Subjective Responses Research Articles

Real-Time Assessment of Alcohol Reward, Stimulation, and Negative Affect in Individuals With and Without Alcohol Use Disorder and Depressive Disorders.

The allostasis theory states that, as addiction develops, alcohol is consumed to relieve negative affect rather than to produce positive effects. This study aimed to investigate the real-time subjective effects of alcohol in individuals with alcohol use disorder (AUD) and those prone to negative affect by virtue of having comorbid depressive disorder (DEP). Participants (N=221) completed high-resolution ecological momentary assessments during 3-hour monitoring of one alcohol drinking episode and one non-alcohol drinking episode in their natural environment. Participants also completed daily mood surveys and next-day surveys. Linear mixed-effect models were used to compare drinking behavior and subjective responses (stimulation, sedation, liking, wanting, negative affect) among 120 participants with AUD (AUD+; with depression [DEP+]: N=64, without depression [DEP-]: N=56) and 101 participants without AUD (AUD-; DEP+: N=45, DEP-: N=56). During the monitoring period, participants with AUD consumed an average of 8.5 standard alcohol drinks (estimated blood alcohol concentration [eBAC]=0.115 g/dl) versus 3.7 drinks (eBAC=0.040 g/dl) for non-AUD participants. The AUD group, regardless of comorbid DEP, reported increases in stimulation and rewarding effects that persisted throughout most of the alcohol episode relative to the non-alcohol episode. To a lesser extent, alcohol relieved negative affect but this was not specific to AUD or DEP groups. Contrary to the allostasis model of addiction's emphasis on negative reinforcement drinking, findings demonstrated that people with AUD prone to negative affect displayed positive alcohol reinforcement with pronounced and prolonged sensitivity to alcohol's pleasurable effects, akin to their noncomorbid counterparts. The findings provided critical testing of addiction theories in the natural environment to enhance external validity.

Does high perceived stress over the past month alter cortisol reactivity to the Trier Social Stress Test?

Theories highlight the important role of chronic stress in remodeling HPA-axis responsivity under stress. The Perceived Stress Scale (PSS) is one of the most widely used measures of enduring stress perceptions, and no previous studies have evaluated whether greater perceptions of stress on the PSS are associated with cortisol hypo- or hyperactivity responses to the Trier Social Stress Test (TSST). To examine if high perceived stress over the past month, as measured by the PSS, alters cortisol and subjective acute stress reactivity to the TSST in healthy young adults. Five studies across three laboratories involving healthy young adults (N = 585) were conducted. Participants were exposed to the TSST, and cortisol levels and subjective stress responses were measured. Studies 1-2 served as exploratory, and Studies 3-5 as explanatory, with pre-registered hypotheses. Higher PSS scores were consistently associated with greater acute subjective stress perceptions during the TSST across four out of five studies. Meta-analytic results revealed that higher perceived stress on the PSS was associated with blunted cortisol reactivity to the TSST. This cortisol hyporeactivity effect was more pronounced in studies using a combined speech and arithmetic TSST protocol compared to a speech-only protocol. Depressive symptoms did not significantly alter cortisol reactivity effects in these studies. Persistent high perceived stress over the past month may be associated with greater acute stress perceptions and blunted cortisol reactivity to the TSST. These findings highlight the potential importance of persistent perceived stress in HPA-axis responses to acute stress in healthy young adults, with potential implications for understanding stress-related health risks. Further research is needed to explore the underlying mechanisms and extend findings to diverse populations.

Bariatric surgery and alcohol and substance use: A case-control survey study.

Studies suggest alcohol and/or other substance misuse may develop after bariatric surgery (BS), but findings are not consistent or conclusive. This cross-sectional online survey investigated alcohol and other substance use, via a modified version of the Alcohol Use Disorders Identification Test, before and after bariatric surgery, compared to a non-bariatric surgery sample. Data were anonymously collected via Qualtrics from adults who reported alcohol or substance use (BS, n = 328; non-BS, n = 292). Problematic alcohol, opioid, amphetamine, and cannabis use were reduced post-surgery compared to pre-surgery. After surgery, participants expressed "guilt" associated with alcohol and other substance use (average 0.24 and 0.31 points higher, respectively) compared to pre-surgery. Compared to controls, the bariatric surgery group reported on average 1.99 points less problematic nicotine use pre-surgery (p = .012) and 2.42 points less post-surgery (p = .004). In contrast, compared to people without any history of bariatric surgery, the bariatric surgery group reported greater problematic use of alcohol, cannabis, hallucinogens, and/or inhalants pre-surgery (all p < .001); same results were found post-surgery for all drugs, (all p < .001) except for hallucinogens which was not significantly different between the two groups. Unlike previous reports, these survey-based results do not show an increase in problematic alcohol and substance use following bariatric surgery. Recall biases and the survey-based methodology are however important limitations of the present study. The observed increase in "guilt" associated with substance use may align with growing evidence suggesting increased subjective response to alcohol and other substances following bariatric surgery.

Revolutionary burnout: Subjective crisis responses and the demobilization of mass protest in Lebanon

ABSTRACT Studies on the outcomes of the Arab uprisings have largely focused on protest-exogenous causes of revolutionary failure. By contrast, endogenous drivers of demobilization remain understudied, despite growing evidence on the role of microlevel dynamics in making and breaking revolutionary momentum. This article addresses this gap by exploring the triangular relation between shifts in the structural environment of revolutionary movements, the lifeworld of those affected by these shifts and organizational dynamics on the meso level. Based on a combination of event data and narrative interviews with protagonists of the Lebanese Thawra uprising of 2019, itrecentres the debate on revolutionary trajectories on the agents of change themselves. Drawing on relational and emotion-sensitive approaches in social movement studies, I argue that complex subjective meaning making processes to navigate multiple social and political crises are crucial in understanding demobilization in post-revolutionary Lebanon. Formerly committed activists responded to increasing uncertainty through a combination of adaptation, disengagement and abeyance. These vectors of demobilization translated their subjective accounts of lived events into the organizational arena of the Thawra. By fuelling fragmentation, channelling activism into divergent avenues and supporting individual exit from politics they catalysed a decline of protest that is described here as a ‘revolutionary burnout’.

Psychometric properties of a German translation of the Functionality Appreciation Scale (FAS) among adults in Germany.

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) is a widely used instrument to measure appreciation for what the body is able to do. However, it has yet to be translated and validated for use in German-speaking populations. The aim of the present work therefore was to validate a German translation of the FAS following the EFA-to-CFA approach. Results of this validation in a representative sample with N = 2570 participants (1300 women, 1270 men) and a community sample with N = 466 participants (371 women, 95 men) indicate good psychometric properties and support the factorial validity, measurement invariance across women and men, construct validity (through associations with body appreciation, body dissatisfaction, self-esteem, mindfulness, intuitive eating, restrained eating, drive for thinness, and risk for disordered eating), incremental validity, internal consistency and preliminarily support the 2-4 week test-retest reliability of the German FAS. A qualitative analysis of participant feedback on understanding and subjective response difficulty provided additional support for the validity of the German translation of the FAS. Overall, the FAS is a suitable instrument for measuring functionality appreciation in adults from Germany.

Is intense exercise bad for your mind? Subjective, behavioral and physiological responses to a cognitive effort to failure

Introduction Most previous research has investigated if a cognitive task reduces the time a person can perform a posterior physical exercise (Holgado et al., 2023). However, no previous research has investigated if performing an intense physical exercise reduces the time a person can complete a cognitive task with an adequate level of performance. The aim of this study was to assess the subjective, behavioral and brain activity responses of performing an intense physical exercise on a posterior cognitive task until failure. Methods In a pre-registered, randomized, within-participant design experiment, 29 physically active participants completed a cognitive task until failure after running at 90% maximal aerobic speed until failure or after walking for 10 min (control condition). During the cognitive task, brain activity was recorded with an electroencephalogram and brain complexity was quantified. Multidimensional subjective experience was assessed with the Temporal Experience Tracing method (TET) (Jachs et al., 2022). Sequential Bayesian analysis for the main hypothesis (intense physical exercise reduces cognitive task performance) until it reached strong evidence in favor of the alternative hypothesis (BF10 &gt; 6), or the null hypothesis (BF10 &lt; 1/6) were conducted. Results The physical exercise induced a reduction in maximal force generating capacity and increased rate of perceived exertion compared to the control condition, evidencing the presence of fatigue. The total duration to complete the cognitive task in both conditions were 4755.8 s (95% CI 3326.8 - 5107.8) and 4308.2 s (95% CI 3902.9 - 5481.2) for the control and experimental conditions, respectively with no difference across sessions (BF10 = 0.329). Subjective experience analysis identified two distinct clusters of task-related feelings, but the time spent in these experiential states did not differ between conditions. However, cognitive task performance was better in the in the phases of low subjective demands. Brain complexity was lower after the physical fatigue condition, indicating a potential shift in physiological states, although neither behavioral performance nor subjective feelings were affected. Discussion/Conclusion In conclusion, our study did not find evidence that short intense physical exercise negatively affected negatively the duration participants could sustain an adequate (or optimal) cognitive effort. However, it offers valuable insights into the dynamic nature of psychological and subjective states during such tasks.

High β-Glucan Whole Grain Barley Reduces Postprandial Glycemic Response in Healthy Adults—Part One of a Randomized Controlled Trial

Background/Objectives: The effects of sweetened and unsweetened high β-glucan whole grain barley on postprandial blood glucose response in normoglycemic human subjects were evaluated in a randomized, controlled, crossover clinical trial. Methods: Sixteen healthy, over-night fasted participants were studied on four or eight separate occasions. Participants consumed an unsweetened preload condition (n = 16): white glutinous rice (WR; 0 g β-glucan), low β-glucan barley (LB; ~4 g), medium β-glucan barley (MB; ~5 g), or high β-glucan barley (HB; ~6 g); or a sweetened condition with high fructose corn syrup (HFCS; n = 8): WR + 50 g HFCS, LB + 50 g HFCS, MB + 50 g HFCS, or HB + 50 g HFCS. After consuming the preload as a breakfast food, participants self-administered blood glucose tests every 15 min for four hours. Results: In both sweetened and unsweetened conditions, higher β-glucan content was associated with lower blood glucose peak response and incremental area under the curve estimates (iAUC). In comparison to the unsweetened conditions, the sweetened conditions resulted in less prominent decreases in mean blood glucose response and iAUC blood glucose as β-glucan content increased. Conclusions: By attenuating postprandial glycemic response, high β-glucan whole grain barley foods could play a role in helping to control blood glucose.

P0362 Bowel urgency in inflammatory bowel disease: The URGENT index

Abstract Background Bowel urgency is commonly defined as the sudden need to rush to the bathroom to empty one’s bowel. In a systematic review including 321 studies evaluating bowel urgency, definition of bowel urgency was heterogeneous (1). In most of these studies, non-validated questionnaires, based on subjective responses of the patients, were used. The objective of this study were to develop the URGENT index, an IBD-specific bowel urgency index, and to evaluate correlation between the URGENT index and the Urgency Numeric Rating Scale (UNRS). Methods URGENT-1 was a cross-sectional, multicenter study with prospective inclusions of IBD patients and with an optional follow-up for a subset of patients. A stratification on the type of IBD was performed. The components of the URGENT index were based on variables describing in systematic review and expert opinion. All the symptoms potentially associated with bowel urgency were collected, and assessed with a 10-point visual analog scale. Results The content validity of the symptoms potentially associated with bowel urgency was tested by five experts. Face validity of the selected items was checked for clarity, comprehension, and ease of response with 20 patients. Then data corresponding to the selected items were collected. The overall Cronbach’s alpha coefficient was 0.972. We systematically removed items based on their individual impact on the overall Cronbach’s Alpha. Three main factors explained most of the variance (87.9%): immediate urgency and action, ability to delay to go to toilets, and emotional and behavioral responses to urgency. There was no difference in gender and IBD type in the distribution in the factorial structure. To construct the index, we extracted the loadings from the PCA results and identified significant loadings with a threshold of 0.6. Next, we calculated the row means for these significant items to create subscale scores for each component. These scores were then weighted by the variance explained by each component. The weights were normalized, and the final index, named URGENT index, was calculated as a weighted sum of the subscale scores. A sample of 40 patients, who were considered as stable, were studied to evaluate the test-retest reliability after a 3- week-period. Consistency of the URGENT index with the UNRS was tested using Spearman correlation test (0.77). Overall, the ICC values indicated good to excellent reliability across different models. Each index proposal will be tested prospectively. Conclusion This study developed an IBD-specific bowel urgency index. This will allow to have a homogeneous and standardized definition of bowel urgency, measure the effectiveness of treatments, and systematically assess this symptom in clinical practice for IBD patients. References Caron B, Ghosh S, Danese S, Peyrin-Biroulet L. Identifying, Understanding, and Managing Fecal Urgency in Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2023 Jun;21(6):1403-1413.e27. doi: 10.1016/j.cgh.2023.02.029. Epub 2023 Mar 9. PMID: 36906079.

Association between herpes simplex virus infection and Alzheimer’s disease biomarkers: analysis within the MAPT trial

In vitro and animal studies have suggested that inoculation with herpes simplex virus 1 (HSV-1) can lead to amyloid deposits, hyperphosphorylation of tau, and/or neuronal loss. Here, we studied the association between HSV-1 and Alzheimer’s disease biomarkers in humans. Our sample included 182 participants at risk of cognitive decline from the Multidomain Alzheimer Preventive Trial who had HSV-1 plasma serology and an amyloid PET scan. Plasma Aβ42/40 ratio, neurofilament light chain and p-tau181 were also available for a sub-sample of participants. Multivariate linear regressions were performed and stratified by APOE4 genotype. The median age was 74.0 years, 85.2% were infected with HSV-1. Infected participants tended to have a lower cortical amyloid load than uninfected participants (β = -0.08, p = 0.06), especially those suspected of reactivating HSV-1 most frequently (i.e. with a high anti-HSV-1 IgG level; n = 58, β = -0.09 p = 0.04). After stratification, the association was only significant in APOE4 carriers (n = 43, β = -0.21 p = 0.01). No association was found with the plasma biomarkers. The trend toward lower cortical amyloid load in HSV-1-infected participants was unexpected given the pre-existing literature and may be explained either by a modified immune response in HSV-1 infected subjects which could favour the clearance of amyloid deposits or by a selection bias.

Higher circulating ACE2 and DPP3 but reduced ACE and angiotensinogen in hyperreninemic sepsis patients.

Sepsis and septic shock are global healthcare problems associated with high mortality rates. Activation of the renin-angiotensin-aldosterone system (RAAS) is an early event in sepsis, and elevated renin may be predictive of worse outcomes. In a subset of sepsis patients enrolled in the Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial, elevated levels of active renin (median value > 189 pg/mL or 5.1 pM) at baseline (day 0) were strongly associated with mortality; however, corresponding plasma levels of the vasopressor hormone Angiotensin II were not substantially increased nor was Angiotensin II associated with disease severity. The current study assessed RAAS components that may impact the Angiotensin II response in control subjects, normal renin sepsis (NRS, renin < 5.1 pM) and high renin sepsis (HRS, renin > 5.1 pM) patients. NRS and HRS subjects exhibited a similar reduction in ACE (40%), but increased levels of ACE2 and DPP3. The ACE to DPP3 ratio was higher in controls but this relationship was reversed in both NRS and HRS subjects. Intact angiotensinogen was 50% lower in the HRS than control or NRS subjects, whereas the intact angiotensinogen to renin ratio was <10% of control or NRS subjects. We conclude that altered expression of ACE, ACE2, DPP3 and angiotensinogen may attenuate the expected increase in Angiotensin II, particularly in sepsis subjects with high renin concentrations.

A subjective response to ‘transitional phenomena’ and case study of chinoiseries in “Afro-Cuban” religions

ABSTRACT This article reflects on the approaches that contributors to this special issue have adopted in their study of religious (and non-religious) things. Most Winnicott-inspired studies of religion thus far have looked at embodied and communicative experience from the perspective of the linguistic turn, with its emphases on symbolism, meaning, narrative, and the interplay of psychic forces. This article observes that the contributors’ interventions bear the stamp of the sensory, affective, and ontological turns, offering insights that build on their layered interrogations of modernity, coloniality, secularism, indigeneity, conversion, and migration. The article concludes with a sketch of Chinese-coded objects (chinoiseries) in ‘Afro-Cuban’ religions that puts their straddling of racial and ontological categories forward as an example of transitional phenomena. This exploration is intended to press beyond the critique of fetishism as an analytic legacy of the transatlantic slave trade while grappling with the synaesthetic nature of engagement with religious things.

The Effect of Denosumab on Pain and Radiological Improvement in Giant Cell Tumours of the Spine in the Acute Setting.

Retrospective Cohort Study. The current recommended treatment for Giant Cell Tumour (GCT) of the spine is en bloc excision. Denosumab is a monoclonal antibody reducing osteoclast activity that shows promising results when used as a neo - adjuvant treatment. However, the current literature remains limited. The purpose of this study was to assess the effect of denosumab on tumour characteristics and symptom relief in the acute phase of treatment of spinal GCT. We performed a retrospective review of 16 patients treated with denosumab as neo-adjuvant and stand - alone treatment. MRI and PET tumour characteristics were taken before and after treatment and patients were interviewed for subjective pain responses. Following treatment, all patients showed improvement of pain, of which 68.7% of patients were pain free with 43.75% noting improvement within 48hours. Mean relative volumetric reduction in tumour volume was 37.3% (P < .001). Eight patients showed high grade of Bilsky classification (Epidural spinal cord compression scale - ESCC) with seven of them showing significant improvement to low grade of ESCC (P = .016). Median baseline PET Standardised Uptake Value (SUV)max was 14.57 and post treatment was 4.8 (P < .001). This study provides necessary insight to the limited literature on the use of denosumab for spinal GCT in the acute phase. The clinical and radiographic responses observed demonstrate the critical role that neo-adjuvant denosumab has by reducing the tumour burden around critical adjacent neurovascular structures before eventual resection, significant pain improvement even with presence of fractured vertebra.

Exploring the role of cardiac activity in forecasting cognitive fatigue with machine learning

Fatigue poses significant risks to safety, productivity, and overall well-being. Traditional statistical methods have been employed for inferring fatigue-related patterns; however, there is a need for interpretable machine learning approaches that integrate time series prediction capabilities to develop intelligent health systems for fatigue management. This study explored forecasting perception and performance scores associated with fatigue using cardiac activity and heart rate variability (HRV), employing both generalized and personalized models with a 10-minute forecast interval during a cognitively fatiguing task. Participants underwent a two-hour working memory task while providing subjective fatigue responses every 10 min, serving as perception labels, and their performance within each 10-minute interval was quantified as their performance labels. The results revealed that performance-labeled models generated lower mean absolute errors compared to perception-labeled models, while the Gradient Boosting Regression algorithm achieved the lowest mean absolute error in forecasting performance scores due to fatigue for both generalized and personalized models. Sample entropy, ratio of Standard Deviation-Poincaré, the proportion of peak-to-peak intervals over 50 ms, coefficient of variation of peak-to-peak intervals, and low frequency were the most important features for predicting performance. These findings offer the potential to forecast performance decline resulting from fatigue in working memory tasks, facilitating the implementation of fatigue mitigation interventions to reduce injury risks and performance impairments. The integration of interpretable machine learning methods with time series forecasting provides valuable insights for developing intelligent systems that proactively manage fatigue and optimize performance across various domains.

Efficacy of extracorporeal photopheresis in the treatment of severe erosive lichen planus: a case series

Abstract There are no good evidence-based recommendations for any systemic treatment of erosive lichen planus (ELP). Extracorporeal photopheresis (ECP) may be an effective therapy for recalcitrant forms of the disease. We report 3 patients with severe ELP treated with ECP. Objective clinical response as assessed by the dermatologist, subjective response as reported by the patient, and recorded adverse events were monitored. Each patient showed a partial response of cutaneous, oral and genital lesions. Esophageal lesions were more resistant to the treatment. The 3 report cases, added to the 38 other cases in the literature, strongly support the value of ECP for the treatment of ELP. ECP may be effective as salvage therapeutic option for ELP refractory to current treatments. Because of the lack of side effects in contrast to other therapies, ECP is an interesting therapeutic option when immunosuppressive drugs are contraindicated.

Effect of exercise training on modulating the TH17/TREG imbalance in individuals with severe COPD: A randomized controlled trial.

Chronic obstructive pulmonary disease (COPD) induces an imbalance in T helper (Th) 17/regulatory T (Treg) cells that contributes to of the dysregulation of inflammation. Exercise training can modulate the immune response in healthy subjects. We aimed to evaluate the effects of exercise training on Th17/Treg responses and the differentiation of Treg phenotypes in individuals with COPD. This randomized controlled trial included 50 individuals with severe or very severe COPD who were allocated to the Exercise or Control groups. The Exercise group underwent eight weeks of aerobic and muscle strength training, whereas the Control group received usual care. The primary outcome was the change in the phenotypic characteristics of Tregs and Th17 profile differentiation in systemic inflammation. Exercise training increased the frequency of total and activated Tregs and decreased the frequency of Th17 cells in between-group comparisons. Additionally, Th17/Treg responses were moderately correlated with improvements in the six-minute walking test, muscle strength of the upper and lower limbs, and daily life physical activity levels. Exercise training improved functional exercise capacity, muscle strength, and physical fitness, which was associated with a decrease in the Th17 inflammatory response and an increase in Treg cell phenotypes immunosuppressive activity.

Dynamic Accommodation Responses in Subjects Wearing Myopia Control Spectacles Modifying Peripheral Refraction.

Peripheral optics have been suggested to play a role in myopia progression, with accommodation responses also considered a potential contributor. This study aimed to investigate whether modifications in peripheral optics through different spectacle lenses affect accommodation responses. Dynamic accommodation responses were assessed using a double-pass instrument while switching the target from distance (3 m for 3 seconds) to near (0.22 m/4.5 D for adults, 0.18 m/5.5 D for children, 5 seconds) and then back to distance (3 m for 3 seconds). Three groups were studied. Group 1 included 13 adults (age = 28 ± 4.5years). Participants wore one of three myopia control lenses (MiYOSMART [Hoya], Stellest [Essilor], or MyoCare [ZEISS]) randomly, along with their habitual glasses. The testing involved both central clear zones and peripheral side-vision zones, with habitual glasses served as reference. Group 2 underwent same procedure, but in children (age = 9.8 ± 1.7years). Group 3 included 8 adults (age = 27.9 ± 5.3years) wearing standard glasses partially excised with central holes (diameter = 12 mm). The lens refraction included plano, +3 D defocus, -3 D defocus, and -3 D oblique astigmatism. The accommodative lag was less than 0.5 D for all eyes under near stimulation. No significant differences in the amplitude of accommodation responses were observed among the myopia control lenses or the partially excised glasses. No effect on accommodation responses was found in subjects wearing different types of myopia control lenses. This finding indicates that the induced changes in the ocular peripheral optics do not have an impact on accommodation.

The effect of co-ingesting rice and liquid on glycemic response and gastric emptying in healthy subjects.

Postprandial glycemic response is closely associated with gastric emptying rate. However, the effects of combining carbohydrates with liquid on gastric emptying and glycemic response are complicated. Here, we investigated the effect of co-ingesting rice and liquid in different ways on gastric emptying and glycemic response in healthy subjects. We performed a randomized crossover study in 12 healthy females. Three types of test meal were prepared: 150 g white rice (rice), 150 g white rice served alongside 200 mL of green tea (rice + tea), and 150 g white rice with 100 mL green tea poured over and served alongside 100 mL green tea (blend). After eating the test meal, measurements of postprandial glucose were performed, and breath samples for gastric emptying evaluation using (1-13C)-labeled sodium acetate breath test were collected for 120 min. Consumption of rice with liquid (both "rice + tea" and "blend") induced significantly higher postprandial glycemic responses, in addition to significantly higher gastric emptying rates, than eating rice only. There were significant positive correlations between gastric emptying rate and postprandial glucose response. Our findings demonstrated that compared with eating rice only, drinking liquid when eating rice causes an increase in postprandial blood glucose levels due to accelerated gastric emptying.

Impact of the Stigma of Mental Illness: A Descriptive Exploratory Study of Outpatients in a Public Mental Health Hospital in Ghana.

Despite ongoing efforts, persons with mental illness (PWMI) continue to experience stigma and discrimination and with profound negative outcomes. This study examined the psychological and social impact of the stigma attached to mental illness as experienced by out-patients at a public mental health facility. We applied a descriptive exploratory method using a semi-structured interview guide to elicit subjective responses from 12 Outpatient Department members. Study participants described various ways the stigma of mental illness impacted them within the social space. Overall, five (5) themes emerged. These include devaluing, losing their partners, social exclusion, unemployment, and loss of self-esteem. Participants' account of their experiences with stigma so far depicts stigma as an everyday occurrence that adversely impacts their social standing. To effectively address stigma requires intentional efforts to bridge the gap created by deliberate acts of discrimination and lack of support for PWMI within our social framework.

Reference Values of Touch Sense Threshold from an Adult Brazilian Cohort

Semmes-Weinstein monofilaments have been widely used in clinical practice to evaluate touch sense in healthy subjects and in the population of risk of neuropathies as Diabetes Mellitus and leprosy patients. It is an effective and low-cost clinical tool indeed, however, it is an instrument of low sensitivity with subjective responses. In the 1980s, a procedure was proposed for the psychophysical assessment of touch sense by sine-wave electric current stimulation. This assessment was based on studies that suggested sinusoidal electric stimuli of several different frequencies would excite sensory fibers of different diameters, increasing the selectivity of the stimulation. This study aims to evaluate and describe touch sense perception threshold of a healthy Brazilian cohort using sine-wave electric stimulation. Reference values of Current Perception Threshold (CPT) were registered in upper limb nerves of 100 healthy subjects, 57 (male) and 43 (female). All subjects had the ulnar, median, and radial nerves evaluated with a sine-wave electric stimulator called NEUROSTIM® to quantify the CPT for the frequencies 1Hz, 250Hz and 3000Hz. The CPT reference values for the Ulnar Nerve varied between 484µA - 1003µA for the 3000Hz frequency, 168µA - 322µA for the 250Hz and 122µA - 571µA for the 1Hz frequency. For the Median Nerve varied between 468µA - 1321µA for the 3000Hz frequency, 168µA - 386µA for the 250Hz and 168µA - 437µA for the 1Hz frequency. For the Radial Nerve varied between 516µA - 1350µA, 144µA - 533µA and 173µA - 342µA for each frequency respectively. The NEUROSTIM evaluation protocol seems to be effective, objective, and able to be replicated for touch sense evaluation in healthy subjects. Having CPT reference values to a Brazilian adult healthy cohort can help professionals in the clinics to have a better understanding, management and treatment of diseases affecting touch sense, such as leprosy, diabetes mellitus and others.

Z hypnotics in the management of narcolepsy: a case series.

Here we report our experience treating patients with narcolepsy using benzodiazepine receptor agonists (BzRA), zolpidem (Zol) or eszopiclone (Esz) taken at bedtime for both excessive daytime sleepiness (EDS) and cataplexy. We reviewed the medical records of 53 patients diagnosed with narcolepsy, between 2002 and 2023. Twenty-three patients, 8 with type1 (NT1), 13 with type 2 (NT2) and 2 with secondary narcolepsy, were treated with BzRA's (20 Zol and 3 Esz). Seven out of 8 (88%) with NT1, 9 out of 13 (69%) with NT2 and 2 out of 2 (100%) with secondary narcolepsy, treated with BzRA, had good to excellent subjective response in their symptoms of EDS and/or cataplexy; 5 patients, 1 of whom with NT1, had marginal or no response. Three of the responding patients remained on zolpidem in monotherapy (ie. no stimulants). The BzRa drugs may be effective to manage several of the cardinal symptoms of narcolepsy, regardless of the narcolepsy type. Placebo controlled trials are needed to confirm our observations.