Experience Of Physical Symptoms Research Articles

Somatic symptom severity, depression and anxiety associations with pancreatitis and undifferentiated abdominal pain in surgical inpatients.

Somatic Symptom Disorder is a psychiatric diagnosis that describes the experience of physical symptoms and associated distress, that is disproportionate to recognized organic pathology. Somatic symptom severity (SSS) may be associated with some surgical diagnoses; particularly the complex pain associated with pancreatitis, or the diagnostic ambiguity of undifferentiated abdominal pain (UAP). We aimed to estimate the prevalence of SSS in different diagnostic groups in surgical inpatients with abdominal pain; and to estimate the magnitude and direction of any association of SSS, anxiety and depression. Cross sectional analysis (n = 465) of adult admissions with non-traumatic abdominal pain, at a tertiary hospital in Australia. We estimated SSS with the Patient Health Questionnaire-15 (PHQ-15), depression with the Patient Health Questionnaire (PHQ-9) and anxiety with the General Anxiety Disorder (GAD-7), at standard cut-points ≥ 10; comparing acute pancreatitis (n = 20), chronic pancreatitis (n = 18) and UAP (n = 64) versus other causes of abdominal pain. Somatic symptoms were common, 52% having moderate and 19.6% severe SSS. There was an association between moderate SSS and pancreatitis (OR 2.11, 95% CI 1.05-4.25) and depressive symptoms and chronic pancreatitis (OR = 3.47, 95% CI 1.31-9.24). There was no significant association between the four mental health categories and UAP. SSS and psychological comorbidity were common in a surgical inpatients admitted for abdominal pain and equally represented across most diagnostic sub-groups. However, the pancreatitis sub-group had greater proportions with clinically significant SSS and depression, suggesting that they have a higher requirement for psychological assessment and intervention.

Emotional, mental health and physical symptom experience of patients hospitalized with COVID-19 up to 3 months post-hospitalization: A longitudinal study.

To explore emotional, mental health and physical symptoms up to 3 months after discharge for adults hospitalized with COVID-19. 10%-30% of adults with COVID-19 experience physical and psychological symptoms 3 months or more following infection. Knowing symptoms can help direct early intervention. A longitudinal descriptive design to study COVID-related symptoms 2 weeks, 6 weeks and 3 months after hospitalization. Sixty-six patients were recruited from a hospital system in Midwestern US (October 2020-May 2021). Participants self-reported demographics, hospital and post discharge symptoms, PROMIS measures (depression, anxiety, fatigue, cognitive function, satisfaction social roles, sleep disturbance) and Impact of Event Scale-Revised (IES-R). Hospital length of stay, comorbidities, lowest oxygen saturation, respiratory support and resources used were collected. Descriptive and nonparametric statistics described the sample and identified correlations between variables. The STROBE checklist was used. Data from 1 (T1) and 3 months (T2) post discharge were analysed (N = 52). A majority were female, white and married; 96% experienced ≥1 COVID-related symptoms at T1; 85% at T2. Fatigue was most prevalent, followed by shortness of breath, muscle weakness and foggy thinking. More physical symptoms during hospitalization correlated positively with number of symptoms at T1 and T2; a majority stated these impacted their normal routine 'somewhat' or 'a lot'. T1 depression highly correlated with all T2 PROMIS and IES-R scores and number of physical symptoms. More symptoms at T1 were associated with worse fatigue, lower cognitive function and lower satisfaction with social roles at T2. This study adds to the growing knowledge of mental, physical and emotional symptoms and relationships between these early after hospitalization with COVID-19. Findings can help identify holistic nursing interventions to improve health and mitigate symptoms for people with long COVID. Patients contributed via study participation.

Premenstrual Dysphoric Disorder: Patterns, Causes, and Effects

Premenstrual Dysphoric Disorder is a condition that many women suffer during the later phases of their menstrual cycle. To clarify, it is nothing but a severe and less common form of Premenstrual Syndrome. A woman goes through the period cycle every month to prepare for motherhood as she grows older, but the side effects she may experience are not discussed enough since there is usually a discomfort attached to this specific conversation. Moreover, when considering menstrual conditions, most women surprisingly are actually only familiar with PMS. While PMS affects most premenopausal women, PMDD is a condition that can cause much more severe repercussions and has to be recognized. This research paper brings attention to PMDD and provides insight on the causes and effects of this certain condition. A woman suffering from PMDD does not only experience physical symptoms that can have an effect on her daily routine but also has intense emotional symptoms that restrict her control of her behavior. These symptoms can heavily strain a female’s relationships with other people and disrupt her work and/or personal environments. The treatment options available for PMDD currently are temporarily effective, and in fact, experts are still trying to find the exact cause of PMDD to develop a more permanent treatment for the condition. Presently, the best treatment options are SSRIs, and others include hormonal medications and therapy which are helpful in the psychological symptoms of PMDD. This paper explains the extent to which these specific treatments are productive and how they work.

More than blood: app-tracking reveals variability in heavy menstrual bleeding construct

BackgroundHeavy menstrual bleeding (HMB) is associated with impaired quality of life and may signal serious health problems. Unresolved challenges in measuring menstrual bleeding and identifying HMB have hampered research and clinical care. Self-reported bleeding histories are commonly used but these may be influenced by recall bias, personal beliefs regarding “normal” flow volume, and the experience of other physical symptoms or disruptions to daily life. The potential usefulness of menstrual-tracking mobile applications, which allow real-time user-entered data recording, for assessing HMB has not been studied. We evaluated recall bias in reported period duration, the relationship of tracked period duration and daily flow volume to subsequently reported period heaviness, variation in quality of life associated with increasing period heaviness, and the advantages and limitations of using app-tracked data for clinical and research purposes.MethodsAn online questionnaire was distributed to current users of Clue, a commercially available menstrual health tracking app, asking them to characterize their last period. We compared responses to the user’s corresponding Clue app-tracked data. The study sample comprised 6546 U.S.-based users (aged 18–45 years).ResultsIncreasing reported heaviness was associated with increasing app-tracked period length and days of heavy flow, impaired quality-of-life (especially body pain severity), and disrupted activities. Of those reporting having had a heavy/very heavy period, ~ 18% had not tracked any heavy flow, but their period length and quality-of-life indicators were similar to those who had tracked heavy flow. Sexual/romantic activities were the most affected across all flow volumes. Compared to app-tracked data, 44% recalled their exact period length; 83% recalled within ± 1 day. Overestimation was more common than underestimation. However, those with longer app-tracked periods were more likely to underestimate period length by ≥ 2 days, a pattern which could contribute to under-diagnosis of HMB.ConclusionPeriod heaviness is a complex construct that encapsulates flow volume and, for many, several other bleeding-associated experiences (period length, bodily impairments, disruptions of daily activities). Even very precise flow volume assessments cannot capture the multi-faceted nature of HMB as experienced by the individual. Real-time app-tracking facilitates quick daily recording of several aspects of bleeding-associated experiences. This more reliable and detailed characterization of bleeding patterns and experiences can potentially increase understanding of menstrual bleeding variability and, if needed, help to guide treatment.

Efficacy of open-label counterconditioning for reducing nocebo effects on pressure pain.

Nocebo effects can adversely affect the experience of physical symptoms, such as pain and itch. Nocebo effects on itch and pain have shown to be induced by conditioning with thermal heat stimuli and reduced by counterconditioning. However, open-label counterconditioning, in which participants are informed about the placebo content of the treatment, has not been investigated, while this can be highly relevant for clinical practice. Furthermore, (open-label) conditioning and counterconditioning has not been investigated for pain modalities relevant to musculoskeletal disorders, such as pressure pain. In a randomized controlled trial, we investigated in 110 healthy female participants whether nocebo effects on pressure pain combined with open-label verbal suggestions can be (1) induced via conditioning and (2) reduced via counterconditioning. Participants were allocated to either a nocebo- or sham-conditioning group. Next, the nocebo group was allocated to either counterconditioning, extinction or continued nocebo conditioning; sham conditioning was followed by placebo conditioning. Nocebo effects were significantly larger after nocebo conditioning than sham conditioning (d=1.27). Subsequently, a larger reduction of the nocebo effect was found after counterconditioning than after extinction (d=1.02) and continued nocebo conditioning (d=1.66), with effects similar to placebo conditioning (following sham conditioning). These results show that (counter)conditioning combined with open-label suggestions can modulate nocebo effects on pressure pain, which provides promise in designing learning-based treatments to reduce nocebo effects in patients with chronic pain disorders, particularly for musculoskeletal disorders. Few studies have investigated the efficacy counterconditioning to reduce nocebo effects. Whereas typically deceptive procedures are used, these are not ethically appropriate for use in clinical practice. The current study demonstrates that open-label counterconditioning in a pain modality relevant for many chronic pain conditions may be a promising new strategy for reducing nocebo effects in a non-deceptive and ethical manner, which provides promise in designing learning-based treatments to reduce nocebo effects in patients with chronic pain disorders.

Psychometric evaluation of the Depression Anxiety Stress Scale 8 among women with chronic non-cancer pelvic pain

Psychiatric comorbidity and abusive experiences in chronic pelvic pain (CPP) conditions may prolong disease course. This study investigated the psychometrics of the Depression Anxiety Stress Scale 8 (DASS-8) among women with CPP (N = 214, mean age = 33.3 ± 12.4 years). The DASS-8 expressed excellent fit, invariance across age groups and menopausal status, good know-group validity (differentiating women with psychiatric comorbidity from those without comorbidity: U = 2018.0, p = 0.001), discriminant validity (HTMT ratios < 0.85), excellent reliability (alpha = 0.90), adequate predictive and convergent validity indicated by strong correlation with the DASS-21 (r = 0.94) and high values of item-total correlations (r = 0.884 to 0.893). In two-step cluster analysis, the DASS-8 classified women into low- and high-distress clusters (n = 141 and 73), with significantly higher levels of distress, pain severity and duration, and physical symptoms in cluster 2. The DASS-8 positively correlated with pain severity/duration, subjective symptoms of depression/anxiety, experiences of sexual assault, fatigue, headache severity, and collateral physical symptoms (e.g., dizziness, bloating, fatigue etc.) at the same level expressed by the parent scale and the DASS-12, or even greater. Accordingly, distress may represent a target for early identification of psychiatric comorbidity, CPP severity, experiences of sexual assault, and collateral physical complaints. Therefore, the DASS-8 is a useful brief measure, which may detect mental distress symptoms among women with CPP.

Mental distress, quality of life and physical symptoms in Chinese women with ovarian cancer receiving olaparib treatment during the COVID-19 pandemic.

ObjectivesWomen with ovarian cancer (OC) have experienced unprecedented challenges since the novel coronavirus disease-2019 (COVID-19) outbreak in China. We aim to evaluate the experience of psychological status, physical symptoms and quality of life (QoL) and investigate the impact of COVID-19 pandemic on OC patients receiving olaparib.MethodsThe survey was conducted online from April 22 to May 12 in 2020. Demographic and clinical questions were listed to collect general information. The degree of insomnia, depression, anxiety, stress symptoms and QoL were assessed by the Chinese versions of the Insomnia Severity Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised, and the General Functional Assessment of Cancer Therapy, respectively. Multivariate logistic regression analysis was conducted to analyze the risk factors for mental distress and QoL.ResultsA total of 56 respondents coming from 15 various provinces in China participated in the survey. The prevalence of insomnia, depressive, anxiety, stress symptoms and reduced QoL were 37.5, 51.8, 37.5, 30.4, and 51.8%, respectively. Unfavorable disease status, shorter period of olaparib administration, adverse events of olaparib and delay in cancer care were correlated with mental health problems. Reduced QoL was also significantly associated with psychological distress.ConclusionsThis study emphasized that mental health problems and reduced QoL should gain more attention in women with OC who are receiving oral olaparib at home. Appropriate psychological healthcare strategies are necessary for OC patients during the COVID-19 pandemic.

A cluster analysis of psychological and physical symptoms in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): CECRI (Center of Excellence for Nursing Scholarship) Rome Background The experience of psychological and physical symptoms of heart failure can be burdensome for patients. Identification of profiles of symptom burden may lead to greater understanding of the mechanism underlying this experience and improve symptom-centered care. Purpose The aim of this analysis was to identify profiles of psychological and physical symptoms in heart failure patients and compare the sociodemographic and clinical characteristics of patients in each cluster. Methods This was a secondary analysis of baseline data from the MOTIVATE-HF trial, that enrolled 510 patients across Italy. Cluster analysis was used to identify profiles of patients based on the two scores of the Hospital Anxiety and Depression scale and the total score of the Heart Failure Somatic Perception Scale. Each profile was described in terms of sociodemographic characteristics (e.g., age, gender, severity of disease), self-care maintenance and management behaviors, and self-efficacy (Self-care of Heart Failure Index), generic quality of life (12-item Short Form Survey), health-related quality of life (Kansas City Cardiomyopathy Questionnaire), and cognitive status (Montreal Cognitive Assessment Scale). Comparisons between the characteristics of each profile were performed by analysis of variance (ANOVA) and chi square test. Results Patients (n = 510) were 72.37 years old on average (SD = 12.28), with a slightly higher prevalence of men (58%). Sixty per cent of the sample were symptomatic: New York Heart Association (NYHA) class 2, 31.4% in NYHA class III, and 6.5% in NYHA class IV. Three profiles were identified: (1) low distress, characterized by the youngest patients (69.76, SD = 12.17), mostly in NYHA class II, and with the highest score on self-care self-efficacy and self-care maintenance behaviors; (2) average distress, characterized by the oldest patients (74.45, SD = 11.99), who were mostly retired, with the highest level of education, and poorest (physical) health-related quality of life and low self-care behaviors; (3) high distress, characterized by an average age of 73.08 (SD = 12.29), with the lowest hemoglobin level, the worst cognitive status, and the worst generic and health-related quality of life. Conclusions The profiles identified in this study and their characteristics provide new insights into the burden of psychological and physical symptoms experienced by heart failure patients. This represents the first step in promoting symptom-centered care in the future.

Experience of Physical and Mental Symptoms when Confirmed Positive COVID-19 among Community in Tarakan City, Indonesia

The coronavirus disease 2019 (COVID-19) is a disease that causes physical symptoms and psychological disorders in patients. The experience of people of Tarakan city who have been confirmed positive for COVID-19 is not yet known. Meanwhile, the number of positive cases of COVID-19 continues to increase. Therefore, this study aimed to explore the physical and mental experiences of COVID-19 patients in Tarakan City.

610-P: Negative Affect and Symptom Experience in Type 2 Diabetes (T2D) : A Bidirectional Evaluation Using Ecological Momentary Assessment (EMA)

Objectives: Physical symptoms (SXS) are commonly reported among adults with T2D and have a significant impact on functioning and self-management. Although there is evidence that symptom reporting is closely linked to the experience of negative affect (NA) , the directionality of this relationship remains unclear. This study used EMA to evaluate bidirectional temporal associations between SXS and NA in adults with sub-optimally controlled T2D. Methods: Adults with T2D (N = 61; Age = 55 (10) yrs; Women = 64.5%; Black = 61%; Latino = 36%; A1C = 8.5 (2.3) completed smartphone EMA of SXS and NA 3 x daily over a 14-day period. Linear mixed effect models were used to assess associations of total number of SXS reported (0-13) and subsequent levels of NA (0-5) , and vice-versa. Results: There were significant within- and between-person bidirectional associations between SXS and NA. Within-persons, a 1-point increase in SXS from one’s personal mean was associated with a 0.03-point increase in subsequent NA (95%CI: 0.01-0.04, p = .008) and a 1-point increase in NA from one’s personal mean was associated with a 0.39-point increase in subsequent SXS (95%CI: 0.27-0.50, p &amp;lt; .0001) . Between-persons, a 1-point increase in SXS personal mean was associated with a 0.18-point increase in subsequent NA (95%CI: 0.12-0.26, p &amp;lt; .0001) and a 1-point increase in one’s NA personal mean was associated with a 1.8-point increase in SXS (95%CI: 1.15-2.46, p &amp;lt; .0001) . Conclusion: Results showed bidirectional relations between SXS and NA, observed both within- and between-persons over the course of a day, among predominantly ethnic minority adults with T2D. If these patterns reflect causal associations, they suggest that interventions that reduce negative affect would also reduce the experience of physical symptoms, and vice versa. Given prior evidence linking these factors to self-management, functioning, and health outcomes in T2D, such interventions could have substantial impact. Disclosure S.R.Fishman: None. J.S.Gonzalez: Consultant; Virta Health Corp. C.J.Hoogendoorn: None. C.Wang: None. S.A.Mulvaney: None. V.H.Jonas: None. H.Mendez-rodriguez: None. R.Fang: None. C.A.Solon: None. J.P.Crandall: Research Support; Abbott Diabetes. Funding NIH P30 DK111022

Perceived role overload and physical symptom experience among caregivers of older adults: The moderating effect of social support

We investigated the association between perceived role overload and physical symptom experience, and the potential moderating effect of social support among caregivers of older adults. We analyzed data of 1,471 caregivers obtained from the 2017 National Study of Caregiving. In the survey, participants were assessed for physical symptoms (pain, limited leg strength, and low energy), symptom-related activity limitations, perceived role overload, and informal/formal support sources. We performed multiple logistic regression analyses with interaction terms. Caregivers who perceived higher role overload were more likely to experience the physical symptoms and frequent limited activities due to the symptoms. The associations of perceived role overload with pain and low energy, respectively, were attenuated among caregivers with high informal support. The moderating effect of formal support appeared to be the opposite in relation to pain. Caregivers who perceived high burden may benefit from their informal support to prevent detrimental effects of caregiving on physical health.

Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program.

This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p < 0.001) and T2 and T3 (t = 5.00, p < 0.001) and T1 and T3 (t = 10.80, p < 0.001). There was a significant reduction in total psychological-symptom score comparing T1 and T2 (t = 4.92, p < 0.001) and between T1 and T3 (t = 4.85, p < 0.001). However, for the physical-symptom experience, a significant increase in the physical-symptom score between T1 and T2 (t = -3.25, p = 0.001) was reported but the scores reduced significantly one month after the program (T2-T3; t = 4.12, p < 0.001). The mentoring concept of the SMP program has beneficial effects on improving attitude towards death and psychophysical-symptom experience associated with cadaver dissection.

Hypochondriasis: A Literature Review

Hypochondriasis is one of six somatoform disorders categorized in the DSM-IV. Hypochondriasis is distinguished from other somatic delusional disorders because this disorder is associated with the experience of physical symptoms experienced by the sufferer, whereas other somatoform disorders do not show physical symptoms in themselves. Symptoms that arise may be an exaggerated statement of physical symptoms, which will actually exacerbate physical symptoms caused by the belief that the patient is sick and in a worse condition than the actual situation. Treatment of hypochondriasis includes recording symptoms, psychosocial review, and psychotherapy. Good prognosis is associated with high socioeconomic status, sudden onset, absence of personality disorders and absence of concomitant non-psychiatric medical conditions.

Just In Time: Challenges and Opportunities of First Aid Care Information Sharing for Supporting Epileptic Seizure Response.

There are over three million people living with epilepsy in the U.S. People with epilepsy experience multiple daily challenges such as seizures, social isolation, social stigma, experience of physical and emotional symptoms, medication side effects, cognitive and memory deficits, care coordination difficulties, and risks of sudden unexpected death. In this work, we report findings collected from 3 focus groups of 11 people with epilepsy and caregivers and 10 follow-up questionnaires. We found that these participants feel that most people do not know how to deal with seizures. To improve others' abilities to respond safely and appropriately to someone having seizures, people with epilepsy and caregivers would like to share and educate the public about their epilepsy conditions, reduce common misconceptions about seizures and prevent associated stigma, and get first aid help from the public when needed. Considering social stigma, we propose design implications of future technologies for effective delivery of appropriate first aid care information to bystanders around individuals with epilepsy when they experience a seizure.

Examination of Food Insecurity, Socio-Demographic, Psychosocial, and Physical Factors among Residents in Public Housing.

Understanding associations between psychosocial and physical factors among those who experience food insecurity could help design effective food insecurity programs for improved cardiovascular health among low-income populations. We examined differences in psychosocial and physical factors between those who were food secure compared with food insecure among public housing residents. Data were from the baseline survey of a randomized controlled trial of a weight management intervention in Boston, Massachusetts from 2016-2017. Food insecurity and psychosocial and physical factors, including perceived stress, personal problems, social support, and physical symptoms, were measured via interviewer-administered screeners. Mean age of the sample (N=102) was 46.5 years (SD=11.9). The majority were Hispanic (67%), female (88%), with ≤high school degree (62%). Nearly half were food insecure (48%). For psychosocial variables, those who were food insecure had higher ratings of perceived stress (adjusted mean difference 3.39, 95% CI:2.00,4.79), a higher number of personal problems (adjusted mean difference 1.85, 95% CI: 1.19, 2.51), and lower social support (adjusted mean difference -0.70, 95% CI:-1.30,-0.11) compared with those who were food secure. For physical variables, those who were food insecure had higher odds of reporting negative physical symptoms (aOR 4.92, 95% CI:1.84,13.16). Among this sample of public housing residents, food insecurity was associated with higher stress, more personal problems, higher experiences of physical symptoms, and lower social support.

“Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. To describe the treatment journeys of pregnant women with RR-TB-including how their care experiences shape their identities-and identify areas in which tailored interventions are needed. In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to "be brave"). Care experiences required them to negotiate seemingly contradictory identities as both new mothers-"givers of life"-and RR-TB patients facing a complicated and potentially deadly disease. In terms of their "pregnancy identity" and "RR-TB patient identity" that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the "mothering" and "patient" roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child's health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

Cost-Related Non-Utilization of Health Services and Self-Perceived Reactions to Race.

There is limited information regarding the prevalence and predictors of cost-related non-utilization (CRNU), while there is increasing attention to the rising out-of-pocket cost of health services including prescription medications. Prior studies have not quantified the role of perceived racism despite its documented relationship with health services utilization. We examine perceptions of reactions to race and quantify their relationship with CRNU. This retrospective cross-sectional study utilized data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) public use file, an annual, state-based telephone survey of US adults aged 18 and older. We utilized data for four states that provided responses to five Reactions to Race items, including information about the self-perceived quality of the respondent's health care experience compared with people of other races (worse vs same or better) and whether the respondent experienced physical symptoms because of treatment due to their race. The three binary outcomes were: 1) did not visit a physician; 2) did not visit a physician due to cost; 3) did not fill a prescription due to cost. We estimated covariate-adjusted odds ratios associated with each outcome using logistic regression models. The BRFSS sample consisted of 20,366 respondents of whom 8% were African American non-Hispanic, 12% were Hispanic and 73% were White. Three percent of respondents considered their experience to be worse than people of other races. Three percent of individuals reported physical symptoms because of treatment due to their race while 5% of respondents reported becoming emotionally upset because of treatment due to their race. The proportions for the three study outcomes were 11%, 13% and 7%, respectively. In covariate-adjusted models, a worse experience with the health care system was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.6 - 4.3]). The experience of physical symptoms because of treatment due to race was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.7 - 4]; prescription fills: 2.1 [1.2 - 3.6]). No Reactions to Race items were associated with general non-utilization. Negative perceptions of reactions to race during the time of health services utilization is positively associated with CRNU, ie, foregoing physician visits and prescription fills due to cost.

Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study.

IntroductionA proportion of patients admitted to acute-stroke settings have not had a stroke, but have conditions mimicking a stroke. Approximately 25% of suspected stroke cases are “stroke mimics” and 2% are patients with functional symptoms — “functional stroke mimics”. This study aimed to explore experiences and illness perceptions of patients with functional symptoms admitted to hyperacute stroke wards.MethodsThis study used mixed methods. Patients with functional stroke symptoms participated in semistructured qualitative interviews immediately after admission to one of two acute-stroke units in London and again 2 months after hospital discharge. Qualitative data were assessed using thematic analysis. The Brief Illness Perception Questionnaire (Brief-IPQ) measured illness perceptions at admission and at 2-month follow-up.ResultsA total of 36 participants completed baseline interviews and 25 completed follow-up. Six themes emerged: physical symptom experience, emotional and coping responses, symptom causes, hospital experiences, views on the future, and uncertainty after hospital discharge. Mean Brief-IPQ score at admission was 49.3 (SD: 9.9), indicating a moderate–high level of perceived illness threat. Participants presented with a range of functional symptoms. At baseline, participants were highly concerned about their symptoms, but this had decreased at 2-month follow-up. Two months later, many were confused as to the cause of their admission.ConclusionThis is the first study to examine functional stroke patients’ experiences of acute-stroke admission. At admission, patients expressed confusion regarding their diagnosis, experienced high levels of emotional distress, and were concerned they were perceived as time wasting by stroke clinicians. While most participants experienced symptom recovery, there was a significant subgroup for whom symptoms persisted or worsened. A lack of care guidelines on the management of functional stroke patients may perpetuate functional symptoms.

Relationship between insecure attachment and physical symptom severity is mediated by sensory sensitivity.

ObjectiveVarious models have been used to explain somatization, including attachment theory, which describes how formative experiences influence perceptions of vulnerability and threat. Although attachment insecurity is associated with greater physical symptoms, the mechanisms by which attachment insecurity influences the experience of physical symptoms are not clear. Sensory processing sensitivity (SPS) describes a low threshold to responding to stimuli and high emotional reactivity. It is associated with both attachment insecurity and physical symptoms. The purpose of this study is to test a model in which attachment insecurity, depression, and SPS interact to influence physical symptoms.MethodsCross‐sectional data from the online Self‐Assessment Kiosk were used (N = 186). Participants were surveyed regarding attachment insecurity (ECR‐M16), physical symptom severity (PHQ‐15), sensory processing sensitivity (HSPS), and depression (PHQ‐9). A path analysis was used to analyze the data.ResultsModal participants were white (74%) single (45%) women (80%) with university education (79%). Attachment anxiety, attachment avoidance, and sensitivity were correlated with physical symptom severity. The data suggested that sensitivity mediates between attachment anxiety and physical symptoms (β indirect = 0.070, p = .003 and β direct = −0.030, p> .05) and this relationship remains significant when controlling for depression.ConclusionsThis study extends our understanding of the potential pathways that lead individuals with attachment insecurity to experience burdensome physical symptoms by supporting a mediating role for SPS.

Health-related quality of life and associated factors among cervical cancer patients at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

BackgroundCancer of the cervix is the most frequent cancer among women in Ethiopia. The disease burden and its treatment adversely affects patients’ health-related quality of life (HRQoL). We aimed to investigate the HRQoL and its predictors among cervical cancer patients in Ethiopia.MethodsA hospital-based cross-sectional study was conducted from January to June 2018 at the oncology unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A total of 404 cervical cancer patients were interviewed using validated Amharic version of the European Organization for Research and Treatment of Cancer module (EORTC QLQ-C30), cervical cancer module (EORTC QLQ-CX24), and Euro Quality of Life Group’s 5-Domain Questionnaires 5-Levels (EQ-5D) questionnaires. ANOVA test was used to determine the effect of patients’ characteristics on mean scores of the different domains of HRQoL and stepwise multivariable logistic regression was performed to identify predictors of HRQoL. Coefficients of level-specific utility values obtained from a hybrid regression model for the Ethiopian general population were used to compute utility.ResultsThe mean age of patients was 52.1 ± 10.4 years and 379 (93.8%) of the patients were receiving service at the outpatient clinic. About one-third (35%) of patients were diagnosed with stage IV cervical cancer. Mean global health status/QoL, mean utility and visual analog scale scores were 48.3 ± 23.77, 0.77 and 65.7 ± 20.83, respectively. Physical functioning (AOR = 4.98, 95% CI:2.16–11.49), emotional functioning (AOR = 5.25, 95% CI:2.26–12.17), pain (AOR = 5.79, 95% CI:2.30–14.57), and symptom experience (AOR = 4.58, 95% CI:1.95–10.79) were associated with patients’ HRQoL.ConclusionsCervical cancer significantly affects patient’s HRQoL and hence, efforts to improve HRQoL should be commenced especially in terms of physical and emotional functioning, pain, and symptom experience.