Negative Illness Research Articles

Putative risk and resiliency factors after an augmented training program for preventing posttraumatic stress injuries among public safety personnel from diverse sectors

ABSTRACT Mental health disorders are particularly prevalent among public safety personnel (PSP). Emotional Resilience Skills Training (ERST) is a cognitive behavioural training program for PSP based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (i.e. Unified Protocol). The current study was designed to assess whether ERST is associated with reduced putative risk factors for mental disorders and increased individual resilience. The PSP-PTSI Study used a longitudinal prospective sequential experimental cohort design that engaged each participant for approximately 16 months. PSP from diverse sectors (i.e. firefighters, municipal police, paramedics, public safety communicators) completed self-report measures of several putative risk variables (i.e. anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, state anger) and resilience at three time points: pre-training (n = 191), post-training (n = 103), and 1-year follow-up (n = 41). Participant scores were statistically compared across time points. Participants reported statistically significantly lower scores on all putative risk variables except pain anxiety, and statistically significantly higher resilience from pre- to post-training. Changes were sustained at 1-year follow-up. The results indicate that ERST is associated with reductions in several putative risk variables and improvement in resilience among PSP.

Factors Associated With Health-Promoting Behaviors Among South Korean Adults: A Cross-Sectional Study.

To examine the association between positive psychological capital, social support, illness attitudes toward COVID-19, and health-promoting behaviors in Korean adults. An online cross-sectional study. The participants were 820 South Korean adults aged 19-64, recruited through quota sampling. The sample was census-matched in terms of age and gender based on the Korean Population Census. The participants completed measures assessing psychological capital, social support, illness attitude toward COVID-19, and health-promoting behaviors. The t-test, one-way analysis of variance, Pearson's correlation, and multiple stepwise regression analysis were used to analyze the data. Participants who were religious, perceived themselves as physically healthy, had negative illness attitudes, had high positive psychological capital, and received high social support were more likely to engage in health-promoting behaviors. These variables explained 44.5% of the participants' health-promoting behaviors. This study is the first to examine illness attitudes toward COVID-19 and health-promoting behaviors among South Korean adults during the COVID-19 pandemic. The results can pave the way for effective public health intervention strategies that consider religiosity, physical health status, illness attitude, and social support, to promote healthy living during future public health crises.

Alexithymia and illness perceptions in persons with multiple sclerosis and their partners

Illness perceptions (IPs) encompass opinions regarding the nature, severity and curability of a disease. The aim of this cross-sectional study was to investigate the association between alexithymia and IPs among persons with multiple sclerosis (PwMS) and their partners, as well as within the dyads composed of PwMS and partners. PwMS referred to the Multiple Sclerosis Center of the University Hospital “Policlinico-San Marco” from 11th August 2021 to 7th January 2022 and their partners completed a battery of questionnaires, including the Toronto Alexithymia Scale-20 and the Illness Perception Questionnaire Revised. A dyadic data analysis (Actor-Partner Interdependence Model) was performed to test the effect of alexithymic traits both on a person’s own illness perceptions (actor effect) and on the partner’s illness perceptions (partner effect). 100 PwMS (71 women; mean age 47.6 ± 10.4 years) and 100 partners (29 women; mean age 49.1 ± 10.8 years), with a mean partnership duration of 20.1 ± 11.7 years, were enrolled. At the dyadic analysis, statistically significant small-to-moderate actor and partner effects were found considering alexithymia (total score and alexithymic facets) and IPs, whereby higher alexithymic traits related to higher negative perceptions (i.e. consequences, emotional representations) and lower positive ones (i.e. coherence, treatment control). Our findings support the relationship between alexithymia and negative illness appraisals. This data may inform therapeutic interventions aimed at reducing alexithymic traits, which in turn may reduce negative, and potentially dysfunctional, illness perceptions.

Pain in Biologic-Treated Rheumatoid Arthritis Patients: The Role of Illness Perception Before and After the COVID-19 Pandemic.

We aimed to assess the role of the COVID-19 pandemic in the association of clinical, physical, and psychological factors with pain in Rheumatoid Arthritis (RA) patients. We included 103 RA patients (81.6% females; mean age 56.1±13.8years). Patients filled out the VAS-pain, GAD-7, PHQ-9, MFI-20, and B-IPQ. Paired sample t-tests, correlations, and multiple regression analyses were used to analyse the data. Our results showed significantly worsened pain in the data collected post-pandemic (p≤0.05). Pre-pandemic, the final regression models showed an association between functional disability (β=0.24; p≤0.05), illness perception (β=0.34; p≤0.05) and pain. In post-pandemic models, significant associations were found between fatigue (β=0.33; p≤0.01) and illness perception (β=0.36; p≤0.01) with pain. Positive illness perception was able to alleviate the associations between fatigue and depression with pain before and after the pandemic. Findings indicate that patients with RA may have been negatively affected by the COVID-19 pandemic given their vulnerability. Even though pharmacological treatment was not interrupted, post-pandemic results showed significantly higher levels of experienced pain. Therefore, in addition to biological therapy, non-pharmacological interventions, including psychological support aimed at diminishing negative illness perception, may be beneficial in reducing RA-related pain, especially when dealing with a crisis.

Correlation between illness perceptions and self-reported degree-of-worry in somatic ill patients in emergency care: a Danish cross-sectional study.

The study aimed to investigate the correlation between illness perceptions and self-reported degree-of-worry (DOW) in patients presenting to the emergency department with acute somatic illness. A cross-sectional survey study collected data from a survey on DOW, the Brief-illness Perception Questionnaire (B-IPQ) and demographics. An emergency department at a university hospital in the Capital Region of Denmark. 944 patients (≥18 years) presenting to the emergency department with acute somatic illness. Data collection was conducted during day and evening shifts on weekdays from 13 January to 19 December 2020. Correlations between B-IPQ scores and DOW, including (1) the total B-IPQ score, (2) emotional representations (emotion and illness concern combined) and (3) the single items, respectively. Secondary analysis: linear relationships between the single B-IPQ items and DOW. Analyses included the variables sex, age, reason for contact, self-reported comorbidity, employment, highest educational attainment, cohabitation status and region of origin. The study found moderate correlations between the total illness perceptions score and DOW of 0.47 (95% CI 0.42 to 0.52) and emotional representations and DOW of 0.57 (95% CI 0.52 to 0.61). Linear regression showed the largest and most significant changes in DOW with an increasing score of the B-IPQ items for consequence, illness concern and emotion. Illness perceptions overall and perceptions of consequences of symptoms, illness concern and emotional representations are correlated with patients' DOW, with increasing DOW related to more negative illness perceptions. This finding contributes to insight into how illness perceptions are related to illness worry when presenting to the emergency department. Incorporating the novel DOW scale may aid triage and clinical encounters in the emergency department. ClinicalTrails.gov reference: NCT04226040.

S1250 Negative Illness Perceptions Are Associated With Clinical Disease Activity in Adult Patients With Inflammatory Bowel Disease

S1250 Negative Illness Perceptions Are Associated With Clinical Disease Activity in Adult Patients With Inflammatory Bowel Disease

Association between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery.

A combination of social inhibition and negative affectivity characterizes Type D personality. Type D, or distressed personality, is an established risk factor for the development and prognosis of coronary heart disease. It occurs in approximately 1 in 4 patients with coronary heart disease. This study aimed to investigate the relationship between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery. This retrospective and cross-sectional study was conducted in a university hospital psychiatry and cardiovascular surgery clinics between February 2022 and April 2022. Seventy-one volunteered patients over the age of 18 who underwent open-heart surgery in the cardiovascular surgery clinic were included in the study. Cardiovascular surgeons recorded the sociodemographic and clinical data of the patients and referred them to the psychiatry clinic for further evaluation. Subsequently, patients underwent psychiatric evaluation and were assessed using the Type D Personality Scale, Coping Attitudes Assessment Scale, Hospital Anxiety and Depression Scale, and Illness Perception Questionnaire. According to this study, individuals with Type D personality tended to have higher scores on the Hospital Anxiety and Depression Scale. Analysis of the subdimensions of the Stress Coping Styles Scale revealed that individuals with Type D personalities showed a significantly lower optimistic approach and a considerably higher helpless approach. In terms of the subdimensions of the Illness Perception Questionnaire, it was found that individuals with Type D personality had a statistically lower treatment control approach and a statistically higher emotional representations approach. Identifying Type D personality traits in patients undergoing open-heart surgery can help manage negative illness perceptions through effective coping mechanisms.

Impact of perception of illness on quality of life in juvenile systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs, notably the skin, joints, and kidneys. The primary goal in managing SLE is to enhance patients' quality of life (QoL). Illness perception can influence QoL in patients with chronic disease. We assessed illness perception in juvenile SLE (jSLE) patients and its effect on patient's and parental QoL. Patients diagnosed with jSLE according to the SLICC 2012 criteria between January and November 2023 were included. Patients' illness perceptions were gaged using the brief illness perception questionnaire (B-IPQ), while patient's and parental QoL were evaluated using PedsQL and WHOQOL- BREF, respectively. The study comprised 32 patients and 32 parents, predominantly female (78.1%). Musculoskeletal involvement was the most common (65.6%), followed by mucocutaneous (59.4%), renal, and hematological involvement (50% each). Neuropsychiatric involvement was absent. The median SLEDAI-2K score at the last outpatient clinic visit, which was documented in the patient's file was 2 (0-18) and was not correlated with the B-IPQ score (r = 0.121, p = .51). A significant negative correlation was found between B-IPQ and patient QoL, indicating poorer QoL in patients with negative illness perceptions (r = -0.576, p < .001). No correlation was observed between parental QoL and B-IPQ (p => .05). Of note, 56.3% of patients had poor QoL, scoring below the PedsQL cut-off, while 43.8% of parents had poor QoL for general health, scoring below the WHOQOL-BREF cut-off for general health. Although disease perception did not correlate with disease activation in jSLE, it significantly impacted patient QoL. Enhancing patients' perceptions of jSLE may improve their overall QoL.

Interpersonal Processes in the Duration of Sick Leave of Workers with Chronic Diseases: A Dyadic Analysis.

Although there is increasing awareness that significant others' perceptions and behavior can affect health outcomes, the role of interpersonal processes between sick-listed workers and significant others in sick leave and return to work (RTW) has hardly been studied. This study aims to examine the associations between illness perceptions, RTW expectations, and behaviors of significant others (engagement, buffering and overprotection) with sick leave duration within dyads of sick-listed workers with chronic diseases and their significant others. We used survey data linked with sick leave registry data of 90 dyads. Pearson correlations were used to study the interdependence within dyads. Multiple linear regression analyses were conducted to examine associations between survey data of both dyad members and sick leave duration. We found moderate to strong correlations between workers and significant others, indicating interdependence within dyads regarding illness perceptions, RTW expectations and perceived significant other behaviors. Dyad members' illness perceptions (R2 = .204, p = .001) and RTW expectations (R2 = .326, p = < .001) were associated with sick leave duration, explaining respectively 12.3% and 24.5% of the variance. We found no associations between sick leave duration and active engagement, protective buffering and overprotection. This study indicates that negative illness perceptions and RTW expectations of both workers and their significant others are associated with a longer sick leave duration. Considering the interdependence within dyads, involving significant others when intervening on maladaptive illness perceptions and RTW expectations may be more effective than solely focusing on the worker's perceptions and expectations.

The Frequency and Impact of Adverse Childhood Experiences on Mood, Alcohol Relapse, and Outcomes in Liver Transplantation: A Retrospective Cohort Study

IntroductionAdverse Childhood Experiences (ACE) are associated with the development of negative health behaviors and medical illness. ACE’s association with poor health outcomes has been well documented in the general population; however, this relationship remains less clear in liver transplant (LT) recipients. The aims of this study therefore were to determine the prevalence of ACE and the influence of ACE on LT outcomes. MethodsA retrospective electronic medical record review of all LT recipients over 11 years at an academic liver transplant center. Demographic, diagnostic, and disease characteristics were extracted and compared for a history of ACE. Associations between a history of ACE and extracted variables were statistically tested using Student’s t-test and Chi-square tests or Fisher’s Exact Test where appropriate. Graft and patient survival were tested using log-rank tests. ResultsOf 1,172 LT recipients, 24.1% endorsed a history of ACE. Females (p = 0.017) and recipients with lower level of education (p < 0.001) had a higher frequency of ACE. Those with a history of ACE had a higher prevalence of HCV (p < 0.001) and higher pre-transplant BMI (P<0.001). Recipients with a history of ACE had higher prevalence of mood (p < 0.001), anxiety (p < 0.001), PTSD (p < 0.001), alcohol use (p < 0.001), and cannabis use (p < 0.001) disorders as well has higher PHQ-9 (p < 0.001) and GAD-7 (p < 0.001) scores pre and post-transplant. Those with ACE had higher incidence of recorded relapse to alcohol by 3 years post-transplant (p = 0.027). Mean lab values, graft survival, and patient survival were not significantly different between those with and without a history of ACE except for total bilirubin at 6 months (p = 0.021). ConclusionOne quarter of LT recipients have experienced ACE. ACE was associated with a history of a psychiatric diagnoses, substance use disorders, elevated PHQ-9 and GAD-7 scores, and a higher prevalence of relapse to alcohol use after transplant. This population may benefit from increased/improved access to appropriate mental health and substance use services and support in the peri and post transplant period.

Factors associated with having previously received a diagnosis of fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome: A cross sectional DanFunD study

ObjectivesFibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome are highly prevalent conditions and part of the functional somatic syndromes (FSS) diagnosis, that are classified under the unifying umbrella term functional somatic disorder (FSD). Multiple factors are associated with FSD symptom development; However, few studies have explored these associations in relation to the diagnosis status. This study aims to examine associations with a previously received FSS diagnosis from a physician in participants fulfilling the FSD diagnostic criteria in a population-based sample. MethodsThis research employs a comprehensive observational approach using a cross sectional design with data from the DanFunD part two cohort. Information about received FSS diagnoses was obtained from self-reported questionnaires. Participants fulfilling the FSD diagnostic criteria were identified with both self-reported questionnaires and diagnostic interviews. Validated questionnaires were used to assess the examined factors. Results1704 cases fulfilled the diagnostic criteria for an FSD according to questionnaires or interviews in the DanFunD study. In participants fulfilling the diagnostic criteria, having previously received an FSS diagnosis by a physician was strongly associated with female sex, negative illness perceptions and poor health-related quality of life for questionnaire and interview-based diagnoses. Less consistent associations were observed for lower socioeconomic status, anxiety, and adverse life events. ConclusionPreviously received FSS diagnoses showed associations with multiple factors with a particular strong association with female sex and poor health related quality of life.

The Mediating and Moderating Role of Resilience Between Stigma and Illness Identity Among People with Inflammatory Bowel Disease.

Stigma is assumed to lead to negative illness identity in one who got chronic illness, and there is a lack of understanding regarding the underly mechanisms. However, no research has examined the extent to which stigma was associated with illness identity in people with IBD. Therefore, we investigated the relationship between stigma and illness identity, specifically to examine whether resilience mediated or moderated the relationship. A cross-sectional study was performed among patients diagnosed with inflammatory bowel disease from three tertiary hospitals in Jiangsu Province, China. Measurement instruments included the Stigma Scale for Chronic Illness (SSCI), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Illness Identity questionnaire (IIQ). Mediation and moderated mediation analyses were conducted. A total of 322 patients with IBD were involved in the current study. We observed that there was a strong connection between stigma and rejection and engulfment. Moreover, resilience played a partial or complete mediating role in stigma and engulfment, acceptance and enrichment, and resilience moderates the relationship between stigma and rejection. The current study examined whether resilience mediated or moderated the relationship between stigma and illness identity. These finding add to the theoretical basis of how stigma influences illness identity and help guide the resilience into engulfment reduction programs for IBD.

Coping Mechanisms and Illness Perception Associated with Health-Related Quality of Life of Prostate Cancer Patients in Ogun State

Background: The second most common malignancy in men globally is prostate cancer. Moreover, one of the regions with the highest estimated death rates from prostate cancer is sub-Saharan Africa. Similarly, the leading cause of cancer-related mortality among Nigerian men is prostate cancer. However, negative illness perceptions, including worry about the disease and the severity of symptoms, have been linked to poorer prognosis among cancer patients. Generally, cancer patients adopt various coping mechanisms to deal with these stressors. Meanwhile, little is known about the health-related quality of life of prostate cancer patients in this region, regarding their coping mechanisms and illness perception. Therefore, this study examined, coping mechanisms and illness perceptions associated with health-related quality of life among prostate cancer patients in Ogun State, Nigeria. Methods: This cross-sectional study employed the Purposive sampling technique. Correlation analysis was used to determine the association between coping mechanisms, illness perception, and the health-related quality of life of participants. Results: The association between illness perception and health-related quality of life was positively correlated and statistically significant (r=.547, p=.000). However, in the association between coping mechanism and health-related quality of life; problem-focused coping and health-related quality of life were found to be positively correlated and statistically significant (r=.228, p=.000); emotion-focused coping and health-related quality of life were found to be positively correlated and statistically significant (r=.388, p=.000); while avoidant coping and health-related quality of life were found to be negatively correlated (r= -0.192, p=.000). Conclusion: This study found that a higher illness perception score correlated with a higher health-related quality of life score. Also, a higher problem-focused and emotion-focused coping mechanism score correlated with a higher health-related quality of life score. While a higher avoidant coping score inversely correlated to a lower health-related quality of life score.

Association between illness perception and social alienation among maintenance hemodialysis patients: The mediating role of fear of progression.

This study aimed to investigate the mediating role of fear of progression on illness perception and social alienation among maintenance hemodialysis (MHD) patients. MHD is frequently accompanied by increased pain and complications such as itchy skin, chronic fatigue, and muscle spasms. Cardiovascular disease rates are also elevated among MHD patients, which can heighten their anxiety regarding prognosis and treatment discomfort. This chronic fear may severely impact social functioning, leading patients to withdraw from interpersonal interactions and experience heightened helplessness and loneliness. Further investigation is necessary to understand the factors behind the high level of social alienation in MHD patients and their underlying mechanisms. A cross-sectional study guided by the STROBE. A convenience sample of 230 MHD patients were enrolled from January to May 2023. Data including demographic and clinical characteristics, illness perception, fear of progression, and social alienation were collected. Descriptive analysis and Pearson correlations were conducted using IBM SPSS version 25.0. The mediating effect was analyzed using Model 4 of the PROCESS macro for SPSS, with the Bootstrap method employed to assess its significance. The score of social alienation in MHD patients was high, with illness perception and fear of progression both significantly correlated with social alienation. In the mediating effects model, illness perception can predict social alienation in MHD patients, and fear of progression use plays a part in mediating the process by which illness perception affects social alienation. The Kappa Squared (κ2) value of 21.9%, suggests a medium effect size. Illness perception directly predicts social alienation in MHD patients and exerts an indirect effect through the mediating role of fear of progression. Suggests that healthcare professionals should concentrate on MHD patients with high negative illness perceptions to alleviate their fear of progression, thereby decreasing the level of social alienation and enhancing their integration into society.

Social participation of rheumatoid arthritis patients: Does illness perception play a role?

Social participation is an important aspect associated with health-related outcomes in chronic diseases. However, little is known about the factors that may affect participation in patients with rheumatoid arthritis (RA). We aimed to examine whether pain, fatigue, anxiety, depression, and illness perception are associated with social participation in patients with RA when controlled for clinical and sociodemographic variables. We also analysed the mediating role of illness perception in the association between physical and psychological variables on social participation. We included 157 RA patients (84.7% females; mean age 56.4 ± 13.9 years) who completed the Participation Scale, Brief Illness Perception Questionaire, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, 36-item Short Form Health Survey, and the Visual Analogue Scale. Multiple linear regressions and mediation analyses were used to analyze the data. In the final regression models, illness perception (β = .42; p ≤ .001) and functional disability (β = .21; p ≤ .05) were associated with social participation. Income (β = -.18; p ≤ .05) lost its significance when physical variables were added to the model, and pain (β = .24; p ≤ .05) and fatigue (β = -.24; p ≤ .05) when psychological distress was added. No significant role of anxiety, depression, disease activity, or age was identified using regression analyses. Illness perception mediated the association of pain, fatigue, anxiety, and depression with social participation, and the indirect effect varied from 65% to 98%. Illness perceptions may significantly diminish the impacts of pain, fatigue, anxiety, and depression on social participation in individual RA patients. Therefore, RA patients could benefit from psychological interventions aimed at tackling negative illness perceptions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predicting symptom response and quality of life to the low FODMAP diet in irritable bowel syndrome: a 6-month longitudinal study

The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet is recommended as a first line therapeutic management strategy for irritable bowel syndrome (IBS)(1). The low FODMAP diet is supported by meta-analytical evidence(2), and demonstrates acceptability and effectiveness for improving symptoms and quality of life (QoL) in 50-75% of individuals with IBS. However, a subset of individuals (25-50%) do not respond to the diet(3). The identification of individual-level predictors of treatment response across all three phases of the low FODMAP diet is currently lacking. The study aims were to assess psychological predictors of symptom and QoL response to the low FODMAP diet in patients with IBS. Adults with IBS underwent a three-phase low FODMAP diet, guided by individualised dietetic education. Predictor variables included levels of depressive, anxiety, and extraintestinal somatic symptoms, stress, treatment beliefs and expectations, behavioural avoidance, and illness perceptions. Symptom severity and QoL were the main outcomes. Questionnaires assessing psychological predictors, symptoms and QoL were administered at five points: pre-dietitian (week 0), post-dietitian, end of elimination (week 5), end of reintroduction (week 13), and end of personalisation (week 25) phases. Latent class growth analysis was used to identify classes of response trajectories for symptoms. Linear mixed models were used to test the effect of baseline psychological scores on symptoms and QoL over time. Cross lagged panel models determined the directional predictive relationship between psychological predictors and symptom severity. 112 participants (89% F) median age 30 ± 17 years were included. There were three classes of symptom response trajectories, including ‘non-improvers’ (21.3% of participants) with high initial symptom severity and minimal improvement, ‘improvers’ (22.5% of participants) with low initial symptom severity and significant improvement, and an ‘intermediate’ group (56.2% of participants) with moderate initial symptom severity and significant improvement. Higher treatment beliefs predicted a stronger initial symptom response (effect on linear slope p = 0.036). Lower gut-specific anxiety, as well as higher levels of personal and treatment control at baseline predicted a stronger reduction in IBS symptom severity and improved QoL from week 0 to week 25. Participants with higher levels of baseline psychological symptoms and negative illness perceptions (i.e., lower emotional representations) predicted a stronger initial and later QoL response (effect on linear (p = 0.006) and quadratic (p = 0.049) slopes). Increased cyclical time beliefs predicted poorer initial and later QoL response (effect on linear (p = 0.015) and quadratic (p = 0.029) slopes). Individuals experiencing lower to mid-range symptom severity at baseline had greater improvement with the low FODMAP diet. Lower anxiety, positive illness views and higher treatment beliefs predict better QoL and symptom response. Personalised strategies are crucial for optimising low FODMAP diet effectiveness in IBS.

The Effect of the Symptom Level on the Illness Perception in Individuals Undergoing Hemodialysis

Purpose: This research was conducted to identify the effect of the symptom level on the illness perception in individuals undergoing hemodialysis. Material and Methods: The study was performed with 240 participants who had the hemodialysis procedure in dialysis units of hospitals and one private dialysis center in a province and satisfied the criteria to be included in the research. Results: In the study, it was found that nearly all patients experienced symptoms such as itching, numbness/tingling in the feet, feeling tired and dry skin. In the sample group that had a negative illness perception, it was found that the symptoms experienced alongside the hemodialysis procedure affected the illness perception, and there was a moderately positive relationship between these two variables. Conclusions: In this context, it was recommended that the frequency and the severity of symptoms of patients undergoing hemodialysis be regularly followed and these patients’ illness perception levels be evaluated. Key words: Illness perception, hemodialysis, symptom

Anxiety in Polish adult patients with inborn errors of immunity: a cross-sectional study.

Patients with inborn errors of immunity (IEI) experience recurrent infections, autoimmunity, and malignancies. Owing to repeated medical procedures, the need for constant treatment and surveillance, and the unpredictable course of the disease, patients with IEI are prone to develop mental health disorders, including anxiety. In this study, we aimed to assess the prevalence and level of anxiety symptoms in adult Polish patients with IEI and explore the determinants of anxiety in this group of patients. Data from 105 Polish patients with IEI were collected via the hospital anxiety and depression scale (HADS), brief illness perception questionnaire (B-IPQ), illness cognition questionnaire (ICQ), Pittsburgh sleep quality index (PSQI), and a questionnaire on general health and demographic data. For statistical analyses of data, the normality of distribution of quantitative data was assessed, and internal consistency of tests was investigated using Cronbach's alpha coefficient; moreover, we performed the analysis of correlations and between-group differences, and path analysis to explore causal relationships. Significance was considered at p < 0.050. Thirty-eight (36.2%) patients had anxiety symptoms (HADS-A ≥ 8); 14 (13.3%) patients had severe anxiety (score ≥ 11), and 24 (22.9%) had moderate anxiety (score of 8-10). Patients with poor sleep quality, higher pain frequency, younger age, and no fixed income had higher anxiety scores than others. Emotional and cognitive representations of illness were positively correlated with anxiety levels. Intense anxiety was related to more negative illness perception, higher helplessness, lower illness acceptance, and lower perceived benefits. Anxiety is common in patients with IEI. However, results indicate that it is not related to a more severe course of IEI or several comorbidities, whereas, pain frequency and poor sleep quality were identified to be important clinical factors for anxiety. Because anxiety was related to negative illness perception, psychological therapy may apply to this group of patients.

Deciphering stage 0 hematogones by flow cytometry in follow-up bone marrow samples of pediatric B-Acute lymphoblastic leukemia cases: A potential mimicker of residual disease after anti CD19 therapy.

CD19 is frequently targeted for immunotherapy in B cell malignancies, which may result in loss of CD19 expression in leukemic cells as an escape mechanism. Stage 0 hematogones (Hgs) are normal CD19-negative very early B cell precursors that can be potentially mistaken for CD19 negative residual leukemic cells by flow cytometry (FCM) in B cell acute lymphoblastic leukemia (BCP-ALL) cases treated with anti CD19 therapy. Our main objective was to characterize and study the incidence of stage 0 hematogones in follow-up bone marrow samples of pediatric BCP-ALL cases. We analyzed the flow cytometry standard files of 61 pediatric BCP-ALL cases treated with conventional chemotherapy and targeted anti-CD19 therapy, for identifying the residual disease and normal B cell precursors including stage 0 Hgs. A non-CD19 alternate gating strategy was used to isolate the B cells for detecting the residual disease and stage 0 Hgs. The stage 0 Hgs were seen in 95% of marrow samples containing CD19+ Hgs. When compared with controls and posttransplant marrow samples, the fraction of stage 0 Hgs was higher in patients receiving anti CD19 therapy (p = 0.0048), but it was not significant when compared with patients receiving chemotherapy (p = 0.1788). Isolated stage 0 Hgs are found in samples treated with anti-CD19 therapy simulating CD19 negative residual illness. Our findings aid in understanding the stage 0 Hgs and its association with CD19+ Hgs in anti CD19 therapy and conventional chemotherapy. This is crucial as it can be potentially mistaken for residual disease in patients treated with anti CD19 therapy.

Cluster Analysis of the Positive and Negative Indicators of Complete Mental Health State Model

&lt;p&gt;本研究目的在了解正負向指標篩檢心理健康型態集群分佈情形，是否符合Keyes主張以主觀幸福感與憂鬱症狀雙指標區分的完整心理健康模式。研究設計以心理健康BMI幸福感問卷、病人健康狀況憂鬱問卷，做為正負向指標篩檢工具，架構完整心理健康模式；以問卷調查法立意取樣739份樣本，經群集分析法作統計分群。結果能區分出有意義的四群集，包括擁有高幸福低憂鬱之完整圓滿心理健康型態的「心盛型」群集（46.28%）、不完整心理健康型態三個群集:「冷靜型」（低幸福低憂鬱之不完整心理亞健康型態，31.94%）、「奮戰型」（高幸福高憂鬱之不完整心理健康型態，11.10%）、「混沌型」（低幸福高憂鬱之不完整心理健康型態，10.69%）。低憂鬱者佔全體 78.22%，其中59.17%擁有高幸福而處於完整圓滿心理健康型態；高憂鬱者佔全體21.78%，其中50.93%擁有高幸福感。驗證了幸福感、憂鬱傾向作為正負向心理健康指標，篩檢完整或不完整心理健康型態。建議:（1）高憂鬱者參照「奮戰型」這群人高幸福感來源，藉由參與社團獲得人際支持、找到工作及收入來增加自我價值感；（2）「冷靜型」不能單看低憂鬱的心理健康篩檢，需提升「友善人際支持 正念情緒平穩 認同自我價值意義」之正向心理健康BMI幸福感，以獲得完整心理健康；（3）未來研究可依據正負向心理健康指標去發展心理健康素養能力，作為心理健檢與自主管理完整心理健康之用。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;This study aimed to understand the cluster distribution of positive and negative indicators for screening mental health patterns and whether they conform to Keyes’ claim that positive and negative indicators should be included in the complete mental health state model. The positive mental health indicators included social, emotional, and psychological well-being, which should be measured using the Mental Health Continuum Short Form (MHC-SF). Negative indicators measure the level of symptoms of mental illness concurrently, serving as a complete assessment of whether the individual is in a healthy state of positive and negative mental health indicators. Keyes employed these to distinguish four clusters of people with four mental health modes, of which the incomplete mental health cluster was in the state. Even if they have a negative mental illness, they could have positive mental health and well-being. Although some people do not have negative mental illness, they cannot have positive mental health and well-being. Therefore, Taiwanese scholar Li corresponded to these three well-being developments and selected three operational mental health skills: &amp;quot;&amp;quot;Befriend-Mindfulness-Identity&amp;quot;&amp;quot; as the Mental Health BMI Well-Being Index questionnaire (mBMI). After using them to evaluate 739 people, it was evident that the scores of the above two questionnaires were significantly correlated, and the mBMI questionnaire total score and Questions B, M, and I could effectively predict the total score, social, emotional, and psychological well-being of the MHC-SF, with a total explanatory power of 30.3%. This test should be used as a simple screening for well-being and as a positive mental health screening tool. Additionally, a Depression Scale Screening Tool for Negative Mental Health Depression was combined to explore the complete mental health state model of Taiwanese people. &lt;/p&gt; &lt;p&gt; Therefore, in this study, the mBMI questionnaire was selected as a simple tool to measure positive mental health well-being, and the patients&amp;rsquo; health questionnaire for depression was used as a screening tool for negative mental health indicators. These are used as positive and negative indicators to test whether a complete or incomplete mental health state model fits. The questionnaire survey method was used to deliberately sample the data from 739 valid samples, and the cluster analysis method was used for statistical grouping to verify its suitability. According to the results of the aforementioned positive and negative indicators, four meaningful clusters were distinguished, including one complete and three incomplete mental health models. One cluster was &amp;quot;&amp;quot;Flourishing type&amp;quot;&amp;quot;(46.28%) of high well-being and low depression, which belonged to the complete mental health state model. The other three clusters were incomplete mental health state models. &amp;quot;&amp;quot;Fighting type&amp;quot;&amp;quot; (31.94%) of high well-being and high depression, &amp;quot;&amp;quot;Calm type&amp;quot;&amp;quot; (11.10%) of low well-being and low depression, and &amp;quot;&amp;quot;Chaos type&amp;quot;&amp;quot; (10.69%) of low well-being and high depression could fight for high well-being. It was verified that well-being and depression could be used as positive and negative mental health indicators to screen for complete or incomplete mental health state models. When we identified people with high depression, we encouraged them to refer to the source of high well-being of the &amp;quot;&amp;quot;fighting type&amp;quot;&amp;quot; group and increase their sense of self-worth by participating in clubs to obtain interpersonal support, find jobs, and earn income. We reminded the &amp;quot;&amp;quot;calm type&amp;quot;&amp;quot; people with low depression to promote their high well-being to have a complete mental health state. Finally, we monitored positive and negative indicators of mental health using screening tools of the Mental Health BMI Well-Being Index and the Patient Health Questionnaire (PHQ-9) to screen for complete or incomplete mental health states as a reference for promoting positive and negative mental health. The befriend-mindfulness-identity skills should be improved to promote well-being and adjust depression to achieve complete mental health.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;