random intercepts cross-lag analysis.

Knowledge about the temporal relationship between disturbed grief and symptoms of posttraumatic stress disorder (PTSD) may have important implications for clinicians working with bereaved trauma survivors. We aimed to investigate the longitudinal association between symptoms of complicated grief and PTSD in a bereaved trauma-exposed sample. In total, 275 bereaved survivors (M age = 19.3, SD = 4.6 years; 47.3% females) of the 2011 massacre on Utøya Island, Norway, participated in semistructured interviews 4-5 months (Time 1 [T1]), 14-15 months (Time 2 [T2]), and 30-32 months (Time 3 [T3]) posttrauma. Complicated grief was measured using the Brief Grief Questionnaire, and posttraumatic stress reactions using the University of California at Los Angeles PTSD Reaction Index. To explore associations between symptoms of complicated grief and PTSD over time, we used a random intercepts cross-lagged panel model. The participants had lost a close friend (n = 256) and/or a family member/partner (n = 19) in the attack. We found a strong correlation between stable individual differences in symptoms of complicated grief and PTSD across the three time-points. PTSD symptoms at T2 predicted complicated grief reactions at T3, but not vice versa. Findings suggest that targeting PTSD symptoms among trauma-exposed bereaved may hinder later development of complicated grief. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The course of symptoms in the first 27 months following bereavement: A latent trajectory analysis of prolonged grief, posttraumatic stress, and depression

BackgroundMuch remains unknown about the course of grief in the early months following bereavement, including the prevalence and timing of a recovery trajectory, whether specific symptoms mark a failure to recover, and the co-occurrence of chronic prolonged grief (PG), posttraumatic stress (PTS) and depression symptoms. MethodsTwo hundred fifty-nine participants completed PG, PTS and depression questionnaires up to eleven times every six weeks during the two years post-bereavement. We used Latent Class Growth Mixture Modeling (LCGMM) to identify subgroups of bereaved individuals sharing similar trajectories for each disorder. We used repeated measures ANOVA to evaluate differences in individual symptoms between trajectories. Finally, we investigated to what extent chronic trajectories of these three disorders co-occurred. ResultsThree trajectories of PG symptoms emerged: resilient (66.4%), chronic (25.1%) and acute recovery (8.4%). The overall severity and symptom profile of the acute recovery group were indistinguishable from that of the chronic group through 6 months post-bereavement, followed by reduction in PG from 6 to 18 months post-bereavement. Chronic PTS in the first-year post-bereavement tended to co-occur with chronic PG and/or chronic depression. ConclusionsTwenty five percent of those with initial elevations in grief recovered in the period of 6 to 12 months post-bereavement. These findings highlight the clinical importance of severe grief in the initial months following loss, but also suggests caution in diagnosing a grief disorder within the first-year post-bereavement.

Supplemental Material for Individual Differences in Symptoms of Maternal Depression and Associations With Parenting Behavior

Supplemental Material for Individual Differences in Symptoms of Maternal Depression and Associations With Parenting Behavior

Social-Emotional Attention in School-Age Children: A Call for School-Based Intervention during COVID-19 and Distance Learning.

Early research indicates that the COVID-19 pandemic and subsequent regulations put children at increased risk of negative mood, anxiety, attention difficulties, and social challenges. Concordantly, these difficulties also are associated with deficits in social–emotional attention in children. On a daily basis, students are required to process and respond to a large amount of complex social–emotional information, including attending to teachers and interacting with peers. These attentional demands and associated stressors have increased as students are required to stare at computer screens during online learning as a result of COVID-19 restrictions. However, there is a dearth of research that investigates the role of social and emotional information on attention in children. The present study assessed the effects of social relevance and emotional valence on attentional demands in children and how functioning is related to individual differences in symptoms and deficits that may be exacerbated by the COVID-19 pandemic. Results show that social and emotional information affect attention in children. Task performance also was associated with negative mood, social stress, and attention focus. This study highlights the need for school-based distance learning interventions to help ameliorate negative social–emotional risks of the COVID-19 pandemic in children. Potential effective avenues include mindfulness-based interventions and attention bias modification training.

O27. Developing a Directly Translational, Non-Subjective Measure of Individual Differences in Negative Affective Bias in Mood and Anxiety Disorders

Mood and anxiety disorders are ubiquitous but current treatment options are ineffective for many. Improved treatments are unlikely without better animal-human translational pipelines and non-subjective measures of individual differences in symptoms. Here, we translate a rodent measure of negative affective bias (and computational model) into humans, and explore its relationship with 1) mood/anxiety diagnosis, 2) transient induced-stress, and 3) self-reported symptoms at scale.

Pulmonary embolism in very elderly patients. A diagnostic challenge

BackgroundDiagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). ObjectiveThe aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. MethodWe conducted a hospital-based, case–control study to review the pulmonary embolisms diagnosed in our center using computed tomography pulmonary angiography between 2013 and 2016. ResultsThe study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58–81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnea (73.4% vs. 63.7% for the elderly and younger groups, respectively; p=.055), chest pain (26.6% vs. 39.5%; p=.013) and cough/haemoptysis (31.1% vs. 18.9%; p=.021). The elderly group had more comorbidity (4.88±2.55 vs. 2.89±2.85; p=.0001). ConclusionThirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients.

Embolia pulmonar en los pacientes muy ancianos. Un reto diagnóstico

BackgroundDiagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). ObjectiveThe aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. MethodWe conducted a hospital-based, case-control study to review the pulmonary embolisms diagnosed in our centre using computed tomography pulmonary angiography between 2013 and 2016. ResultsThe study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58-81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnoea (73.4% vs. 63.7% for the elderly and younger groups, respectively; P=.055), chest pain (26.6% vs. 39.5%; P=.013) and cough/haemoptysis (31.1% vs. 18.9%; P=.021). The elderly group had more comorbidity (4.88±2.55 vs. 2.89±2.85; P=.0001). ConclusionThirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients.

Clusters of midlife women identified by cognitive symptoms

ObjectivesThe study aimed to identify clusters of midlife women by their cognitive symptoms and to examine racial/ethnic differences in the clusters. Study designThis secondary analysis was conducted on the data from 1054 midlife women of multi-ethnic groups in two Internet studies (conducted from 2005 to 2013). Main outcome measuresOnly the data from the questions on background characteristics, health status, and menopausal status and the Cognitive Symptom Index for Midlife Women were used for this secondary analysis. The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic analyses, and analyses of covariance. ResultsFour clusters were extracted: the low total symptom group (Cluster 1; 49.9%), the low-moderate total symptom group with high tertiary symptoms (Cluster 2; 17.3%), the high-moderate total symptom group with low tertiary symptoms (Cluster 3; 21.2%); and the high total symptom group (Cluster 4; 11.7%). There were significant differences in the level of education, employment status, family income, marital status, social support, the country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease(s), access to health care, and menopausal status among the clusters (p < .01). There were significant racial/ethnic differences in the total numbers and total severity scores of tertiary symptoms in Cluster 1. Also, there were significant racial/ethnic differences in individual symptoms in each cluster. ConclusionsRacial/ethnic differences in midlife women’s cognitive symptoms and multiple factors that might differently influence their cognitive symptoms need to be considered in health care for midlife women in menopausal transition.

The effect of limited cognitive resources on communication disturbances in serious mental illness

Semantically incoherent speech is a pernicious clinical feature of serious mental illness (SMI). The precise mechanisms underlying this deficit remain unclear. Prior studies have found that arousal of negative emotion exaggerates the severity of these communication disturbances; this has been coined “affective reactivity”. Recent research suggests that “cognitive reactivity” may also occur, namely reflecting reduced “on-line” cognitive resources in SMI. We tested the hypothesis that communication disturbances manifest as a function of limited cognitive resources in SMI above and beyond that associated with state affectivity. We also investigated individual differences in symptoms, cognitive ability, and trait affect that may be related to cognitive reactivity. We compared individuals with SMI (n=52) to nonpsychiatric controls (n=27) on a behavioral-based coding of communication disturbances during separate baseline and experimentally-manipulated high cognitive-load dual tasks. Controlling for state affective reactivity, a significant interaction was observed such that communication disturbances decreased in the SMI group under high cognitive-load. Furthermore, a reduction in communication disturbances was related to lower trait and state positive affectivity in the SMI group. Contrary to our expectations, limited cognitive resources temporarily relieved language dysfunction. Implications, particularly with respect to interventions, are discussed.

Review of the epidemiology of overactive bladder.

Overactive bladder (OAB) is common in both men and women. It is a symptom complex that causes significant detriment to quality of life in patients. Although the prevalence of OAB is similar in both sexes, there are sex-specific differences in individual symptoms and the impact on quality of life. The coexistence of benign prostatic hyperplasia with OAB can worsen quality of life in men. This review examines the major studies that looked at the epidemiology of OAB as it relates to both sexes. It focuses on both the overall prevalence rates and the incidence of individual symptoms. This paper also addresses the level of bother and quality of life in men and women with OAB. In addition, the relationship between OAB and benign prostatic hyperplasia is reviewed.

Cluster analysis of midlife women's sleep-related symptoms: racial/ethnic differences.

The purpose of this study was to identify clusters of midlife women by sleep-related symptoms in multiethnic groups and to examine racial/ethnic differences in the clusters. This secondary analysis was conducted on data from 1,054 midlife women who participated in two cross-sectional descriptive national Internet surveys. The instruments included questions on background characteristics, health, and menopause status, and the Sleep Index for Midlife Women. The data were analyzed using hierarchical clustering methods, χ2 test, analysis of variance, and multinomial logistic regression analyses. A four-cluster solution was adopted: cluster 1 (low total symptoms group), cluster 2 (moderate physical and psychosomatic symptoms group), cluster 3 (moderate psychological symptoms group), and cluster 4 (high total symptoms group). There were significant differences in education, employment status, family income, social support, country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease, access to health care, and menopause status among clusters (P < 0.05). In cluster 1 only, there were significant racial/ethnic differences in the total number of total severity scores for physical symptoms (P < 0.01). When racial/ethnic differences in individual symptoms in each cluster were determined, there were no consistent racial/ethnic differences. Researchers need to consider that racial/ethnic differences could be prominent in midlife women with low sleep-related symptoms.

Cases of cryptosporidiosis co-infections in AIDS patients: a correlation between clinical presentation and GP60 subgenotype lineages from aged formalin-fixed stool samples.

Nine cases of cryptosporidiosis co-infections in AIDS patients were clinically categorised into severe (patients 1, 3, 8 and 9), moderate (patients 4 and 5) and mild (patients 2, 6 and 7). Formalin-fixed faecal specimens from these patients were treated to obtain high quality DNA competent for amplification and sequencing of the 60-kDa glycoprotein (GP60) gene. Sequence analysis revealed that one patient was infected with Cryptosporidium hominis whereas the remaining eight patients were infected with C. parvum. Interestingly, the patients showing severe cryptosporidiosis harboured two subtypes within the C. parvum allelic family IIc (IIcA5G3 and IIcA5G3R2), whereas patients with moderate or mild infections showed various subtypes of the C. parvum allelic family IIa (IIaA14G2R1, IIaA15G2R1, IIaA17G3R1 and IIaA18G3R1).DNA extraction and genotyping of Cryptosporidium spp. is a challenging task on formalin-fixed stool samples, whose diagnostic outcome is age-dependent. The method herein reported represents a step forward routine diagnosis and improves epidemiology of HIV-related clinical cases. Due to the need to elucidate genetic richness of Cryptosporidium human isolates, this approach represents a useful tool to correlate individual differences in symptoms to subgenotyping lineages.

Oral budesonide for maintenance of remission of Crohn’s disease: a pooled safety analysis

Budesonide exhibits similar efficacy to systemic glucocorticosteroids (GCSs) in Crohn's disease (CD), but with fewer adverse events (AEs). Aim To evaluate budesonide's safety profile in CD patients, in particular, incidences of clinically important AEs known to be associated with systemic GCSs. Five 1-year, double-blind, placebo-controlled trials evaluating budesonide for mild-to-moderate CD were pooled for analysis. The highest incidence rates of AEs were gastrointestinal- and endocrine systems-related in both groups (budesonide 6 mg/day, n = 208; placebo, n = 209). Incidence rates were similar, except for higher incidence of endocrine disorders in budesonide versus placebo patients (P = 0.0042) caused by a higher overall occurrence of cutaneous GCS symptoms (P = 0.0036) in the budesonide group; differences in individual symptoms were nonsignificant. Percentage of patients with normal adrenal function was significantly lower at 13 weeks (three of five studies), but not at 52 weeks (two studies) in the budesonide versus placebo groups. Occurrence of clinically important or serious AEs associated with systemic GCSs, including sepsis, cataracts, adrenal insufficiency was rare and similar between groups. Budesonide treatment for up to 1 year is well-tolerated in CD patients, with an AE profile similar to placebo and only rare occurrences of clinically important AEs associated with systemic GCSs.