Severity Of Physical Symptoms Research Articles

Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure.

Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL. The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL. In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire). The mean age of the sample (N = 202) was 57 ± 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL. In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.

Effects of Emotional Regulation Strategies on the Relations of Spousal Abuse, Depression and Physical Symptoms

The emotional and physical problems can arise from spousal abuse. The purposes of this study were to investigate the influence of spousal abuse on depression and physical symptoms and to examine direct and indirect effects of functional and dysfunctional emotion regulation strategies to depression and physical symptoms. The participants were 232 adults. The Korea version of the Index of Spouse Abuse (K-ISA), Regulation of Emotions Questionnaire (REQ), Beck Depression Inventory (BDI), Physical Symptoms Scale were administered to participants. Structural Equation Modeling (SEM) with AMOS was used for the purpose of analysis. The results showed that physical and psychological abuse and controlling behavior were associated with severity of depression and physical symptoms and the functional emotion regulation strategies had the direct and indirect effects on depression and physical symptoms of those who experience spousal abuse. These results might contribute to development of psychological intervention program for those who have experienced spousal abuse. Finally, the limitations and implications of the current study were discussed.

Sleep quality at 3 months postpartum considering maternal age: A comparative study

BackgroundPoor sleep quality is related to old age among the general population, but few studies have focused on postpartum women of advanced maternal age. The present study aimed to describe and compare sleep quality between women younger or older than 35 years of age at 3 months postpartum, and to examine the related factors. MethodsA cross-sectional survey was conducted with 160 postpartum women who had given birth at a teaching hospital in Taiwan. The participants were assigned to two groups according to age (≥35 years, n=80; and 20–34 years, n=80). Sleep quality was measured using the Pittsburgh Sleep Quality Index with a cut-off score of 5. ResultsThe prevalence of poor sleep quality at 3 months postpartum was higher in older mothers (61.6%) than in younger mothers (38.4%, p<0.01). Multiple logistic regression revealed that poor sleep quality was positively correlated with the severity of postpartum physical symptoms, lack of exercise, and room-sharing with infants. After adjustment for those variables, older mothers were three times more likely to have poor sleep quality than younger mothers (odds ratio=3.08; 95% confidence interval 1.52–6.23). ConclusionHealth care providers should pay attention to sleep problems among postpartum women, especially mothers of advanced maternal age. In particular, health care providers should evaluate sleep quality among postpartum women, instruct them not to share the bed with their infants at night, perform exercise, and manage their postpartum physical symptoms to improve the sleep quality.

Gut Streptococcus species affect persistence and severity of atopic dermatitis during infancy

Perturbations of gut microbiota in early life can disrupt the development of immune system and directly associated with the risk of atopic dermatitis (AD). This study evaluated the association between persistence and severity of AD and the composition of gut microbiota at 6 months of age. The composition of gut microbiota was analyzed in fecal samples from 116 infants (6-month-old) by pyrosequencing, including 58 healthy infants and 58 infants with AD from Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA). AD in infants was diagnosed by a pediatric allergists at 6 months and 1 year of age, and severity of physical symptoms assessed by the SCORAD (Scoring Atopic Dermatitis) index at 6 months. Persistence was defined as AD symptom up to 12 months. The OTUs (P = 0.027) and Simpson index (P = 0.006) of diversity in gut microbiota were lower in healthy infants than those in persistent AD infants. The composition of Streptococcus was enriched in persistence AD infants than healthy infants (P = 0.001). The composition of Streptococcus pseudopneumoniae, Streptococcus mitis and Streptococcus salivarius were enriched in infants with persistent AD, compared to healthy infants. The relative abundance of S. pseudopneumoniae was increased in persistence AD infants compared with non-persistence AD. The relative abundance of gut S. mitis and S. pseudoneumoniae were positively correlated with serum IgE in infants with AD. S. pseudoneumoniae was positively correlated with SCORAD. Gut Streptococcus may affect persistence and severity of AD via IgE mediated allergic inflammation.

Testing the influence of cultural determinants on help-seeking theory.

Despite increased risks for mental health problems, East Asian immigrant women have the lowest overall service-utilization rates of any cultural group in the United States. Although the influence of cultural processes as the cause of low service use is widely speculated, no empirical study has tested cultural determinants (including culturally specific idioms of distress, culture-based illness interpretations, or concerns about social consequences), social contextual factors, perceived need (PN), and help-seeking (HS) behaviors. In the present study, we examined how cultural determinants, such as symptom experience, beliefs and interpretations, and perceptions about the social environment, affect PN and HS type for Japanese women living in the United States. Increasing physical symptom severity increased the predicted probability of endorsing PN. For those participants with PN, 48.6% of them used medical HS (χ2 = 11.27, p = .00), and 12.5% of them used the psychological HS (χ2 = 7.43, p = .01). Multivariate logistic regression revealed that, when PN is considered with the other cultural variables while controlling for structural variables, PN increases the odds of medical HS (OR = 2.78, 95% CI [1.0-5.8], p < .01). The odds of medical HS are also increased with higher social support (OR = 1.07, 95% CI [1.0-1.1], p < .01). Finally, the presence of interpersonal stigma beliefs decreased the odds of medical HS (OR = 2.4, 95% CI [1.1-5.3], p < .03). Clinical and research implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Pregabalin pain and anxiety treatment in oncological patient–Case report

Severe side effects of chemotherapy during treatment of malignant disease significantly disrupt patient's mental and physical state. Seventy five-years-old female patient was treated for breast cancer by protocol (operation, radiotherapy, chemotherapy-paclitaxel (CHT-PX) every tree weeks) and for dysthymia and generalized anxiety disorder with escitalopram (ESC). Tramadol (TRA) and clonazepam (KLO) given by oncologist due to severe side effects of CHT-PX: muscle cramps, lower back pain, walking difficulties, had partial results, increased anxiety and drug abuse (TRA doses increase from 100 to 300 mg/day and KLO from 4 to 6 mg/day). Efficiency of pregabalin (PG) in pain and anxiety control during CHT-PX application. The assessment was made by 100 mm visual analogue scale (VAS), which assessed physical symptom severity and Hamilton Anxiety Rating Scale (HAMA) on the first day after CHT-PX application, on the 7th, 14th and 21th day. Effective PG dose was 300 mg/day with EST, KLO and TRA previously taken. On the first day after CHT-PX, patient rated pain level as 9 according to VAS. During TRA and KLO treatment, pain level on VAS was 6 from the 7th till 14th day after CHT-PX, on 21th day deceased to 2. HAMA score was 49. After PG augmentation, according to VAS, pain level was 3 on the 7th day and 0 on 14th day. HAMA score was 20. Tapering off the dose of TRA and KLO started till discontinuation of both medications. Pregabalin efficiency in pain and anxiety control increase compliance of oncological patient and reduce harm of drug abuse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A prospective patient-focused evaluation of the tolerance and acceptability of a stereotactic radiosurgery procedure

Stereotactic radiosurgery (SRS) is a frequently used non-surgical procedure to treat benign and malignant brain lesions. Few studies have focused on patient perceptions of SRS. The aims of this patient-focused study were to assess patient experiences of SRS, and changes in patient-reported symptoms over 12weeks post-SRS. Using the 6-point Likert Scoring Scale in a diary-format for a less discriminatory evaluation, patients self-reported presence or absence, and severity of physical and psychological symptoms within 24h, 1-week, and 12-weeks post-SRS. Non-parametric repeated measures ANOVA was used to evaluate changes in symptoms. Of the 748 recruited patients, 690 returned the first diary (92%), while 564 patients returned all three diaries for matched responses analysis (82%). Three-quarters of 690 patients reported receiving clear verbal explanations and printed material prior to their procedure, and 99% reported the clinical team were ‘very supportive’ or gave ‘wonderful care’. Fatigue (82%) and headaches (65%) were the most frequently reported symptoms within 24-h post-SRS. Over 12weeks, patients reported significant reductions in headache, nausea, fatigue, anxiety and tension (p<0.001); loss of balance and concentration significantly increased by 12-weeks post-SRS (p<0.001). Some patients attributed symptoms such as fatigue or headaches to the demands of the procedure day. Findings of this study reflect the need to further research patients’ physical and psychological symptoms post-SRS, which may differ from the clinicians’ perception of the effects of treatment.

Do changes in illness perceptions, physical activity, and behavioural regulation influence fatigue severity and health-related outcomes in CFS patients?

ObjectiveExamine to what extent changes in cognitions and changes in physical activity and behavioural regulation patterns influence fatigue severity, physical symptoms, and physical and psychological functioning of patients suffering from Chronic Fatigue Syndrome (CFS) at follow-up. MethodsThe present study is an observational longitudinal study with a 12-month follow-up. A total of 144 CFS patients participated both at baseline and at follow-up. Four separate hierarchical regression analyses were conducted with fatigue, physical symptoms, physical functioning and psychological functioning at follow-up as the dependent variables, and (changes in) illness perceptions and behavioural regulation patterns (all-or-nothing and limiting behaviour) as the independent variables. Data were collected making use of self-report questionnaires. ResultsIncreased Consequence and Identity beliefs over time, as well as increases in all-or-nothing behaviour predicted higher fatigue severity at follow-up. Both number and severity of physical symptoms and psychological functioning at follow-up were only determined by changes in illness perceptions, with increased Consequence beliefs influencing both outcomes, and increased Timeline beliefs only determining physical symptoms. Physical functioning at follow-up was predicted by changes in illness perceptions as well as increased levels of both all-or-nothing and limiting behaviour. ConclusionThe findings point at a differential pattern of associations between changes in illness perceptions and behaviour regulation patterns on the one hand, and patient outcomes on the other hand. Whereas illness perceptions significantly contribute to each of the outcomes, behaviour regulation patterns contribute only to fatigue severity and physical functioning.

Stress of the Off-Season May Be Greater for the Student-Athlete than during Competition: A Pilot Study

We assessed 16 student-athletes in their first year of college on several dimensions, including severity of psychological and physical symptoms, mental health upset, academic concerns, suicidal tendencies, depressive outlook, anxiety and tension, attention difficulties, and alcohol abuse. We assessed half during their sports’ competition season and half during their off-season. Results pointed to increased perceived stress during the down time of off season. It may be that for student-athletes, the structure of competition season offsets the stress of competition, such that when the structure is removed or lessened, perceived stress increases. Implications of these data are discussed as well as plans for developing follow-up studies.

Socioeconomic status, perceived control, diurnal cortisol, and physical symptoms: A moderated mediation model

Social class is a robust predictor of health, with risk for disease and mortality increasing towards the lower end of the socioeconomic (SES) spectrum. While certain psychological characteristics, such as high sense of control, can protect low-SES individuals from adverse health outcomes, very few studies have investigated the biological mechanisms underlying these relationships. In this study, we tested whether sense of control mitigated the associations between SES and cortisol activity, and SES and physical health in daily life (i.e., number and severity of physical symptoms). Next, we tested whether individual differences in cortisol secretion would act as a mechanism by which SES and perceived control influenced physical health. In a large national sample from the Midlife in the United States (MIDUS) survey, we found that SES interacted with perceived control in predicting morning cortisol levels, cortisol slopes, number of physical symptoms, and severity of physical symptoms. Specifically, SES disparities in these health outcomes were more pronounced among individuals reporting low levels of perceived control than among individuals endorsing high levels of perceived control. Further, we found that a flatter cortisol slope mediated the link between lower SES and greater number and severity of physical symptoms for those individuals who reported lower levels of perceived control, but not for individuals reporting higher levels of perceived control. These findings suggest that perception of greater control may act as a buffer against the effect of low SES on health-related physiological processes.

Burden of COPD in patients treated in different care settings in the Netherlands

IntroductionCare for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization. MethodsCurrent data are part of the Chance study. Demographics, functional mobility (Care Dependency Scale (CDS); Timed-Up-and-Go (TUG) test), mood status (Hospital Anxiety and Depression scale (HADS)), health status (COPD Assessment test (CAT); Clinical COPD questionnaire (CCQ); COPD specific St. George Respiratory questionnaire (SGRQ-C)), received treatments and severity of physical and psychological symptoms were assessed in subjects with and without COPD. Results836 subjects (100 primary care patients, 100 secondary care patients, 518 tertiary care patients and 118 non-COPD subjects) were included. The burden of disease significantly increased from primary care to tertiary care. However, in all three healthcare settings a high percentage of patients with an impaired health status was observed (i.e. CAT ≥10 points, 68.0% vs. 91.0% vs. 94.5%, respectively). Furthermore, many patients treated in secondary care remain highly symptomatic despite treatment, while others with low burden of disease would allow for de-intensification of care. ConclusionThis study revealed important shortcomings and challenges for the care of COPD patients in the Netherlands. It emphasizes the need for detailed patient characterization and more individualized treatment, independent of the healthcare setting.

THE EFFECT OF CINNAMON ON PHYSICAL SYMPTOMS OF PREMENSTRUAL SYNDROME AMONG ADOLESCENT GIRLS

Background: Menstruation is a landmark in every female's life. Premenstrual syndrome is a particularly commonest gynecological complains in adolescent stage, in Egypt the prevalence of PMS was found to be (89.6 %) among medical students of Ain Shams University. The aim of this study was to assess the effect of cinnamon on physical symptoms of premenstrual syndrome among adolescent girls at Mansoura University. A quasi-experimental research design was utilized. The study setting was conducted at nursing School of Mansoura University. A purposive sample of 150 students complains from premenstrual syndrome from September 2012 to May 2013 study that served as a one arm intervention. Three tools were used to collect data, the first tool; was structured questionnaire sheet, the 2nd tool was the present assessments tool to assess severity of physical symptoms of PMS and the third tool was satisfaction Likerts scale for measure the level of student's satisfaction from using cinnamon as a way of relieving physical symptoms. The Results: More than half (52%) of nursing school students had menarche at age 10, also around half 41.3% of students were sever general body discomfort while more than half of them 56% have moderate abdominal pain pre-intervention. After intervention by using cinnamon there were highly significant positive effects to decrease symptoms from baseline to post dairy one and post dairy two. It's clearly the association that highly significantly positive relationship between the reductions of severity of physical symptoms and regularity of taking cinnamon, also approximately three quarter of the student were satisfied from the positive effect of cinnamon. Conclusion: There were highly significant positive effect in reduction of severity of PMS physical symptoms after regular taking cinnamon packet supplementation and most of students were satisfied from the effect of the cinnamon. Recommendation: Raising the awareness of adolescent girl about the safety and efficacy of a herbal therapy especially cinnamon

Health-related quality of life in chronic kidney desease: Predictive relevance of mood and somatic symptoms

ObjectiveTo compare the predictive capacity of self-reported somatic symptoms and mood (depression and anxiety) on health-related quality of life (HRQoL) in patients with chronic renal disease. MethodData were obtained from 52 patients undergoing haemodialysis. Measures included (a) the SF-36 health survey, (b) the somatic symptoms scale revised (ESS-R) and (c) the hospital anxiety and depression scale (HADS). Multiple regression was the main method of statistical analysis. ResultsPatients exhibited HRQoL levels below normative values, with anxiety and depression prevalence at 36.5% and 27%, respectively. Mood was the strongest predictor of physical (β=−.624) and mental (β=−.709) HRQoL. Somatic symptoms were also associated with physical HRQoL, but their predictive value was weaker (β=−.270). ConclusionsThese results indicate that mood is a superior predictor of the physical and mental components of HRQoL in patients compared with the number and severity of physical symptoms. The data underline the importance of assessing negative emotional states (depression and anxiety) in kidney patients as a basis for intervention, which may facilitate reduction of the impact of chronic renal disease on HRQoL.

Calidad de vida relacionada con la salud en la enfermedad renal crónica: relevancia predictiva del estado de ánimo y la sintomatología somática

ObjectiveTo compare the predictive capacity of self-reported somatic symptoms and mood (depression and anxiety) on health-related quality of life (HRQOL) in patients with chronic renal disease. MethodData were obtained from 52 patients undergoing haemodialysis. Measures included a) the SF-36 health survey, b) the somatic symptoms scale revised (ESS-R) and c) the hospital anxiety and depression scale (HADS). Multiple regression was the main method of statistical analysis. ResultsPatients exhibited HRQOL levels below normative values, with anxiety and depression prevalence at 36.5% and 27%, respectively. Mood was the strongest predictor of physical (β=−.624) and mental (β=−.709) HRQOL. Somatic symptoms were also associated with physical HRQOL, but their predictive value was weaker (β=−.270). ConclusionsThese results indicate that mood is a superior predictor of the physical and mental components of HRQOL in patients compared with the number and severity of physical symptoms. The data underline the importance of assessing negative emotional states (depression and anxiety) in kidney patients as a basis for intervention, which may facilitate reduction of the impact of chronic renal disease on HRQOL.

Clinical significance of physical symptom severity in standardized assessments of patient reported outcomes.

Standardized measures of physical symptoms predict mortality and healthcare utilization, but clinicians remain uncertain about how to apply them in routine clinical care. Recognizing the tendency for physician documentations to routinely underestimate symptom burden, we assessed whether or not severity was an important dimension of symptom assessments that may determine their usefulness in clinical encounters. Retrospective cohort study using data from audio computer-assisted self-interviews augmented by chart review of patients from a primary care clinic of an urban health system. We sampled 145 patients who completed the Memorial Symptom Assessment Scale (MSAS) short form-physical symptom severity measurement-before their primary care visit. Most were women (60%), and non-Hispanic black (59%), and many responded in Spanish (19%). All but three reported>1 symptom. Overall, 79% of elicited symptoms were not documented in physician notes from the same day. Severe symptoms were more likely to be documented [MSAS mean (95% confidence interval): documented 2.2 (1.9, 2.4) vs. undocumented 1.8 (1.7, 1.9)]. Documentations reflect usual patient-clinician communications that prioritize severe symptoms, while standardized instruments target their comprehensive assessments. Among the many validated instruments, those eliciting the severity of physical symptoms may simultaneously help clinicians with prioritization and risk assessments.

End-of-life care pathways for improving outcomes in caring for the dying.

This is an updated version of a Cochrane review published in Issue 11, 2013 in the Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. Since the last update, there have been sustained concerns about the safety of implementing end-of-life care pathways, particularly in the United Kingdom (UK). Therefore, there is a significant need for clinicians and policy makers to be informed about the effects of end-of-life care pathways via a systematic review. To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community).In particular, we aimed to assess the effects on symptom severity and quality of life of people who are dying, or those related to the care, such as families, carers and health professionals, or a combination of these. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library; 2015, Issue 6), MEDLINE, EMBASE, PsycINFO, CINAHL, review articles, trial registries and reference lists of relevant articles. We conducted the original search in September 2009, and the second updated search in July 2015. All randomised controlled trials (RCTs), quasi-randomised trials or high quality controlled before-and-after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying. Two review authors independently assessed the results of the searches against the predetermined criteria for inclusion, assessed risk of bias, and extracted data. We used standard methodological procedures expected by Cochrane. We screened 3028 titles, and included one Italian cluster RCT with 16 general medicine wards (inpatient units in hospitals) and 232 carers of cancer patients in this updated review. We judged the study to be at a high risk of bias overall, mainly due to a lack of blinding and rates of attrition. Only 34% of the participants (range 14% to 75% on individual wards) were cared for in accordance with the care pathway as planned. However, these issues were to be expected due to the nature of the intervention and condition. The study population was all cancer patients in their last days of life. Participants were allocated to care using the Liverpool Care Pathway (LCP-I, Italian version of a continuous quality improvement programme of end-of-life care) or to standard care. The primary outcomes of this review were physical symptom severity, psychological symptom severity, quality of life, and any adverse effects. Physical symptom severity was assessed as overall control of pain, breathlessness, and nausea and vomiting. There was very low quality evidence of a difference in overall control of breathlessness that favoured the Liverpool Care Pathway group compared to usual care: the study reported an odds ratio (OR) of 2.0 with 95% confidence intervals (CIs) 1.1 to 3.8. Very low quality evidence of no difference was found for pain (OR 1.3, 95% CI 0.7 to 2.6, P = 0.461) and nausea and vomiting (OR 1.5, 95% CI 0.7 to 3.2, P = 0.252). None of the other primary outcomes were assessed by the study. Limited data on advance care planning were collected by the study authors, making results for this secondary outcome unreliable. None of our other secondary outcomes were assessed by the study. There is limited available evidence concerning the clinical, physical, psychological or emotional effectiveness of end-of-life care pathways.

Aspectos clínicos e psicossociais avaliados por critérios de diagnóstico para disfunção temporomandibular

RESUMO Objetivo: analisar a associação entre a classificação de diagnósticos clínicos (dor miofascial, desordem discal e articular) e a graduação de dor crônica, depressão e sintomas físicos não específicos em sujeitos com disfunção temporomandibular. Métodos: foram incluídos 32 pacientes, com média de idade de 28,71±4,66 anos. Como instrumento de avaliação, foi utilizado o Critério de Diagnóstico para Pesquisa das Desordens Temporomandibulares - Eixo I e II. Quanto ao grupo diagnóstico, 88,13% dos indivíduos apresentaram diagnóstico misto, sendo 43,75% dos grupos I e III (distúrbios musculares e articulares) e 34,38% dos grupos I, II e III (distúrbios musculares, articulares e deslocamento de disco). Resultados: de acordo com o eixo II, 96,88% dos participantes foram classificados com dor crônica grau I e II (baixa incapacidade e baixa intensidade; baixa incapacidade e alta intensidade). Graus moderado e grave de depressão foram observados em 84,38% dos participantes. Na avaliação de sintomas físicos não específicos incluindo e excluindo dor, respectivamente, 59,38% apresentaram sintomas severos e 71,88% apresentaram sintomas moderados e severos. Verificou-se relação significante dos diagnósticos clínicos de disfunção temporomandibular com o grau de sintomas físicos não específicos incluindo dor. Conclusão: alguns aspectos clínicos e psicossociais estão associados em pacientes com disfunção temporomandibular, observando uma multiplicidade de diagnósticos clínicos com a presença de uma relação significante entre os diagnósticos clínicos encontrados e a presença de sintomas físicos inespecíficos com dor. Queixa de maior gravidade de sintomas físicos foi encontrada em pacientes com diagnóstico clínico múltiplo.

Cognitive dysfunction and symptom burden in women treated for breast cancer: a prospective behavioral and fMRI analysis.

Neural dysfunction and cognitive complaints are associated with chemotherapy for breast cancer although trajectory and contributory factors remain unclear. We prospectively examined neurocognition using fMRI and self-reported cognitive, physical and psychological symptoms in women treated with adjuvant chemotherapy over one year. Patients treated with (n=28) or without (n=34) chemotherapy for localized breast cancer and healthy controls (n=30) performed a Verbal Working Memory Task (VWMT) during fMRI and provided self-reports at baseline (pre-adjuvant treatment), five- (M5) and 12-months (M12). Repeated measures ANOVA and multivariable regression determined change over time and possible predictors (e.g., hemoglobin, physical symptoms, worry) of VWMT performance, fMRI activity in the frontoparietal executive network, and cognitive complaints at M12. Trajectories of change in VWMT performance for chemotherapy and healthy control groups differed significantly with the chemotherapy group performing worse at M12. Chemotherapy patients had persistently higher spatial variance (neural inefficiency) in executive network fMRI-activation than both other groups from baseline to M12. Cognitive complaints were similar among groups over time. At M12, VWMT performance and executive network spatial variance were each independently predicted by chemotherapy treatment and their respective baseline values, while cognitive complaints were predicted by baseline level, physical symptoms and worry. Executive network inefficiency and neurocognitive performance deficits pre-adjuvant treatment predict cognitive dysfunction one-year post-baseline, particularly in chemotherapy-treated patients. Persistent cognitive complaints are linked with physical symptom severity and worry regardless of treatment. Pre-chemotherapy interventions should target both neurocognitive deficits and symptom burden to improve cognitive outcomes for breast cancer survivors.

The effect of Valerian root extract on the severity of pre menstrual syndrome symptoms

Premenstrual syndrome (PMS) is a common disorder. Due to the knowledge lack of the precise etiology of this syndrome, different treatment methods are recommended, one of them is the use of medicinal herbs. This study aimed to investigate the effect of Valerian (纈草 xié cǎo) root extract on the intensity of PMS symptoms.In this double-blind clinical trial, 100 female students of Islamic Azad University, Tonekabon Branch, Mazandaran Province, Iran, with PMS were randomly divided into groups receiving Valerian (scientific name: Valeriana officinalis) and placebo in 2013. The participants received 2 pills daily in the last seven days of their menstrual cycle for 3 cycles and recorded their symptoms.The data collection tools included demographic information questionnaire, daily symptom severity questionnaire, and a provisional diagnosis of premenstrual syndrome questionnaire.Data were compared previous, one, two, and three cycles after student's intervention using and analyzed by independent t-test, paired t-test, chi-squared test, and repeated measures ANOVA in SPSS 16.A significant difference was seen in mean emotional, behavioral and physical premenstrual symptom severity in the intervention group before and after the intervention (P < 0.001). However, this difference was not statistically significant in the control group. The results of this study showed that Valerian root extract may reduce emotional, physical, and behavioral symptoms of premenstrual syndrome.

The Incidence and Severity of Physical Pain Symptoms in Marfan Syndrome: A Survey of 993 Patients.

To characterize the incidence, severity, quality, and treatment of pain in a large cohort of Marfan patients. A web-based survey was distributed to all individuals on the Marfan Foundation listserv. Respondents who endorsed a diagnosis of Marfan syndrome were queried as to the presence, frequency, severity, location, and quality of their pain and were asked to describe the specific treatments used to manage pain. The primary outcome was the presence of pain symptoms in respondents during the 7-day period preceding completion of the survey. Of the 993 patients with a verified diagnosis of Marfan syndrome, 67% (95% confidence interval, 64%-69%) reported pain in the preceding 7 days. Median (interquartile range) "average daily pain" was 4 (3 to 5) on the numeric rating scale; "worst pain" was 7 (5 to 8). "Worst pain experienced" was ≥4 in 93% of respondents. Analgesic use to control pain related to Marfan syndrome was reported in 56% of respondents with 55% reporting <50% pain relief with this modality. Few patients underwent interventional procedures for pain control, despite intractable back and joint pain being common. A majority (52%) of respondents rated "chronic pain care" from their physicians as either "poor" or "fair." Our findings suggest that pain symptoms in Marfan patients are underestimated and likely undertreated. We propose a need for improved patient and medical provider awareness of pain management options in this population, including the development of effective algorithms to treat pain in Marfan patients.