Reduction In Symptom Severity Research Articles

Impact of Omalizumab Treatment on Quality of Life and Activity of Chronic Spontaneous Urticaria

Objective: Omalizumab treatment has shown promise in managing Chronic spontaneous urticaria (CSU). This study focuses on evaluating its effect on improving the quality of life and reducing CSU activity and severity in patients of different age groups. Materials and Methods: Conducted at Derince Training and Research Hospital, this observational study involved 50 CSU patients, categorized into adolescents (≤18years, n=15) and adults (>18years, n=35). Data were collected through clinical and demographic assessments, including Urticaria Activity Score (UAS), Urticaria Control Test (UCT), and Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) questionnaires, at the beginning and the third month of Omalizumab treatment. Results: Significant improvements were observed in UAS, UCT, and CU-Q2oL scores post-Omalizumab treatment, indicating reduced symptom severity and enhanced quality of life. The median UAS at the start was 35 (28-35); at the third month, 7 (0-7); median UCT at the start was 2 (1.25-3), at the third month 16 (13-16); median CU-Q2oL at the start was 70.5 (66-74), at the third month 23 (23-28); (p

The impact of outpatient supportive oncology on cancer care cost and utilization.

Supportive oncology (SO) care reduces symptom severity, admissions, and costs in patients with advanced cancer. This study examines the impact of SO care on utilization and costs. Retrospective analysis of utilization and costs comparing patients enrolled in SO versus three comparison cohorts who did not receive SO. Using claims, the authors estimated differences in health care utilization and cost between the treatment group and comparison cohorts. The treatment group consisting of patients treated for cancer at an National Cancer Institute-designated cancer center who received SO between January 2018 and December 2019 were compared to an asynchronous cohort that received cancer care before January 2018 (n=60), a contemporaneous cohort with palliative care receiving SO care from other providers in the Southeastern Pennsylvania region during the program period (n=86), and a contemporaneous cohort without palliative care consisting of patients at other cancer centers who were eligible for but did not receive SO care (n=393). At 30, 60, and 90 days post-enrollment into SO, the treatment group had between 27% and 70% fewer inpatient admissions and between 16% and 54% fewer emergency department visits (p<.05) compared to non-SO cohorts. At 90 days following enrollment in SO care, total medical costs were between 4.4% and 24.5% lower for the treatment group across all comparisons (p<.05). SO is associated with reduced admissions, emergency department visits, and total costs in advanced cancer patients. Developing innovative reimbursement models could be a cost-effective approach to improve care of patients with advanced cancer.

Novel Medical Treatments and Devices for the Management of Heart Failure with Reduced Ejection Fraction.

Heart failure (HF) is a growing issue in developed countries; it is often the result of underlying processes such as ischemia, hypertension, infiltrative diseases or even genetic abnormalities. The great majority of the affected patients present a reduced ejection fraction (≤40%), thereby falling under the name of "heart failure with reduced ejection fraction" (HFrEF). This condition represents a major threat for patients: it significantly affects life quality and carries an enormous burden on the whole healthcare system due to its high management costs. In the last decade, new medical treatments and devices have been developed in order to reduce HF hospitalizations and improve prognosis while reducing the overall mortality rate. Pharmacological therapy has significantly changed our perspective of this disease thanks to its ability of restoring ventricular function and reducing symptom severity, even in some dramatic contexts with an extensively diseased myocardium. Notably, medical therapy can sometimes be ineffective, and a tailored integration with device technologies is of pivotal importance. Not by chance, in recent years, cardiac implantable devices witnessed a significant improvement, thereby providing an irreplaceable resource for the management of HF. Some devices have the ability of assessing (CardioMEMS) or treating (ultrafiltration) fluid retention, while others recognize and treat life-threatening arrhythmias, even for a limited time frame (wearable cardioverter defibrillator). The present review article gives a comprehensive overview of the most recent and important findings that need to be considered in patients affected by HFrEF. Both novel medical treatments and devices are presented and discussed.

Anxiety, Depression, and Stress on School-Aged Children and Adolescents in 2021: An Urgent Need for Comprehensive Intervention and Support

IntroductionIn the year 2021, there was a notable increase in behaviors associated with anxiety, depression, and stress among school-aged children and adolescents, possibly attributed to the pervasive effects of social isolation and confinement measures.ObjectivesThis study conducted a thorough analysis of cases involving students aged 11 to 17 years who exhibited risk factors, anxious and depressive symptoms, and mood disturbances.MethodsThis study focused on students aged 11 to 17 years and employed a comprehensive approach to assess the impact of anxiety, depression, and stress. Cases were meticulously analyzed, and key categories were established to characterize the multifaceted challenges faced by the students. These categories included the availability of family support, utilization of psychopharmacological treatment, engagement in psychological therapies, participation in psychopedagogical interventions, and patterns of school absenteeism.ResultsThe analysis revealed a concerning prevalence of anxiety, depression, and stress-related symptoms among the student population. Many students exhibited risk factors that warranted immediate attention, including social isolation, disrupted routines, and uncertainty about the future. Furthermore, a significant portion of students displayed anxious and depressive symptoms, often leading to altered mood and behavioral challenges. In the context of family support, it was apparent that students with robust familial backing tended to cope more effectively with the psychological strain induced by the pandemic. However, a noteworthy number of students lacked adequate family support systems, exacerbating their mental health struggles. Students in need of such interventions benefited significantly from their implementation, demonstrating improved emotional well-being and a reduction in symptom severity. Nonetheless, the accessibility of these services remained a concern, with disparities in access evident among different demographic groups. Psychopedagogical interventions played a pivotal role in addressing issues related to school absenteeism and facilitating a smoother transition to remote learning. Students who engaged in these interventions showed positive progress in terms of school attendance and academic performance.ConclusionsThe findings of this study underscore the urgency of a holistic approach to addressing anxiety, depression, and stress in school-aged children and adolescents. It is imperative that consultations with child and adolescent psychiatry specialists be conducted promptly and in a manner that considers the unique contextual factors influencing each student’s mental health. Moreover, efforts should be directed toward enhancing family support, expanding access to psychopharmacological treatment and psychological therapies, and promoting the implementation of psychopedagogical interventions.Disclosure of InterestNone Declared

Factors associated with the worsening of COVID-19 symptoms among cohorts in community- or home-isolation care in southern Thailand.

This study aimed to investigate factors associated with time-to-referral due to worsening symptoms in patients with laboratory-confirmed COVID-19 in southern Thailand. While underlying diseases have been evaluated to assess COVID-19 severity, the influence of vaccinations and treatments is also crucial. A cohort of 8,638 patients quarantined in home or community isolation with laboratory-confirmed COVID-19 was analyzed. Survival analysis and the Cox proportional hazard ratio were employed to assess factors influencing time-toreferral. Age ≥ 60 years, neurologic disorders, cardiovascular disease, and human immunodeficiency virus infection were identified as significant risk factors for severe COVID-19 referral. Patients who received full- or booster-dose vaccinations had a lower risk of experiencing severe symptoms compared to unvaccinated patients. Notably, individuals vaccinated during the Omicron-dominant period had a substantially lower time-to-referral than those unvaccinated during the Delta-dominant period. Moreover, patients vaccinated between 1 and 6 months prior to infection had a significantly lower risk of time-to-referral than the reference group. These findings demonstrate early intervention in high-risk COVID-19 patients and the importance of vaccination efficacy to reduce symptom severity. The study provides valuable insights for guiding future epidemic management strategies and optimising patient care during infectious disease outbreaks.

No two without three: Modeling dynamics of the trio RNA virus-defective interfering genomes-satellite RNAs

Almost all viruses, regardless of their genomic material, produce defective viral genomes (DVG) as an unavoidable byproduct of their error-prone replication. Defective interfering (DI) elements are a subgroup of DVGs that have been shown to interfere with the replication of the wild-type (WT) virus. Along with DIs, other genetic elements known as satellite RNAs (satRNAs), that show no genetic relatedness with the WT virus, can co-infect cells with WT helper viruses and take advantage of viral proteins for their own benefit. These satRNAs have effects that range from reduced symptom severity to enhanced virulence. The interference dynamics of DIs over WT viruses has been thoroughly modeled at within-cell, within-host, and population levels. However, nothing is known about the dynamics resulting from the nonlinear interactions between WT viruses and DIs in the presence of satellites, a process that is frequently seen in plant RNA viruses and in biomedically relevant pathosystems like hepatitis B virus and its δ satellite. Here, we look into a simple phenomenological mathematical model that describes how a WT virus replicates and produces DIs in presence of a satRNA. The WT virus is subject to mechanisms of complementation, competition, and various levels of interference from DIs and the satRNA. Examining the dynamics analytically and numerically reveals three possible regimes: (i) full extinction, (ii) satellite extinction and virus-DIs coexistence and (iii) full coexistence. Assuming DIs replicate faster than the satRNA owed to their smaller size drives to scenario (ii), which implies that DIs could wipe out the satRNA. In addition, a small region of the parameter space exists wherein the system is bistable (either scenarios (ii) or (iii) are concurrently stable). We have identified transcritical bifurcations in the transitions between scenarios (i) to (iii) and saddle–node bifurcations behind the change from bistability to monostability. Despite the model simplicity, our findings may have applications in biomedicine and agronomy. They will cast light on the dynamics of this three-species system and aid in the identification of scenarios in which the clearance of the satRNAs may be possible thus e.g., allowing for less severe disease symptoms.

Music Therapy Intervention to Reduce Symptom Burden in Hospice Patients: A Descriptive Study.

Background: Music therapy (MT) offers benefits of improved symptom relief and quality of life at the end of life, but its impact on hospice patients and caregivers needs more research. Objective: To assess the impact of MT intervention on symptom burden and well-being of hospice patients and caregivers. Methods: A total of 18 hospice patients, selected based on scores ≥4 on the revised Edmonton Symptom Assessment System (ESAS-r) items on pain, depression, anxiety, or well-being, participated in MT sessions provided by a board-certified music therapist. Over a period of 2-3weeks, 3-4MT sessions were conducted for each. Patient Quality of life (QOL) was assessed using the Linear Analogue Self-Assessment (LASA). Depression and anxiety were measured with the Patient Health Questionnaire-4 (PHQ-4). For the 7 caregivers enrolled, stress levels were measured using the Pearlin role overload measure and LASA. Results: Patients reported a reduction in symptom severity and emotional distress and an increase in QOL. All patients endorsed satisfaction with music therapy, describing it as particularly beneficial for stress relief, relaxation, spiritual support, emotional support, and well-being. Scores on overall QOL and stress were worse for caregivers. Conclusion: This study provides evidence that MT reduces symptom burden and enhances the quality of life for hospice patients. Hospice patients and their caregivers endorsed satisfaction with MT. Given the benefits observed, integrating MT into hospice care regimens could potentially improve patient and caregiver outcomes. Larger studies should be conducted to better assess the impact of MT in this population.

A computational model of motion sickness dynamics during passive self-motion in the dark.

Predicting the time course of motion sickness symptoms enables the evaluation of provocative stimuli and the development of countermeasures for reducing symptom severity. In pursuit of this goal, we present an Observer-driven model of motion sickness for passive motions in the dark. Constructed in two stages, this model predicts motion sickness symptoms by bridging sensory conflict (i.e., differences between actual and expected sensory signals) arising from the Observer model of spatial orientation perception (stage 1) to Oman's model of motion sickness symptom dynamics (stage 2; presented in 1982 and 1990) through a proposed "Normalized Innovation Squared" statistic. The model outputs the expected temporal development of human motion sickness symptom magnitudes (mapped to the Misery Scale) at a population level, due to arbitrary, 6-degree-of-freedom, self-motion stimuli. We trained model parameters using individual subject responses collected during fore-aft translations and off-vertical axis of rotation motions. Improving on prior efforts, we only used datasets with experimental conditions congruent with the perceptual stage (i.e., adequately provided passive motions without visual cues) to inform the model. We assessed model performance by predicting an unseen validation dataset, producing a Q2 value of 0.91. Demonstrating this model's broad applicability, we formulate predictions for a host of stimuli, including translations, earth-vertical rotations, and altered gravity, and we provide our implementation for other users. Finally, to guide future research efforts, we suggest how to rigorously advance this model (e.g., incorporating visual cues, active motion, responses to motion of different frequency, etc.).

Bridging the gap: Unveiling the crisis of physical inactivity in inflammatory bowel diseases

In this editorial we comment on the article titled “Inflammatory bowel diseases patients suffer from significant low levels and barriers to physical activity: The BE-FIT-IBD study” published in a recent issue of the World Journal of Gastroenterology 2023; 29 (41): 5668-5682. Inflammatory bowel diseases (IBD) are emerging as a significant global health concern as their incidence continues to rise on a global scale, with detrimental impacts on quality of life. While many advances have been made regarding the management of the disease, physical inactivity in these patients represents an underexplored issue that may hold the key for further and better understanding the ramifications of IBD. Chronic pain, fatigue, and fear of exacerbating symptoms promotes physical inactivity among IBD patients, while the lack of clear guidelines on safe exercise regimens contributes to a norm of physical inactivity. Physical activity (PA) is accepted to have a positive effect on disease outcomes and quality of life, while inactivity exacerbates comorbidities like cardiovascular disease and mental health disorders. The “BE-FIT-IBD” study, focusing on PA levels and barriers in IBD patients of Southern Italy, revealed that a significant proportion (42.9%) were physically inactive. This lack of PA is attributed to barriers such as fear of flare-ups and misconceptions about exercise exacerbating the disease. The study also highlighted the need for better communication between healthcare providers and patients regarding the benefits of PA and safe incorporation into lifestyles. Moreover, physical inactivity may also contribute to disability in IBD patients, having a great impact on employment status. Of note is the fact that IBD also comes with an important psychological burden with relevant evidence suggesting that regular PA can improve mood, reduce anxiety, and enhance mental health. The “BE-FIT-IBD” study advocated for the integration of PA into IBD management, emphasizing the bidirectional link between PA and IBD. Regular exercise can influence the course of IBD, potentially reducing symptom severity and prolonging remission periods. As such, it is mandatory that healthcare providers actively educate patients, dispel misconceptions, and tailor exercise recommendations to improve the quality of life and reduce IBD-related complications.

Chiari Type I Revision Decompressive Surgery Indications and Operative Technique: Experience in a Large Adult Cohort

IntroductionChiari Malformation is characterized by inferior displacement of the cerebellar tonsils through the foramen magnum, frequently resulting in strain related headaches, and motor/sensory dysfunction. Chiari decompression technique varies significantly, possibly contributing to frequent revisions. We reviewed revision Chiari decompressions at our institution to determine the primary indications for revision and outcomes after revision. MethodWe retrospectively reviewed patients who underwent revision of Chiari decompression at our institution from 2005-2020. Demographics, indications for revision surgery, operative techniques, imaging findings, and pre-/post-operative symptoms were collected. Chi-squared test was performed to determine statistical significance using a p<0.05. Independent predictors of operative outcomes were identified. ResultA total of 46 patients (91% female, mean age 38.8 years) were included for analysis. The median time to revision surgery was 69.1 months (range 0-364 months) with headache (n=37, 80%) being the most commonly recurring symptom. Large craniectomy (n=28, 61%) was the most frequent indication for revision surgery. Thirty-two (70%) patients underwent cranioplasty, 20 (43%) required duraplasty, 15 (33%) required arachnoid dissection, and 15 (33%) required tonsillar reduction during revision surgery. Post-revision follow-up (at 8.9 ± 5.2 months average, range 1-18 months), revealed an average reduction in all Chiari-related symptoms relative to symptoms before the revision. ConclusionThe most common indication for revision Chiari decompression was a large craniectomy resulting in cerebellar ptosis. We found that tonsillar reduction paired with modest craniectomy achieved near-complete resolution of symptoms with minimal complications. For patients with recurrent or persistent sequelae of Chiari malformation after decompression, revision may reduce symptom severity.

The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation.

Background Telemedicine and remote patient monitoring have emerged as transformative solutions in contemporary healthcare. This study aimed to conduct a comprehensive evaluation of the impact of these technologies on healthcare delivery, focusing on patient outcomes, economic parameters, and overall satisfaction. Methods A prospective observational study was conducted in various healthcare facilities, involving 186 participants with chronic diseases. Inclusion criteria included patients actively using telemedicine services. Data collection methods included surveys, interviews, and review of medical records, focusing on patient demographics, clinical outcomes, and economic parameters. The intervention involved a seamless integration of telemedicine technologies into the existing health system. Results Primary outcomes revealed significant improvements in patient health, including a decrease in disease-specific markers (mean reduction of 12,000 to 11,000, p = 0.002), a substantial reduction in severity of symptoms (mean reduction from 3,500 to 2,500, p < 0.001), and a general improvement in health status (mean increase from 7,200 to 8,500, p < 0.001). The savings in healthcare costs were evident, with direct costs decreasing from 25,000 to 12,000 (p < 0.001) and indirect costs decreasing from <10,000 to <5,000 (p = 0.004). Secondary results demonstrated increased patient satisfaction with communication (increase from 80% to 95%, p < 0.001) and convenience of services (increase from 75% to 90%, p < 0.001). Patient satisfaction also increased significantly (from 80% to 95%, p < 0.001). Accessibility to healthcare services improved, with a reduction in geographic barriers (increase from 65% to 90%, p < 0.001) and a decrease in the frequency of healthcare utilization (decrease from 2.5 to 1.5, p < 0.001). Conclusion The study provides robust evidence of the positive impact of telemedicine and remote patient monitoring on healthcare delivery. Significant improvements in patient outcomes, coupled with substantial cost savings and increased satisfaction levels, underscore the transformative potential of these technologies.

Evaluation of the internet-based intervention “Selfapy” in participants with unipolar depression and the impact on quality of life: a randomized, parallel group study

PurposeDepressive disorders cause a major burden of disease worldwide and often lead to a loss of social functioning. Patients suffering from depressive disorders report a lower quality of life (QOL) than people without a history of mental health issues. Internet-based interventions (IBIs) based on cognitive behavioral therapy (CBT) are effective in reducing symptom severity but data on their impact on quality of life in clinically depressed patients so far is scarce.MethodsSelfapy is a CBT-based IBI for depressive disorders. 401 participants (332 female, mean age 37 (SD = 11) with a diagnosis of major depressive disorder (MDD) or dysthymia were enrolled in a randomized, parallel, three-arm trial comparing a therapist-guided Selfapy intervention with an unguided Selfapy intervention and a waiting list control. QOL was measured using the WHOQOL-BREF at baseline, post-treatment (12 weeks) and at 24-week follow-up. The effects of the interventions on QOL were calculated using linear mixed effects models.ResultsAt post-treatment (12 weeks) the guided and unguided intervention groups reported an increase in QOL on physical and psychological health domains compared to controls (significant group*time interaction). The gain in QOL was maintained over the follow-up period only for psychological health. QOL decreased in the social relationships and environment domains over the course of treatment and during the follow-up treatment for all participants. There were no differences between the guided and the unguided intervention.ConclusionSelfapy proved to positively affect psychological and physical QOL in a sample of participants suffering from depressive disorders and can therefore be considered an effective and highly scalable therapeutic tool. The pattern of results might partly be attributable to effects of the COVID-19 pandemic and public health measures that coincided with the trial.Trial registration: German Clinical Trials Register (DRKS): DRKS00017191. Registered June 14th, 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017191.

COVID-19 reinfections in Mexico City: implications for public health.

Since its appearance, COVID-19 has immensely impacted our society. Public health measures, from the initial lockdowns to vaccination campaigns, have mitigated the crisis. However, SARS-CoV-2's persistence and evolving variants continue to pose global threats, increasing the risk of reinfections. Despite vaccination progress, understanding reinfections remains crucial for informed public health responses. We collected available data on clinical and genomic information for SARS-CoV-2 samples from patients treated in Mexico City from 2020 epidemiological week 10 to 2023 epidemiological week 06 encompassing the whole public health emergency's period. To identify clinical data we utilized the SISVER (Respiratory Disease Epidemiological Surveillance System) database for SARS-CoV-2 patients who received medical attention in Mexico City. For genomic surveillance we analyzed genomic data previously uploaded to GISAID generated by Mexican institutions. We used these data sources to generate descriptors of case number, hospitalization, death and reinfection rates, and viral variant prevalence throughout the pandemic period. The fraction of reinfected individuals in the COVID-19 infected population steadily increased as the pandemic progressed in Mexico City. Most reinfections occurred during the fifth wave (40%). This wave was characterized by the coexistence of multiple variants exceeding 80% prevalence; whereas all other waves showed a unique characteristic dominant variant (prevalence >95%). Shifts in symptom patient care type and severity were observed, 2.53% transitioned from hospitalized to ambulatory care type during reinfection and 0.597% showed the opposite behavior; also 7.23% showed a reduction in severity of symptoms and 6.05% displayed an increase in severity. Unvaccinated individuals accounted for the highest percentage of reinfections (41.6%), followed by vaccinated individuals (31.9%). Most reinfections occurred after the fourth wave, dominated by the Omicron variant; and after the vaccination campaign was already underway. Our analysis suggests reduced infection severity in reinfections, evident through shifts in symptom severity and care patterns. Unvaccinated individuals accounted for most reinfections. While our study centers on Mexico City, its findings may hold implications for broader regions, contributing insights into reinfection dynamics.

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.

Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4mg/day provided no benefit over 2mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p<0.001); use of higher doses (OR 4.3, p=0.03) and lower symptom scores (OR 0.9, p=0.01) were also determinants of effectiveness. Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.

Higher-Order Intrinsic Brain Network Trajectories After Antipsychotic Treatment in Medication-Naïve Patients With First-Episode Psychosis

BackgroundIntrinsic brain network connectivity is already altered in first-episode psychosis (FEP), but the longitudinal trajectories of network connectivity, especially in response to antipsychotic treatment, remain poorly understood. The goal of this study was to investigate how antipsychotic medications affect higher-order intrinsic brain network connectivity in FEP. MethodsData from 87 antipsychotic medication-naïve patients with FEP and 87 healthy control participants were used. Medication-naïve patients received antipsychotic treatment for 16 weeks. Resting-state functional connectivity (FC) of the default mode, salience, dorsal attention, and executive control networks were assessed prior to treatment and at 6 and 16 weeks after treatment. We evaluated baseline and FC changes using linear mixed models to test group × time interactions within each network. Associations between FC changes after 16 weeks and response to treatment were also evaluated. ResultsPrior to treatment, significant group differences in all networks were found. However, significant trajectory changes in FC were found only in the default mode and executive control networks. Changes in FC in these networks were associated with treatment response. Several sensitivity analyses showed a consistent normalization of executive control network FC in response to antipsychotic treatment. ConclusionsHere, we found that alterations in intrinsic brain network FC were not only alleviated with antipsychotic treatment, but the extent of this normalization was also associated with the degree of reduction in symptom severity. Taken together, our data suggest modulation of intrinsic brain network connectivity (mainly frontoparietal connectivity) as a mechanism underlying antipsychotic treatment response in FEP.

Reduction in Long COVID Symptoms and Symptom Severity in Vaccinated Compared to Unvaccinated Adults.

The impact of vaccination prior to infection on postacute sequelae of coronavirus disease 2019 (COVID-19, PASC), also known as long COVID, remains unclear. Here we assess the protective effect of vaccination on long COVID in a community-based setting. The Immunity Associated with SARS-CoV-2 (IASO) study is an ongoing prospective cohort of working adults that began in October 2020. Participants are actively followed for severe acute respiratory syndrome coronavirus 2 infection. We compared the prevalence of symptoms and symptom severity in vaccinated compared to unvaccinated cases. Our primary definition of long COVID was the presence of symptoms at 90 days postinfection; 30 days postinfection was also examined. Overall, by 90 days postinfection, 13% of cases had long COVID, with 27% of unvaccinated cases and 8% of vaccinated cases reporting long COVID (relative risk [RR], 0.31 [95% confidence interval {CI}, .22-.42]). Vaccination was also associated with significantly lower average severity scores at all timepoints (eg, relative severity at 90 days postinfection: -2.70 [95% CI, -1.68 to -3.73]). In the pre-Omicron era, 28% of unvaccinated cases and 18% of vaccinated cases reported long COVID (P = .07), and vaccinated cases reported less severe symptoms including less difficulty breathing (P = .01; 90-day RR, 0.07). Vaccinated cases had lower prevalence of long COVID and reduced symptom severity.

Influence of mental health service provision on the perceived quality of life among psychiatric outpatients: associations and mediating factors.

ObjectiveTo investigate the relationship between perceived mental health service provision and quality of life (QoL) as perceived by patients in psychiatric outpatient care.MethodsA total of 373 adult patients registered at 15 psychiatric outpatient clinics in three regions in central and southern Sweden were included in the study. Survey data were collected using a questionnaire on mental health service provision, symptom severity, recovery, clinical diagnosis, sociodemographics (serving as independent variables) and QoL (serving as the dependent variable). Three aspects of mental health service provision were used: patients’ perceived quality of care, perceived staff-patient interaction, and patient reported psychiatric treatments. Structural equation modelling was used to model the relationship among the variables.ResultsVariables in mental health service provision showed few direct associations with patients’ perceived QoL. Instead, the associations of mental health service provision on QoL were mainly mediated through symptom severity and recovery. These relationships were retained after adjusting for sociodemographic variables and clinical diagnoses. The final model achieved excellent goodness of fit (χ2 = 49.502, p = 0.230, RMSEA = 0.020, CFI = 0.997 and a SRMR = 0.024).ConclusionThis study shows that mental health service provision is associated with patients’ perceived QoL; however, this association is mostly indirect and mediated by reduced symptom severity and increased recovery. This finding can help inform the design of future interventions to enhance service provision to improve patients’ QoL.

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

Recent evidence supports the implementation of massed delivery of disorder-specific treatments in the military service member and veteran population. However, many treatment settings serve patients with a wide range of diagnoses, and often patients present with comorbid conditions. Growing evidence suggests transdiagnostic cognitive behavioral treatments are effective for a wide range of emotional disorders and may reduce barriers to access. Little is known about the feasibility and outcomes of the massed delivery of transdiagnostic treatments. The present study examined real-world outcomes of a 2-week intensive outpatient program using the Unified Protocol for emotional disorders (UP-IOP). The sample included military service members and veterans diagnosed with a range of emotional disorders, namely trauma- and stressor-related disorders, unipolar depressive disorders, and anxiety disorders. The present study examined outcomes of UP-IOP (depression, trauma-related symptom severity, and emotion dysregulation). Participants included all patients who sought UP-IOP in its first 15 months of operation (N = 117). A diagnosis of posttraumatic stress disorder (PTSD) was an exclusion criterion because the site had an established PTSD-specific IOP treatment option. Findings indicate UP-IOP was feasible, had 94% patient retention, and was effective in reducing symptom severity (Cohen's d = 0.76 for depression symptom severity, Cohen's d = 0.80 for trauma-related symptom severity). There was no observed reduction in emotion dysregulation over the 2-week course of treatment. The intensive transdiagnostic approach resulted in effective symptom reduction in an accelerated timeframe while minimizing patient attrition. These findings indicate massed delivery of transdiagnostic cognitive behavioral therapy (CBT) treatments should continue to be explored, especially for this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reduced Concussion Symptom Burden in Early Adolescent Athletes Using a Head-Neck Cooling Device.

To determine whether an investigational head-neck cooling device, Pro2cool, can better reduce symptom severity compared with standard postconcussion care in early adolescent athletes after a sports-related concussion. Prospective, longitudinal, randomized trial design conducted over a 28-day period. Six pediatric medical centers in Ohio and Michigan. The study enrolled 167 male and female 12- to 19-year-old athletes who experienced a sports-related concussion within 8 days of study enrollment and registering a Sports Concussion Assessment Tool 5 (SCAT5) composite score >7. Pro2cool, an investigational head-neck cooling therapy device, was applied at 2 postinjury time points compared with postconcussion standard of care only. Baseline SCAT5 composite symptom severity scores were determined for all subjects. Sports Concussion Assessment Tool 5 scores for concussed athletes receiving cooling treatment were analyzed across 6 independent postenrollment time points compared with subjects who did not receive cooling therapy and only standard care. Adverse reactions and participate demographics were also compared. Athletes who received Pro2cool cooling therapy (n = 79) experienced a 14.4% greater reduction in SCAT5 symptom severity scores at the initial visit posttreatment, a 25.5% greater reduction at the 72-hour visit posttreatment, and a 3.4% greater reduction at the 10-day visit compared with subjects receiving only standard care (n = 88). Overall, 36 adverse events (increased blood pressure, decreased pulse, and dizziness) were reported, with 13 events associated with the device, of which 3 were classified as moderate in severity. This study demonstrates the efficacy and safety of head and neck cooling for the management of concussion symptoms in adolescent athletes of an age group for which little to no prior data are available.

Recognizing and Treating Major Depression in Fibromyalgia: A Narrative Primer for the Non-Psychiatrist.

Fibromyalgia (FM) affects 2% to 8% of the general population. FM patients often experience self-stigma and feel rejected by healthcare providers and families, resulting in isolation and distressing symptoms of pain, fatigue, and poor cognitive functioning, increasing the risk of depressive symptoms. Major Depressive Disorder (MDD) is the most common comorbidity in FM patients (Any depression: 43%; MDD: 32%). Genome-wide association studies (GWAS) have identified a common genetic risk loci for major depression and fibromyalgia. Given that even minor symptoms of depression worsen the outcomes of FM patients, clinicians are challenged to identify and manage depression in these patients. However, due to overlapping symptoms, limited screening, and contamination bias, MDD often goes undiagnosed and presents a critical challenge. Unrecognized and untreated MDD in FM patients can exacerbate fatigue, sleep disturbances, and pain, reduce physical functioning, and increase the risk of developing comorbid conditions, such as substance abuse and cardiovascular disease. These comorbidities are associated with a lower treatment response rate, a higher dropout rate, and a greater risk of relapse. Clinicians may effectively identify and treat MDD in FM patients with appropriate pharmacologic agents combined with aerobic exercise and cognitive-behavioral therapies for core FM symptoms, thus significantly reducing symptom severity for both MDD and FM. Such a comprehensive approach will result in a much-improved quality of life. MedLine content was searched via PubMed to identify eligible articles between 1995 and 2023 using search terms fibromyalgia, major depressive disorder, and treatment of depression in fibromyalgia, and the most current information is presented. In this primer for clinicians caring for FM patients, we describe clinically relevant pharmacologic and non-pharmacologic management approaches for treating MDD in FM patients.