Extent Of Symptoms Research Articles

Cortex-wide topography of 1/f-exponent in Parkinson’s disease

Parkinson’s disease (PD) is a progressive and debilitating brain disorder. Besides the characteristic movement-related symptoms, the disease also causes decline in sensory and cognitive processing. The extent of symptoms and brain-wide projections of neuromodulators such as dopamine suggest that many brain regions are simultaneously affected in PD. To characterise brain-wide disease-related changes in neuronal function, we analysed resting state magnetoencephalogram (MEG) from two groups: PD patients and healthy controls. Besides standard spectral analysis, we quantified the aperiodic components (κ, λ) of the neural activity by fitting a power law κ/fλ – f is the frequency, κ and λ are the fitting parameters—to the MEG power spectrum and studied its relationship with age and Unified Parkinson’s Disease Rating Scale (UPDRS). Consistent with previous results, the most significant spectral changes were observed in the high theta/low-alpha band (7–10 Hz) in all brain regions. Furthermore, analysis of the aperiodic part of the spectrum showed that in all but frontal regions λ was significantly larger in PD patients than in control subjects. Our results indicate that PD is associated with significant changes in aperiodic activity across the whole neocortex. Surprisingly, even early sensory areas showed a significantly larger λ in patients than in healthy controls. Moreover, λ was not affected by the Levodopa medication. Finally, λ was positively correlated with patient age but not with UPDRS-III. Because λ is closely associated with excitation-inhibition balance, our results propose new hypotheses about neural correlates of PD in cortical networks.

A Cognitive Biotype of Depression and Symptoms, Behavior Measures, Neural Circuits, and Differential Treatment Outcomes

Cognitive deficits in depression have been associated with poor functional capacity, frontal neural circuit dysfunction, and worse response to conventional antidepressants. However, it is not known whether these impairments combine together to identify a specific cognitive subgroup (or "biotype") of individuals with major depressive disorder (MDD), and the extent to which these impairments mediate antidepressant outcomes. To undertake a systematic test of the validity of a proposed cognitive biotype of MDD across neural circuit, symptom, social occupational function, and treatment outcome modalities. This secondary analysis of a randomized clinical trial implemented data-driven clustering in findings from the International Study to Predict Optimized Treatment in Depression, a pragmatic biomarker trial in which patients with MDD were randomized in a 1:1:1 ratio to antidepressant treatment with escitalopram, sertraline, or venlafaxine extended-release and assessed at baseline and 8 weeks on multimodal outcomes between December 1, 2008, and September 30, 2013. Eligible patients were medication-free outpatients with nonpsychotic MDD in at least the moderate range, and were recruited from 17 clinical and academic practices; a subset of these patients underwent functional magnetic resonance imaging. This prespecified secondary analysis was performed between June 10, 2022, and April 21, 2023. Pretreatment and posttreatment behavioral measures of cognitive performance across 9 domains, depression symptoms assessed using 2 standard depression scales, and psychosocial function assessed using the Social and Occupational Functioning Assessment Scale and World Health Organization Quality of Life scale were analyzed. Neural circuit function engaged during a cognitive control task was measured using functional magnetic resonance imaging. A total of 1008 patients (571 [56.6%] female; mean [SD] age, 37.8 [12.6] years) participated in the overall trial and 96 patients participated in the imaging substudy (45 [46.7%] female; mean [SD] age, 34.5 [13.5] years). Cluster analysis identified what may be referred to as a cognitive biotype of 27% of depressed patients with prominent behavioral impairment in executive function and response inhibition domains of cognitive control. This biotype was characterized by a specific profile of pretreatment depressive symptoms, worse psychosocial functioning (d = -0.25; 95% CI, -0.39 to -0.11; P < .001), and reduced activation of the cognitive control circuit (right dorsolateral prefrontal cortex: d = -0.78; 95% CI, -1.28 to -0.27; P = .003). Remission was comparatively lower in the cognitive biotype positive subgroup (73 of 188 [38.8%] vs 250 of 524 [47.7%]; P = .04) and cognitive impairments persisted regardless of symptom change (executive function: ηp2 = 0.241; P < .001; response inhibition: ηp2 = 0.750; P < .001). The extent of symptom and functional change was specifically mediated by change in cognition but not the reverse. Our findings suggest the presence of a cognitive biotype of depression with distinct neural correlates, and a functional clinical profile that responds poorly to standard antidepressants and instead may benefit from therapies specifically targeting cognitive dysfunction. ClinicalTrials.gov Identifier: NCT00693849.

Type 2M VWD Laboratory Defects More Consistent Than Bleeding Symptoms across Family Members

Background Von Willebrand disease (VWD) is an inherited bleeding disorder characterized by a defect or decrease of von Willebrand factor (VWF). Type 2 VWD results from qualitative defects in VWF. Type 2M VWD is defined by defective platelet binding to GPIb and/or collagen. While the inheritance of type 2M VWD is autosomal dominant, the extent of symptoms across family members has not been well characterized. Methods Subjects included index cases with type 2M VWD and all enrolled family members from a large US study of VWD (Zimmerman Program). Index cases were enrolled due to a prior diagnosis of VWD. All available family members were enrolled if willing. VWF testing performed included VWF antigen (VWF:Ag), VWF platelet binding by either VWF ristocetin cofactor activity (VWF:RCo) or VWF:GPIbM, collagen binding with types I, III or IV collagen (VWF:CB1, VWF:CB3, VWF:CB4) and VWF multimer distribution. Bleeding scores were calculated using the ISTH bleeding assessment tool (BAT). DNA sequencing was performed for the full length VWF gene. Statistics were calculated using GraphPad Prism with a p value of <0.05 considered significant. Family members were defined as affected if they had VWF activity levels consistent with type 2M VWD and presence of genetic variant if identified. Results 24 index cases, 51 affected family members and 40 unaffected family members were available for analysis. The mean VWF:RCo/VWF:Ag ratio for index cases was 0.5 and the mean VWF:CB/VWF:Ag ratio was 1.05. The VWF:RCo/VWF:Ag ratio was similar in affected family members (0.44, p=NS) but higher as expected in unaffected members (0.89, p<0.001 for index case vs. unaffected, p<0.001 for affected vs. unaffected). In contrast, there was no difference in VWF:CB/VWF:Ag ratios between index cases and affected family members (0.94, p=NS). Data for VWF:GPIbM, collagens I and IV were available only on index cases, and showed low VWF:GPIbM/VWF:Ag (mean 0.79), higher VWF:CBI/VWF:Ag (mean 1.31) and lower VWF:CBIV/VWF:Ag (mean 0.85). There was a negative correlation between VWF:GPIbM and VWF:CBIV, with subjects having either low VWF:GPIbM and normal VWF:CBIV or low VWF:CBIV and normal VWF:GPIbM. Similar results were seen for VWF:CB1 although only 1 subject was diagnosed with type 2M VWD and low VWF:CB1. Median bleeding scores were highest in index cases (7.5), intermediate in affected family members (3) and normal in unaffected family members (1). There was a significant difference between index cases and affected family members (<0.015), and between index cases and unaffected family members (p<0.001). One subject had a genetic variant in the VWF A3 domain, one in the VWF D3 domain and the remainder of index cases had a defect in the VWF A1 domain. Conclusions These findings suggest that decreases in platelet and collagen binding activity increase bleeding risk in families with type 2M VWD. Index cases had higher bleeding scores as compared to affected family members, suggesting that diagnosis of family members may require more attention. Precise understanding of these defects may assist in better diagnosis and treatment of von Willebrand disease.

Outcome Prospective of Late Duodenal Perforation Repairs in Elderly

Introduction: Perforated duodenal ulcer is the communal emergency seen in surgical department, and postoperative complications of this emergency surgeries are very high which requires the related factors identification with this incidence. Aim: This study was designed to evaluate duodenal ulcer in older patients by revealing the patient's health status, early and late repair, choice of surgical procedure, and differences between older and younger duodenal ulcer patients. Study Design: A Retrospective study. Place and duration: In the Surgical Unit 2 of, Sheikh Zayed Medical College/ Hospital Rahim Yar Khan for two-year duration from January 2020 to December 2021. Methods: This study included 140 patients were alienated into 2 age groups as geriatric patients’ group (A) and adult age group (B). Patient age, gender, co-morbidities, drug use, presence of Helicobacter pylori infection, medical conditions that may have been affected by perforation, such as characteristic pain (severe upper abdominal pain or vague abdominal pain), extent of symptoms at presentation, smoking, outcomes of late repair versus early repair was recorded. Results: 140 patients were registered in the analysis. Group I (n = 70) consisted of geriatric patients (age&gt; 65) and Group-II (n = 70) adults’ patients (age &lt;65). Both groups have male dominance in this study. In both groups, the most common comorbidities were diabetes (25.7% and 8.6%, respectively) and arterial hypertension (42.8% and 41.4%, respectively), hypertension (p = 0.002) and coronary artery disease (p = 0.035) was much high in group I, while morbidity and mortality were higher in the group of elderly patients. Conclusion: Duodenal perforation is a serious disease that requires urgent surgical intervention, especially in the geriatric age. Keywords: Duodenal ulcer perforation, acute abdomen, geriatric surgery.

Metabolite trajectories across the perinatal period and mental health: A preliminary study of tryptophan-related metabolites, bile acids and microbial composition

Depression and anxiety during pregnancy and postpartum are common, but affected women differ in timing, trajectories, and extent of symptoms. The objective of this pilot, feasibility study is to analyze trajectories of serotonin and tryptophan-related metabolites, bile acid metabolites, and microbial composition, in relation to psychiatric history and current symptoms across the perinatal period. Serum and fecal samples were collected from 30 women at three times points in the perinatal period and assayed with LC-MS/MS and 16S sequencing respectively. We defined mean trajectories for each metabolite, clustered individuals by metabolite trajectories, tested associations between metabolites, and examined metabolite levels in relation to microbial composition. Findings of note include: (1) changes in kynurenine and the ratio of kynurenic acid to kynurenine from second trimester to third trimester were strongly associated with baseline primary and secondary bile acids. (2) Secondary bile acid UDCA and its conjugated forms were associated with lower bacterial diversity and levels of Lachnospiraceae, a taxa known to produce Short Chain Fatty Acids. (3) History of anxiety was associated with UDCA levels, but history of major depression was not associated with any of the bile acids. (4) There was a trend towards lower dietary fiber for those with history of anxiety or depression. Overall, our results reveal substantial temporal variation in tryptophan-related metabolites and in bile acid metabolites over the perinatal period, with marked inter-individual variability. Trajectories of TRP -related metabolites, primary and secondary bile acids, and the absence or presence of microbes that produce Short Chain Fatty Acids (SCFAs) considered in concert have the potential to differentiate individuals based on perinatal adaptations that may impact mental and overall health.

Epidemiology of Chocolate Spot (Botrytis fabae sard.) and Faba Bean (Vicia faba l.) Resistance Potential for Disease Control in Ethiopia: A Review

Faba bean (Vicia faba L.) is an important pulse crop produced all over the world, however, its production is reducing especially due to chocolate spots (Botrytis fabae Sard.) which is a highly dominant and damaging disease in Ethiopia. The objective of this review is; to point out the opportunities and challenges of disease epidemics and the resistance potential of faba bean crops in Ethiopia. This disease, causing a yield reduction up to 34 to 67% varies on the tolerances and the susceptibility of the cultivar as well as environmental variables. Its occurrence differs among districts, years, growth stages, agronomic practices, and climatic conditions. Under favorable conditions, chocolate spot disease increases as the plant's growth stage and the quantity as well as the potential of inoculum transported to the crop canopy and the time of arrival of inoculum related to the stage of the crop development and weather condition. The main selection criterion and epidemiological components of resistance are infection efficiency, the extent of symptoms, and the latent period. Some efforts have been made to integrate host plant resistance, epidemiological knowledge, chemical and cultural practices to manage the disease.

Radiologic Efficacy and Patient Satisfaction after Minimally Invasive Unilateral Laminotomy and Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Analysis.

Lumbar spinal stenosis (LSS) is the most common spinal disease in older adults. Although surgical modalities are recommended in patients who are unresponsive to conservative treatment, the most appropriate minimally invasive surgical procedure for patients with LSS remains controversial. Moreover, few previous studies have focused on patient-centered outcomes with radiologic correlation. In the present study, we aimed to investigate radiologic efficacy and patient satisfaction following bilateral decompression via unilateral laminotomy. We performed a retrospective analysis of radiologic efficacy and patient satisfaction in a series of surgical patients treated at our institution. We classified patients into two groups based on the primary pathology (i.e., central or lateral recess stenosis). Medical records were analyzed retrospectively for radiologic outcomes and clinical parameters including pain and changes in quality of life. Data related to outcomes were collected at 2 weeks, 3 months, and 12 months after surgery in the outpatient clinic. Among the 122 patients enrolled in this study, 51 had central spinal stenosis; 71 had lateral recess stenosis. Radiologically, we observed significant improvements in the anteroposterior diameter and cross-sectional area of the dural sac (central stenosis) and the lateral width of the central canal and depth of the lateral recess (lateral recess stenosis). Two weeks and 12 months after the surgical procedure, we observed significant improvements in the extent of symptoms, patient satisfaction, and quality of life (including physical function). Our findings suggest that bilateral decompression via a unilateral approach shows improved radiologic outcomes, varying based on the type of stenosis. Furthermore, patient satisfaction significantly improved regardless of the type of disease.

Phenotyping of interstitial cystitis/bladder pain syndrome.

Interstitial cystitis/bladder pain syndrome is a chronic, potentially debilitating condition characterized by pain perceived to be related to the bladder in conjunction with lower urinary tract symptoms, and includes a wide variety of clinical phenotypes with diverse etiologies. Currently the only clinically relevant proven phenotype of interstitial cystitis/bladder pain syndrome is the Hunner lesion. Whether the presence of Hunner lesions is a hallmark of a distinct disease cohort or a potentially transient feature of non-Hunner lesion phenotype has been debated but remains controversial. There are few documented examples of a patient converting between the two forms. Growing clinical and basic evidence supports eliminating the Hunner lesion phenotype from the bladder pain syndrome umbrella and considering it a distinct disease. The Hunner lesion phenotype is characterized by distinct bladder histology, including subepithelial chronic inflammatory changes and epithelial denudation, and specific clinical characteristics (older onset age, severe bladder-centric symptoms, reduced bladder capacity, and favorable response to the lesion-targeted therapies). To define the Hunner lesion phenotype, it is necessary to develop an atlas of standardized images of cystoscopic (and, if possible, pathological) appearances of Hunner lesions. A true potential and clinically relevant phenotype of interstitial cystitis/bladder pain syndrome may be patients with non-bladder-centric symptoms, characterized by the affect dysregulation and somatic symptoms, and a greater bladder capacity in absence of Hunner lesions. In the present workshop, we concluded that the Hunner lesion is a valid phenotype and can reasonably be considered a disease in its own right. Assessment of bladder capacity and the extent of symptoms (bladder beyond or bladder centric) may help phenotyping of interstitial cystitis/bladder pain syndrome. Proper phenotyping is essential for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome, and for facilitating research.

Baseline Burden of Endometriosis-Associated Pain among Women in Two Phase 3 Elagolix Studies [10Q

INTRODUCTION: Few data exist on the extent of symptoms in women with endometriosis. This analysis examined baseline pain burden among women with moderate to severe endometriosis pain in two phase 3 studies of elagolix (an oral, non-peptide GnRH antagonist) for the management of endometriosis-associated pain. METHODS: Elaris EM-I and Elaris EM-II were two double-blind, randomized, 6-month, placebo-controlled phase 3 studies evaluating two elagolix doses (150 mg once daily and 200 mg twice daily) in women with endometriosis-associated pain. This analysis included randomized women pooled across studies and treatment groups. Dysmenorrhea (DYS) and non-menstrual pelvic pain (NMPP) scores were recorded in a daily electronic-diary and characterized as ‘none’, ‘mild’, ‘moderate’, and ‘severe’, with definitions that incorporated daily functioning. Days with DYS or NMPP and severity of pain are summarized. Baseline was defined as the average of the last 35 days during the screening period. RESULTS: At baseline, the mean [SD] number of days women reported DYS and NMPP was 8.0 [3.0] days (97.6% of menstruating days) and 20.5 days [5.4] (90.3% of non-menstruating days), respectively (N=1686 for the combined studies). Enrolled women reported moderate/severe DYS and NMPP most days during the baseline phase (mean [SD]: DYS, 80.5% [21.2] of menstruating days; NMPP, 57% [29.0] of non-menstruating days). CONCLUSION: On average in these two phase 3 studies, women with endometriosis-associated pain experienced DYS or NMPP &gt; 90% of days during the baseline phase and moderate/severe pain was reported for a majority of the days when pain was reported.

Development of three fusarium crown rot causal agents and systemic translocation of deoxynivalenol following stem base infection of soft wheat

Fusarium pseudograminearum, F. culmorum and F. graminearum are the most important fusarium crown rot (FCR) causal agents. They have the common ability to biosynthesize deoxynivalenol (DON). To elucidate the behaviour of each of the three species, a comparative study was carried out to investigate symptom progression, fungal systemic growth and translocation of DON following stem base inoculation of soft wheat. FCR symptoms were mainly localized in the inoculated area, which extended up to the second node for all inoculated species. Only the most aggressive strains caused symptoms up to the third node. Real‐time quantitative PCR showed that fungal colonization reached the third node for all the tested species, but a low percentage of plants showed colonization above the third node following inoculation with the most aggressive strains. Fungal growth was detected in symptomless tissues but none of the three species was able to colonize as far as the head tissues. However, even if the pathogens were not detected in the heads, DON was detected in head tissues of the plants inoculated with the most aggressive strains. These results demonstrate that F. pseudograminearum, F. culmorum and F. graminearum, under the same experimental conditions, follow a similar pattern of symptom progression, fungal colonization and DON translocation after stem base infection. Differences in the extent of symptoms, fungal colonization and mycotoxin distribution were mainly attributable to strain aggressiveness. These findings provide comparative information on the events following infection of the stem base of wheat by three of the most important FCR casual agents.

P3.01-016 Factors Associated with Symptoms Improvement and HRQoL for First-Line EGFR-TKIs in NSCLC: A Multicenter Prospective SMILE Study

First-line epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) offer an advantage compared to doublet chemotherapy in progression free survival, tolerability, and quality of life (QOL) in EGFR-mutated advanced non-small cell lung cancer (NSCLC) patients. In Taiwan, gefitinib, erlotinib and afatinib are all reimbursed as first-line therapy. It provides a rare opportunity to investigate factors associated with the extent of symptoms and QOL improvement in real-world patient population.

Pest categorisation of Little cherry pathogen (non-EU isolates).

The EFSA Panel on Plant Health performed a pest categorisation of non‐EU isolates of the Little cherry pathogen (LCP) for the European Union (EU) territory. LCP is now known to be in fact two distinct, well characterised viruses, Little cherry virus 1 (LChV1) and Little cherry virus 2 (LChV2) collectively referred to here as LChV. Efficient molecular detection assays are available for both viruses but not to discriminate EU and non‐EU isolates. LChV are transmitted by vegetative multiplication of infected hosts and, for LChV2, by mealybug vectors. LChV are reported from a range of countries, both outside and within the EU. Non‐EU isolates are not known to occur in the EU and therefore do not meet one of the criteria for being a Union regulated non‐quarantine pest. The host ranges of LChV are restricted to Prunus species, in particular cultivated and ornamental cherries. LChV non‐EU isolates are listed for some, but not all hosts, in Annex IIAI of Directive 2000/29/EC. LChV isolates are expected to be able to enter and establish in the EU. They have the potential to subsequently spread through plants for planting and, for LChV2, through the action of the Phenacoccus aceris vector, which is present in many EU MS. LChV are able to cause severe symptoms in some cherry varieties while others are less affected. Overall, non‐EU LChV isolates meet all the criteria evaluated by EFSA to qualify as Union quarantine pests. However, given the currently limited impact of EU LChV isolates, the impact of non‐EU isolates, if introduced, could be similarly limited. The main knowledge gaps and uncertainties concern (1) whether EU and non‐EU isolates of LChV might differ in their biology, epidemiology or symptomatology, (2) efficiency of natural spread by vectors under EU conditions and (3) extent of symptoms caused on many EU‐grown varieties.

Mood Disorders

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

Mood Disorders

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

Mood Disorders

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

Mental Health in Children from Families Seeking Asylum in Mecklenburg-Western Pomerania 2007-2009 - Personal and Contextual Risk Factors

Mental Health in Children from Families Seeking Asylum in Mecklenburg-Western Pomerania 2007-2009 - Personal and Contextual Risk Factors The study presented describes severity and conditions of various psychiatric symptoms in children from families seeking refuge in Germany 2007-2009 and registered in the province of Mecklenburg-Western Pomerania. Mothers of 58 children (aged 12 years on average, 23 girls, 33 boys) answered the items of the Child Behavior Checklist (Achenbach, 1991). First, the burden of disease among refugee children was compared to standard burdens of German children. Second, the extent of symptoms was predicted by person- and context-related factors. Internalizing symptoms were predicted by more proximal factors, such as parental burden of stress and parental education. Externalizing symptoms and social problems were rather predicted by the length of stay in Germany, the reason for migration, the school career and parental education. On one hand, the study underscores the immediate need for intervention among refugee parents and children. On the other hand, structural factors in the country of arrival (length of stay, schooling) play an important role.

Aerobic Physical Fitness and Recreational Sports Participation After Total Knee Arthroplasty.

Context:Total knee arthroplasty (TKA) is routinely performed in younger patients who desire to be active in fitness and recreational sports. The activities patients can participate in without symptoms and the level of aerobic fitness routinely maintained are important to investigate.Objective:To determine physical activity (PA) and recreational sports resumed after primary TKA, symptoms or limitations with these activities, and the effect of postoperative rehabilitation on achieving fitness and sports goals.Data Sources:A systematic review of the literature from 2005 through 2015 was conducted using the PubMed database.Study Selection:Original investigations that were conducted at least 1 year after primary TKA and reported the percentage of patients who returned to recreational activities or routinely participated in aerobic PA recommended by the American Heart Association (AHA) were included in this study.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Data were extracted as available from 19 eligible studies. Assessment of study quality was rated using the MINORS (Methodological Index for Non-Randomized Studies) instrument.Results:There were 5179 knees (mean age, 67.5 years) followed for a mean 4.8 years postoperatively. Marked variability was present between studies regarding the percentage of patients who resumed recreational activities (34%-100%), most of which were low impact. Only 2 studies used accelerometers to measure PA; these reported a low range (0%-16.5%) of patients who met AHA guidelines. Few studies determined whether symptoms or limitations were experienced during PA. None described rehabilitation exercises or factors that would influence patients’ ability to return to recreational or fitness activities.Conclusion:Little evidence is available regarding the effect of TKA on return to recreational and (objectively measured) aerobic fitness. The extent of symptoms or limitations during PA and the long-term effects of such problems remain unclear. Valid predictions cannot be made on factors that may affect return to recreational sports or other aerobic PA after TKA.

Characterising those with incident polymyalgia rheumatica in primary care: results from the PMR Cohort Study.

BackgroundThe aim was to characterise the sociodemographic, general health and polymyalgia rheumatica (PMR)-specific features of participants in a large inception cohort of patients with PMR diagnosed in UK primary care.MethodsPatients (n = 739) with a new diagnosis of PMR were referred into the study and mailed a questionnaire detailing their general health and sociodemographic characteristics in addition to the symptoms of and treatment for PMR. Characteristics of responders and non-responders were compared and descriptive statistics were used to characterise the health of the cohort.ResultsA total of 654 individuals responded to the questionnaire (adjusted response 90.1 %). Responders and non-responders were similar in age, gender and deprivation (based on postcode). The mean (standard deviation) age of the recruited cohort was 72.4 (9.3) years; 62.2 % were female. The sample reported high levels of pain and stiffness (8 out of 10 on numerical rating scales) and reported stiffness that lasted throughout the day. High levels of functional impairment, fatigue, insomnia and polypharmacy were also reported. Overall, women reported worse general and PMR-specific health than did men.ConclusionsThis first primary care cohort of patients with incident PMR is similar in demographic terms to cohorts recruited in secondary care. However, the extent of symptoms, particularly reported stiffness, is higher than has been described previously. Given the majority of patients with PMR are exclusively managed in primary care, this cohort provides important information on the course of PMR in the community that will help clinicians managing this painful and disabling condition.

Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson's Disease Cases

ABSTRACT Introduction Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both extent of symptoms and effect on quality of life. These should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately. Aim To develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients and to study its reliability and validity. Materials and methods We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India) and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending n in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders) (n = 63) attending the ear, nose, and throat (ENT); neurology; and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity. Results Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference, indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851). Conclusion The present questionnaire to assess dysphagia in PD patients has been found to be reliable and valid for use. We recommend it as a screening tool in the neurology outpatient department (OPD). How to cite this article Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(2):78-82.

Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases

ABSTRACT Background Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both the extent of symptoms and the effect on quality of life. Questionnaires should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately. Aims This study aims to develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients, and to study its reliability and validity. Materials and methods We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India), and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending neurologist in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders; n = 63), attending the ENT, neurology, and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity. Results Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851). Conclusion The present questionnaire to assess dysphagia in PD patients was found to be reliable and valid for use. We recommend it as a screening tool in the neurology OPD. How to cite this article Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(1):35-39.