Levels Of Symptoms Research Articles

Intense symptoms of pain are associated with poor sleep, fibromyalgia, depression and sleep apnea in patients with rheumatoid arthritis and psoriatic arthritis. A register-based study

ObjectivesTo study whether poor sleep and comorbidities are associated with high symptom levels of patient-reported outcomes (PROs) pain, patient global assessment and fatigue in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in a nation-wide cross-sectional setting. MethodsClinical data were extracted from The Finnish Rheumatology Quality Register between 1.2021 and 9.2022. Self-reported sleep was categorized as “good” (little/no difficulties) or “poor” (great difficulties/can’t) sleep. Data concerning comorbidities were collected from national registers. Descriptive statistics were used. Regression analyses were applied to analyze independent associations of sleep status, comorbidities and disease activity with pain in RA and PsA, adjusting for age and sex. ResultsAmong 13,512 patients with RA, 6052 [mean (SD) age 62 (13), 71% female] had sleep status reported; in PsA 1861/3636 [age 55 (13), 48% female]. In RA, 5072 (84%) reported good and 980 (16%) poor sleep; the corresponding numbers in PsA were 1460 (78%) and 401 (22%). Median values for objective disease activity were low and similar in patients with poor sleep and good sleep in both diseases. Among patients with no swollen joints, the median values for PROs were approximately three times higher for patients with poor sleep vs. good sleep in both diagnoses (P<0.001). In regression analyses, “poor” sleep was independently associated with higher symptoms in pain [B (95%CI) 20 (18,22) in RA and 23 (19, 26) in PsA], followed by comorbid fibromyalgia, as well as depression in RA and sleep apnea in PsA. Conclusion“Poor” sleep quality and comorbidities are independently associated with pain. Patient's sleep status is important to know especially in patients with severe symptoms without objective disease activity.

A network analysis of exhaustion disorder symptoms throughout treatment

BackgroundStress-induced Exhaustion Disorder (ED) is associated with work absenteeism and adverse health outcomes. Currently, little is known regarding how the symptoms of ED are interrelated and whether the patterns of symptoms influence treatment outcomes. To this end, the current study applied network analyses on ED patients participating in a multimodal intervention.MethodsThe first aim of the study was to explore the internal relationships between exhaustion symptoms and identify symptoms that were more closely related than others. A second aim was to examine whether the baseline symptom network of non-responders to treatment was more closely connected than the baseline symptom networks of responders, by comparing the sum of all absolute partial correlations in the respective groups’ symptom network. This comparison was made based on the hypothesis that a more closely connected symptom network before treatment could indicate poorer treatment outcomes. Network models were constructed based on self-rated ED symptoms in a large sample of patients (n = 915) participating in a 24-week multimodal treatment program with a 12-month follow-up.ResultsThe internal relations between self-rated exhaustion symptoms were stable over time despite markedly decreased symptom levels throughout participation in treatment. Symptoms of limited mental stamina and negative emotional reactions to demands were consistently found to be the most closely related to other ED symptoms. Meanwhile, sleep quality and irritability were weakly related to other exhaustion symptoms. The symptom network for the full sample became significantly more closely connected from baseline to the end of treatment and 12-month follow-up. The symptom network of non-responders to treatment was not found to be more closely connected than the symptom network of responders at baseline.ConclusionsThe results of the current study suggest symptoms of limited mental stamina and negative emotional reactions to demands are central ED symptoms throughout treatment, while symptoms of irritability and sleep quality seem to have a weak relation to other symptoms of ED. The implications of these findings are discussed in relation to the conceptualization, assessment, and treatment of ED.Trial registrationThe clinical trial was registered on Clinicaltrials.gov 2017-12-02 (Identifier: NCT03360136).

Trajectories of Gender Identity and Depressive Symptoms in Youths

Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health. To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms. This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023. Gender identity trajectories and gender identity variability. The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants' gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time. Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline (Β = 4.66; SE = 2.10; P = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account (Β = 3.31; SE = 2.36; P = .16). Gender identity variability was not associated with within-person change in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33). These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.

Lutetium [177Lu]-DOTA-TATE in gastroenteropancreatic-neuroendocrine tumours: rationale, design and baseline characteristics of the Italian prospective observational (REAL-LU) study.

Gastroenteropancreatic -neuroendocrine tumours (GEP-NETs) are commonly treated with surgical resection or long-term therapies for tumour growth control. Lutetium [177Lu]-DOTA-TATE was approved for the treatment of GEP-NETs after the phase III NETTER 1trial demonstrated improved progression free survival, objective response rates and health-related quality of life (HRQoL) compared to high-dose somatostatin analogues. No real-world data exist on prescribing habits and clinically significant endpoints for [177Lu]Lu-DOTA-TATE treatment in Italy. REAL-LU is a multicentre, long-term observational study in patients with unresectable/metastatic GEP-NETs progressing on standard therapies in Italian clinical practice. A pre-specified interim analysis was performed at the end of the enrolment period, data from which are described herein. Overall duration of REAL-LU will be approximately 48months, with 12- and 36-month recruitment and follow-up periods, respectively. The primary objective is to evaluate [177Lu]Lu-DOTA-TATE effectiveness in terms of progression-free survival. Secondary objectives include safety, impact on HRQoL, and identification of prognostic factors. This pre-specified interim analysis describes patient profiles, at the end of enrollment, of those prescribed [177Lu]Lu-DOTA-TATE for GEP-NETs in Italy. Among 161 evaluable patients, mean age was 64.7 ± 10.3years at study entry, 83.8% presented with no clinical signs of disease at physical examination, and most had minor disease symptoms. All patients had metastatic disease, most commonly in the liver (83.9%) with a median of two metastatic sites. In 90.7% of patients, the disease was stage IV, and 68.3% had ≥ 1 target lesion. [177Lu]Lu-DOTA-TATE was prescribed mainly as second-line therapy (61.6%) and following surgery (58.4%). HRQoL assessments revealed high levels of functioning and low levels of symptoms at baseline; 50.0% of patients were symptom-free at study entry. The characteristics of patients who received [177Lu]Lu-DOTA-TATE in Italy are similar to those of the GEP-NET population of NETTER 1 with trial but with a higher proportion of patients with a grade 2 (71%). With regard to the tumor grade profile, our study cohort appears to be closer to that of NETTER-2 study population which included patients with G2 or G3 advanced GEP-NETs (i.e. Ki-67 ≥ 10% and ≤ 55%). Further analysis of effectiveness and safety can be anticipated as REAL-LU data mature. ClinicalTrials.gov, NCT04727723; Study Registration Date: 25 January, 2021; https://clinicaltrials.gov/study/NCT04727723?cond=NCT04727723&rank=1.

Light spectrum affects growth, metabolite profile, and resistance against fungal phytopathogens of Solanum lycopersicum L. seedlings

Tomato is a widely cultivated and economically important crop worldwide. This study aimed to test the effect of light spectra used in indoor cultivation on the growth, biochemical profile, and resistance of Solanum lycopersicum ‘Bawole Serce’ seedlings against Alternaria alternata, Alternaria solani and Botrytis cinerea. During the phase of first leaf emergence, the seedlings were transferred to a semi-sterile growth room with a controlled environment (20°C, 18-h photoperiod, 50 μmol · m−2 · s−1 PPFD, 65% RH) for a 3-week cultivation period. Five light treatments differing in red/blue (R/B) light ratio were tested: I (LED tube; R/B 5.55), II (fluorescent tube; R/B 0.72), III (fluorescent tube; R/B 1.19), IV (LED panel; R/B 0.51), V (LED panel; R/B 0.20). The best parameters in terms of shoot length, shoot fresh and dry weights, and number of leaves were obtained in treatment I, in contrast to IV and V. Plants from treatments IV and V had the smallest leaf area, perimeter, vertical length, and horizontal width. As for the root system, the highest fresh weight, area, length of the longest root, total length, and the number of root tips and forks were found in treatments I and II. The least developed root systems were observed in IV and V. The greatest chlorophyll, carotenoids and anthocyanins accumulation was enhanced by treatment II. Treatments I−III stimulated the biosynthesis of phenolic compounds. The highest superoxide dismutase activity was detected in plants from treatments I and II. As for A. alternata and A. solani, the level of disease symptoms was significantly higher for treatments IV and V than for I-III. The highest/lowest level of B. cinerea infection was found in treatments II/I, respectively. The least susceptible to infection by all tested pathogens were leaves from treatment I. Light spectrum composition is of practical importance for tomato seedling production.

Longitudinal effects of sexual minority stigma on depressive symptoms among young men who have sex with men: Distinguish between and within person effects.

Young men who have sex with men (YMSM) may experience high levels of sexual minority stigma (SMS) and depressive symptoms (DS) over the world and in China. However, there is a lack of studies investigating the longitudinal effects of SMS on DS of YMSM, especially focusing on YMSM and separating the between-person and within-person effects. This study aimed to fill the said gaps. Study data were derived from a prospective cohort of 349 YMSM from central China (Wuhan, Changsha, Nanchang), the baseline survey was started in 2017 with one follow-up visit every year. SMS and DS were measured three times using valid and reliable instruments. The cross-lagged panel model (CLPM) and the random intercept CLPM (RI-CLPM) were used to examine the between-person and within-person concurrent and lagged effects, respectively. Findings of CLPM revealed bidirectional associations between SMS and DS over time. RI-CLPM suggested that at the between-person level, SMS was significantly associated with DS, echoing the results of CLPM. However, this reciprocal relationship has not been found at the within-person level. The associations between SMS and DS among YMSM at the population level is more significant than that at the individual level. We suggest that interventions should be against the adverse effects of cultural marginalization and systemic change the social concepts to reduce the amount of SMS in society.

Patterns of adverse childhood experiences and mental health symptoms among young adults

It is well known that adverse childhood experiences (ACEs) are linked with mental health problems. Identifying different patterns of exposure to adverse childhood experiences can provide information regarding what types of adversity may place individuals at most risk for poor mental health. The aims of our study were to identify underlying patterns of 10 types of ACEs in a sample of young adults (i.e., 18–21 years) and to examine relations between the ACEs classes and mental health symptoms (i.e., somatization, depression, anxiety, overall psychological stress). We found that a three-class model fit the data best: low ACEs, high emotional abuse only, and high multiple ACEs. We found significant differences across classes for all mental health symptoms. The high multiple ACEs class had significantly higher mean somatization, anxiety, and overall psychological stress scores than both the high emotional abuse only and low ACEs classes, and the high emotional abuse only class had higher mean anxiety and overall psychological stress scores in comparison to the low ACEs class. In contrast, our results suggest that the low ACEs and high emotional abuse only classes had higher mean levels of depression symptoms than the high multiple ACEs class. Our findings highlight the importance of examining the unique effects of different patterns of exposure to ACEs on mental health to inform prevention and intervention efforts that mitigate the harmful effects of ACEs on mental health.

Psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia

ABSTRACT Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels. Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe. Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated. Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831−.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%). Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.

Family Stress Processes Underlying COVID‐19–Related Economic Insecurity for Mothers and Fathers and Children's Internalizing Behaviour Problems

ABSTRACTCOVID‐19 and its economic fallout have resulted in unprecedented financial insecurity and material hardship for many American families, with a disproportionately negative impact on children and families from socioeconomically disadvantaged contexts. The current study applied the family stress model to examine the family processes underlying pandemic‐related economic insecurity and children's internalizing behaviours. Online survey data from an economically diverse sample of mothers and fathers, who experienced at least one type of pandemic‐related economic insecurity in the United States (N = 259), were collected across two longitudinal time points in the early weeks of COVID‐19: (1) 14 April and (2) 30 April of 2020. Parental depressive symptoms, negative partner relationship quality and harsh parenting were tested as mediators. Results from the path model showed that pandemic‐related economic insecurity was associated with higher levels of parental depressive symptoms, which were then associated with higher levels of negative partner relationship quality. Negative partner relationship quality was subsequently associated with more harsh parenting, which was then associated with increased child internalizing behaviours. Indirect effects were found for all hypothesized mediators. The family stress model can be applied and extended to the early COVID‐19 period. Child and family social work implications include targeting parents' mental health, relationship quality and parenting behaviours, as well as directly addressing financial and material hardship, to mitigate the adverse effects of pandemic‐related economic insecurity on children's mental health.

Validation of Patient-Reported Outcome Measurement Information System (PROMIS) for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma

OBJECTIVES: The efficiency and validity of PROMIS surveys were determined for pediatric orthopaedic trauma patients with posttraumatic stress disorder (PTSD) symptoms in a clinic setting. METHODS: Design: Prospective cohort study. Setting: Single-institution, Level I Trauma Center. Patient Selection Criteria: All consecutive children aged 8-18 years undergoing procedures or surgery for orthopaedic trauma. Outcome Measures and Comparisons: The convergent, divergent, and discriminant validity of the PROMIS Anger and Anxiety computerized adaptive tests (CATs) were evaluated and compared to the previously validated Child PTSD Symptom Scale (CPSS). The efficiency in time to completion of the outcome measures was compared between the CPSS and PROMIS surveys. Cutoffs for increased likelihood of PTSD were established for the PROMIS questionnaires. RESULTS: A total of 233 subjects were included in this study (mean age 13.1 years with SD 2.8 years, 71% male). The majority (51%) of injuries were sports-related and most (60%) involved the upper extremity. Of those included, 41 patients had high levels of PTSD symptoms on the CPSS (18%; 95% CI=13.1-23.2%). The CPSS took 182 (IQR 141-228) seconds versus 52 (IQR 36-84) and 52 (IQR 36-70) seconds for PROMIS Anger and Anxiety CATs, respectively. Convergent validity showed patient scores on both PROMIS instruments significantly correlated with CPSS scores (Anger: p&lt;0.001, r=0.51; Anxiety: p&lt;0.001, r=0.41). Neither PROMIS score correlated with UCLA Activity Score (Anger: r=-0.26; Anxiety: r=-0.22), a functional outcome measure, demonstrating divergent validity. Both PROMIS instruments sufficiently discriminated across PTSD risk groups (Anger p&lt;0.001; Anxiety p&lt;0.001). A score of at least 53 on PROMIS Anger or at least 48 on PROMIS Anxiety indicated an increased likelihood of PTSD risk. CONCLUSIONS: PROMIS Anger and Anxiety CATs are efficient and valid for evaluating posttraumatic stress in children following orthopaedic trauma procedures. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Healthcare worker burnout during a persistent crisis: a case-control study.

During the immediate outbreak of the COVID-19 pandemic, burnout symptoms increased among healthcare workers. Knowledge is needed on how early symptoms developed during the persistent crisis that followed the first pandemic wave. To investigate if high levels of burnout symptoms during the first pandemic wave led to high burnout and depressive symptoms up to a year later, and if participation in psychological support was related to lower levels of symptoms. A longitudinal case-control study followed 581 healthcare workers from two Swedish hospitals. Survey data were collected with a baseline in May 2020 and three follow-up assessments until September 2021. The case group was participants reporting high burnout symptoms at baseline. Logistic regression analyses were performed separately at three follow-ups with case-control group assignment as the main predictor and burnout and depression symptoms as outcomes, controlling for frontline work, changes in work tasks and psychological support participation. One out of five healthcare workers reported high burnout symptoms at baseline. The case group was more likely to have high burnout and depressive symptoms at all follow-ups. Participation in psychological support was unrelated to decreased burnout and depressive symptoms at any of the follow-ups. During a persistent crisis, healthcare organizations should be mindful of psychological reactions among staff and who they place in frontline work early in the crisis. To better prepare for future healthcare crises, preventive measures on burnout are needed, both at workplaces and as part of the curricula in medical and nursing education.

Sexual orientation concealment, hope, and depressive symptoms among gay and bisexual men: a moderated-moderation model

ABSTRACT The prevalence of depressive symptoms among gay and bisexual men is cause for concern. This study aimed to investigate whether hope and its two components (agency and pathways) moderated the relationship between sexual orientation concealment and depressive symptoms in gay and bisexual men and whether the moderating effects were conditional on sexual orientation. Participants were 197 gay men aged 18 to 71 years (M = 35.13 years, SD = 12.18 years) and 212 bisexual men aged 18 to 66 years (M = 29.24 years, SD = 10.46 years) who completed The Centre for Epidemiologic Studies Depression Scale, The Sexual Orientation Concealment Scale, and The Adult Hope Scale. Results did not support the moderating role of hope, agency, or pathways. The interaction between sexual orientation and pathways was significantly associated with depressive symptoms. Higher levels of pathways were associated with lower levels of depressive symptoms for both groups of men, however, the association was stronger for gay men compared with bisexual men. Higher levels of hope, agency, and pathways were associated with lower levels of depressive symptoms. Interventions aimed at increasing hope may be beneficial for reducing depressive symptoms among gay and bisexual men.

Brief online ACT intervention to improve adolescents’ well-being: Effectiveness among adolescents with depressive symptoms during COVID-19

BackgroundThe mental health and well-being of children and adolescents declined globally during the COVID-19 pandemic. Young people need support, yet relatively few receive psychological help, even among those who experience psychological symptoms. The existing options for support that focus on the traditional one-on-one treatment delivery approach require alternatives that can be widely disseminated. PurposeThe current study examined the effectiveness of a brief acceptance- and values-based online intervention for alleviating symptoms of stress, anxiety and depression and for improving psychological flexibility among adolescents who experience depressive symptoms. MethodsA total of 43 adolescents reporting elevated levels of depression symptoms who were selected from a total of 348 adolescents were randomized to receive a five-week intervention with support from a coach and/or virtual coach or to participate in the treatment-as-usual control condition. ResultsThe results suggest that the online intervention alleviated symptoms of depression and anxiety, while adolescents who received only the usual support from their schools reported increasing symptoms during the COVID-19 pandemic (Cohen’s d = 0.70 and d = 0.66, respectively). ConclusionsThe online intervention is a promising alternative to respond to the increased need for support among young people who experience ill-being. Technology-based approaches can increase the reach of evidence-based psychological support while also offering an acceptable and motivating approach to young people who may not actively seek traditional face-to-face treatment. The current results support the inclusion of online support in the services provided to young people facing mental health problems.

The comorbidity mechanism of problematic internet use and depression among Chinese college students: A cross-lagged panel network analysis

Problematic internet use (PIU) and depression usually co-occur and are common among college students. According to network theory, it may be attributed to the interplay of symptoms that connect these two mental health problems. However, most studies have failed to examine complex and subtle connections at the symptom level and have not clarified how PIU and depression symptoms are intercorrelated, which symptoms serve as the source of comorbidity (i.e., the central symptoms), and whether such a comorbidity mechanism would change with higher grades. To explore these questions, this study examined four contemporaneous networks and three cross-lagged panel networks, visualizing the symptoms as nodes and the connections between symptoms as edges. A total of 2,420 college students (Mage = 18.35, SD = 0.84; 67.98 % girls) completed four annual surveys. Overall, the results of contemporaneous networks and cross-lagged panel networks indicated that (a) PIU and depression symptoms are intercorrelated; (b) the core symptoms responsible for comorbidity mostly belonged to PIU, and (c) the comorbidity mechanism would change with time. These findings explain the dynamic relation between PIU and depression and identify possible primary symptoms that comorbidity programs can mitigate at different stages of the college years.

Further examination of the dual-factor model: characteristics of emerging adults with non-traditional mental health profiles

Traditionally, the mental health field has focused on psychological symptoms and distress, and health is considered the absence of illness. An alternative view suggests that optimal mental health must include the presence of positive characteristics in addition to the absence of illness. Accordingly, a dual-factor model of mental health includes measures of both psychopathology and positive subjective well-being to determine an individual’s mental health status. The current study investigated this dual-factor model by examining whether subjective well-being and psychopathology combine to produce distinct mental health profiles in emerging adults. A sample of 559 university students completed self-report surveys indicating their life satisfaction and internalizing and externalizing symptoms. Cluster analysis yielded four unique mental health groups. The well-adjusted cluster included individuals with high life satisfaction and low internalizing and externalizing symptoms. The dissatisfied cluster consisted of individuals with low externalizing, but also low life satisfaction and slightly above-average levels of internalizing. The externalizing cluster had high life satisfaction but also high externalizing psychopathology, and the troubled cluster exhibited low life satisfaction and high levels of both psychopathology symptoms. The clusters also differed in their personality traits, coping responses, and automatic thoughts, with the most favorable pattern across all three dimensions exhibited by the well-adjusted cluster. These findings highlight the importance of considering positive indicators of mental health in addition to measures of psychopathology and support the use of an empirical classification procedure in determining the mental health status of emerging adults.

Characterization of CKD illness representation profiles using patient-level factors.

Illness perceptions are the unique perspective individuals have on their illness, based on their context and experiences, and are associated with patient outcomes including coping and adherence. The purpose of this study was to explore characteristics that may be driving membership in illness perceptions cluster groups for adults with chronic kidney disease (CKD). This study was conducted within the multicenter longitudinal Chronic Renal Insufficiency Cohort (CRIC) Study. Cross-sectional data were collected and combined with CRIC data. Illness perceptions were measured using the Revised Illness Perception Questionnaire. Clustering analysis was conducted in R, and bivariate analysis including linear regression was performed in STATA 16. The sample (n = 197) had a mean age of 68, was 52% women, 53% non-White, and mean estimated glomerular filtration rate (eGFR) 56 ml/min/1.73 m2. Three cluster groups were identified, labeled as "Disengaged" (n = 20), "Well-Resourced" (n = 108), and "Distressed" (n = 69). The "Disengaged" group was characterized by low CKD knowledge, many recent hospitalization days, and the lowest perceived CKD burden. The "Well-Resourced" group was characterized by the highest levels of education, CKD knowledge, optimism, and medication adherence. The "Distressed" group was characterized by the highest levels of depression scores, comorbidity burden, CKD burden, CKD symptoms, and lowest optimism. Group membership significantly predicted the number of hospitalization days in adjusted analyses. Illness perceptions groups are associated with number of hospitalization days but are independent of many patient characteristics. Illness perceptions data could be used to tailor care for specific patients at risk for poor health outcomes.

The vestibular symptomatology of Machado-Joseph Disease.

Machado Joseph Disease (MJD) is an autosomal dominant neurodegenerative disease. In previous studies, we described significant bilateral horizontal Vestibulo-Ocular Reflex (VOR) deficit within this population without any reference to the presence of vestibular symptomatology. To evaluate whether, beyond cerebellar ataxia complaints, MJD patients have typical vestibular symptomatology corresponding to the accepted diagnostic criteria of Bilateral Vestibulopathy (BVP) according to the definition of the International Barany Society of Neuro-Otology. Twenty-one MJD, 12 clinically stable chronic Unilateral Vestibulopathy (UVP), 15 clinically stable chronic BVP, and 22 healthy Controls underwent the video Head Impulse Test (vHIT) evaluating VOR gain and filled out the following questionnaires related to vestibular symptomatology: The Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence Scale (ABC), the Vertigo Visual Scale (VVS) and the Beck Anxiety Inventory (BAI). The MJD group demonstrated significant bilateral vestibular impairment with horizontal gain less than 0.6 in 71% of patients (0.54±0.17). Similar to UVP and BVP, MJD patients reported a significantly higher level of symptoms than Controls in the DHI, ABC, VVS, and BAI questionnaires. MJD demonstrated significant VOR impairment and clinical symptoms typical of BVP. We suggest that in a future version of the International Classification of Vestibular Disorders (ICVD), MJD should be categorized under a separate section of central vestibulopathy with the heading of bilateral vestibulopathy. The present findings are of importance regarding the clinical diagnosis process and possible treatment based on vestibular rehabilitation.

Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study.

Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants' digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants' severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. This study is a step toward more frequent assessment of older adults' behavioral symptoms and holistic in situ monitoring of older adults' behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms.

Understanding Australia’s teacher shortage: the importance of psychosocial working conditions to turnover intentions

AbstractAustralian policymakers are currently attempting to address an ‘unprecedented teacher shortage’. Through a survey of 905 teachers in Australian government schools, this paper examines some of the key factors influencing the career intentions of teachers in Australian government schools. Drawing upon the concept of the psychosocial work environment from the field of occupational health, this analysis examines the relationship between key workplace demands, workplace resources, teachers’ experiences and attitudes towards work, teachers’ mental health outcomes, and their intentions to either remain in or leave their roles. The results reveal significant relationships between teachers’ intentions to leave their roles and challenging working conditions, adverse work experiences, as well as heightened levels of stress, burnout, and depressive symptoms. In contrast, remaining in their role was associated with factors indicative of a supportive psychosocial work environment, such as job recognition, trust in management, organisational justice, positive work experiences, and lower levels of mental health difficulties. The study underscores the urgent need to understand and assess the psychosocial work environments of teachers, and for multi-level strategies that address both protective and risk factors.

Residential Move During COVID-19 Pandemic and Psychological Health Among College Students: The Role of Perceived Social Support

Research has widely documented the high stress levels posed to college students by the Coronavirus Disease 2019 (COVID-19). However, the role of social support in mitigating the mental health impacts of stressors like residential instability among college students is less well-researched. Using data from a multi-campus online survey of college students’ experiences during the COVID-19 pandemic (n = 2,486), this study examines the role of social support in the association between residential move during COVID-19 pandemic and college students’ reports of depressive symptoms and anxiety. We tested whether perceived social support was more significantly related to depressive symptoms among students who moved in response to COVID-19. The results show significantly higher levels of depressive symptoms and higher prevalence rates of severe anxiety among college students with COVID-19-related move relative to those who did not move during the pandemic. Irrespective of their residential status, college students who received less support than needed during the pandemic had significantly higher levels of depressive symptoms and higher odds of severe anxiety. The findings add to the existing studies showing how the COVID-19 pandemic compounds the problems of depression and anxiety among college students, particularly those experiencing residential instability and with limited social support.