Self-reported Physical Symptoms Research Articles

Attentional, anticipatory and spatial cognition fluctuate throughout the menstrual cycle: potential implications for female sport

Current research suggests that menstruating female athletes might be at greater risk of musculoskeletal injury in relation to hormonal changes throughout the menstrual cycle. A separate body of work suggests that spatial cognition might also fluctuate in a similar manner. Changes in spatial cognition could, in theory, be a contributing risk factor for injury, especially in fast-paced sports that require precise, millisecond accuracy in interactions with moving objects in the environment. However, existing theories surrounding causes for increased injury risk in menstruating females largely focus on biomechanical mechanisms, with little consideration of possible cognitive determinants of injury risk. Therefore, the aim of this proof-of-principle study was to explore whether menstruating females exhibit fluctuations in cognitive processes throughout their cycle on a novel sport-oriented cognitive test battery, designed to measure some of the mental processes putatively involved in these sporting situations.A total of 394 participants completed an online cognitive battery, a mood scale and a symptom questionnaire twice, 14 days apart. After exclusions, 241 eligible participants were included in the analyses (mean: 28 ± 6 years) (male = 96, female(menstruating) = 105, female(contraception) = 47). Cycle phase for menstruating females was based on self-reported information. The cognitive battery was designed to measure reaction times, attention, visuospatial functions (including 3D mental rotation) and timing anticipation. Three composite scores were generated using factor analysis with varimax rotation (Errors, Reaction Time, Intra-Individual Variability). Mixed model ANOVAs and repeated measures ANOVAs were performed to test for between and within-subject effects.There was no group difference in reaction times and accuracy between males and females (using contraception and not). However, within subject analyses revealed that regularly menstruating females performed better during menstruation compared to being in any other phase, with faster reaction times (10ms c.ca, p < .01), fewer errors (p < .05) and lower dispersion intra-individual variability (p < .05). In contrast they exhibited slower reaction times (10ms c.ca, p < .01) and poorer timing anticipation (p < .01) in the luteal phase, and more errors in the predicted ovulatory phase (p < .01). Self-reported mood, cognitive and physical symptoms were all worst during menstruation (p < .01), and a significant proportion of females felt that their symptoms were negatively affecting their cognitive performance during menstruation on testing day, which was incongruent with their actual performance.These findings suggest that visuospatial and anticipatory processes may fluctuate throughout the menstrual cycle in the general population, with better performance during the menstrual phase and poorer performance during the luteal phase. If these extend to associations between phase-specific cognitive performance and injury incidence, they would support a cognitive theory of determinants of injury risk in cycling female athletes, opening an opportunity to develop mitigation strategies where appropriate.

Study protocol: Identifying transcriptional regulatory alterations of chronic effects of blast and disturbed sleep in United States Veterans.

Injury related to blast exposure dramatically rose during post-911 era military conflicts in Iraq and Afghanistan. Mild traumatic brain injury (mTBI) is among the most common injuries following blast, an exposure that may not result in a definitive physiologic marker (e.g., loss of consciousness). Recent research suggests that exposure to low level blasts and, more specifically repetitive blast exposure (RBE), which may be subconcussive in nature, may also impact long term physiologic and psychological outcomes, though findings have been mixed. For military personnel, blast-related injuries often occur in chaotic settings (e.g., combat), which create challenges in the immediate assessment of related-injuries, as well as acute and post-acute sequelae. As such, alternate means of identifying blast-related injuries are needed. Results from previous work suggest that epigenetic markers, such as DNA methylation, may provide a potential stable biomarker of cumulative blast exposure that can persist over time. However, more research regarding blast exposure and associations with short- and long-term sequelae is needed. Here we present the protocol for an observational study that will be completed in two phases: Phase 1 will address blast exposure among Active Duty Personnel and Phase 2 will focus on long term sequelae and biological signatures among Veterans who served in the recent conflicts and were exposed to repeated blast events as part of their military occupation. Phase 2 will be the focus of this paper. We hypothesize that Veterans will exhibit similar differentially methylated regions (DMRs) associated with changes in sleep and other psychological and physical metrics, as observed with Active Duty Personnel. Additional analyses will be conducted to compare DMRs between Phase 1 and 2 cohorts, as well as self-reported psychological and physical symptoms. This comparison between Service Members and Veterans will allow for exploration regarding the natural history of blast exposure in a quasi-longitudinal manner. Findings from this study are expected to provide additional evidence for repetitive blast-related physiologic changes associated with long-term neurobehavioral symptoms. It is expected that findings will provide foundational data for the development of effective interventions following RBE that could lead to improved long-term physical and psychological health.

A register and questionnaire study of long-term general health symptoms following SARS-CoV-2 vaccination in Denmark

Many individuals who refuse COVID-19 vaccination have concerns about long-term side effects. Here, we report findings on self-reported symptoms from a Danish survey- and register study. The study included 34,868 vaccinated primary course recipients, 95.8% of whom received mRNA vaccines, and 1,568 unvaccinated individuals. Participants had no known history of SARS-CoV-2 infection. Using g-computation on logistic regression, risk differences (RDs) for symptoms between vaccinated and unvaccinated persons were estimated with adjustments for possible confounders. Within six weeks after vaccination, higher risks were observed for physical exhaustion (RD 4.9%, 95% CI 1.1% to 8.4%), fever or chills (RD 4.4%, 95% CI 2.1% to 6.7%), and muscle/joint pain (RD 7.0%, 95% CI 3.1% to 10.7%), compared to unvaccinated individuals. Beyond twenty-six weeks, risks were higher among the vaccinated for sleeping problems (RD 3.0, 95% 0.2 to 5.8), fever or chills (RD 2.0, 95% CI 0.4 to 3.6), reduced/altered taste (RD 1.2, 95% CI 0.2 to 2.3) and shortness of breath (RD 2.6, 95% CI 0.9 to 4.0). However, when examining pre-omicron responses only, the difference for reduced/altered taste was significant. As expected, the risk of experiencing physical exhaustion, fever or chills, and muscle/joint pain was higher among persons who responded within six weeks of completing the primary course. No significant differences were observed for the 7-25-week period after vaccination. Associations for the period beyond 26 weeks must be interpreted with caution and in the context of undetected SARS-CoV-2 infection, wide confidence intervals, and multiple testing. Overall, we observe no concerning signs of long-term self-reported physical, cognitive, or fatigue symptoms after vaccination.

Physical symptoms among professional gamers within eSports, a survey study

BackgroundThere is a need to establish the prevalence of self-reported physical symptoms such as pain in professional gamers (PGs) and to analyse whether there are correlations between lifestyle factors and self-reported physical symptoms. The purpose of this study was to analyse the prevalence of self-reported physical symptoms including eye-related problems in PGs. A further aim was to analyse the association between physical symptoms and lifestyle factors such as sleep time, play time and physical activity.MethodsThis study was designed as a cross-sectional study with data based on an electronic survey, created specifically for this study, through discussion and screening of established validated questionnaires for physical symptoms in musculoskeletal conditions: the Karolinska Sleep Questionnaire and the Nordic Musculoskeletal Questionnaire. The survey comprised age and years of experience as a PG as descriptive variables, as well as questions on sleep, play time, physical activity and physical symptoms for the purpose of analysis. The directors of 10 professional gaming corporations were contacted by email with a link to the study-specific survey to distribute to all employees.ResultsA total of 40 answers to the electronic survey were retrieved from 40 PGs, of which 62.5% (n = 25) had experienced at least one physical symptom in the three months prior to answering the survey. There was a significant association between playing time and physical symptoms (OR = 8.0; 95% CI 1.4–44.6, p = 0.018), where playing for more than 35 h a week was positively associated with eight times higher odds of experiencing physical symptoms.ConclusionThere is a high prevalence of physical symptoms, such as headache and eye symptoms, in professional eSports gamers. There was an association between playing more than 35 h per week with the prevalence of physical symptoms.

Physical activity, physical frailty and depressive symptoms among Chinese male and female older adults: do different indicators make a difference?

Older adults become more inactive and frailer with aging. Physical status is closely linked to mental health, but it is unclear which physical indicator is more strongly associated with depressive symptoms in older adults. The present study aimed to compare relationships between self-reported physical activity, physical frailty (muscle mass, muscle strength, and gait ability) and depressive symptoms in community male and female older adults. A total of 1,180 adults aged 60 years and older were recruited to participate in this study from a Chinese community receiving annual check-up service from September 2018 to May 2019. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). The Bio-electrical Impedance Analyzer was used to determine the muscle mass. As the indicators of muscle function, grip strength and gait ability were assessed by the dynamometer and Timed Up and Go Test (TUGT), respectively. The 15-item version of Geriatric Depression Scale (GDS-15) was used to examine depressive symptoms. Demographic variables, health status and sleep quality were collected using questionnaire. 11.8% men and 11.9% women reported depressive symptoms. Logistic regression showed that depressive symptoms was associated with low grip strength (OR = 2.42, 95% CI: 1.04-5.63), slow gait ability (OR = 3.60, 95% CI: 1.28-10.13) in older males, and associated with low level of self-reported physical activity (OR = 3.85, 95% CI: 2.00-7.42) in older females. No significant association was found between muscle mass and depressive symptoms. There were gender differences in the relationship between physical activity, physical frailty, and depressive symptoms. Grip strength and gait ability may be a better indicator of frailty for predicting depressive symptoms in older men while physical activity may be useful in predicting depressive symptoms in older women.

Preliminary efficacy and predictors of response to a remotely-delivered symptom self-management program for persistent symptoms after concussion

ABSTRACT Background More than a quarter of adults with concussion endure prolonged symptoms of >3 months. We developed the Concussion Education Self-Management program to help people manage persisting symptoms. Here, we assess feasibility, preliminary efficacy, and correlates of response. Methods N = 80 adults participated in the program; ages ranged from 18 to 65 years and time post-injury ranged from 6 months to 18 years. Weekly sessions, delivered remotely and in groups, comprised education and strategies for management of cognitive, emotional, and physical symptoms. Primary outcome: Confidence to self-manage symptoms. Secondary outcomes: Quality of life; mood/anxiety/stress. Predictors of response: Self-reported cognitive, emotional and physical symptoms at intake. Results Pre- to post-program improvements were observed in confidence to self-manage, p < 0.03; quality of life, p < 0.001; depression, p < 0.001; anxiety, p < 0.001; and stress, p < 0.001. Considering confidence to self-manage, those with fewer cognitive and physical symptoms benefitted more (p’s < 0.0005 and p < 0.01, respectively). Discussion This program shows promise for improving self-management of prolonged symptoms. Those with high symptom burden may need extra sessions to benefit. This is a cost-effective and scalable program that can reach people regardless of geographic location or impediments to travel.

Clinical Impact of Systematic Assessment and Psychoeducation in Specialized Treatment of Adolescents with Severe Functional Somatic Disorders: Results from the AHEAD Study.

Functional somatic disorders (FSD), characterized by persistent and disabling physical symptoms, are common in adolescents. Diagnostic uncertainty and insufficient illness explanations are proposed perpetuating factors that may constitute barriers for treatment engagement. This study describes the impact of manualized assessment and psychoeducation on diagnostic certainty and various clinical outcomes in adolescents with multi-system FSD. Ninety-one adolescents (15-19 years) received systematic assessment (4 h) and a subsequent psychiatric consultation (1.5 h). Clinical characteristics included self-reported physical health, symptom severity, illness perception, illness-related behavior, and psychological flexibility assessed before and approximately two months after assessment, prior to specialized treatment. Data were analyzed using t-tests. Immediately following assessment, 71 (80.7%) adolescents out of 88 reported a higher diagnostic certainty and 74 (84.1%) reported that attending assessment gave them positive expectations for future treatment. A clinically relevant improvement of physical health was not observed at two months but considerable reductions were seen in symptom severity, illness worry, negative illness perceptions, illness-related limiting behavior, and psychological inflexibility. The results emphasize that systematic assessment and psychoeducation are important in their own right in the specialized treatment of adolescents with severe FSD.

The added value of supervised hydrotherapy sessions to a 12-week exercise program after breast cancer treatment: a three-arm pseudo-randomized pilot study

Sufficient physical activity after breast cancer treatment is crucial for improvement of a wide range of health-related outcomes and survival. The first aim of this pilot study was to explore whether adding supervised hydrotherapy sessions to a standard 12-week exercise program consisting of already two supervised sessions of land-based exercises has beneficial effects on physical and mental functioning and quality of life in breast cancer survivors. As a secondary aim, the added value of a third supervised training session with land-based exercises to the same standard exercise program was investigated. Breast cancer patients who finished primary cancer treatment were allocated to one of the three 12-week exercise programs, i.e. a standard exercise program with two supervised land-based exercise sessions per week (control group) or the same standard program with an additional weekly supervised hydrotherapy session (hydrotherapy-group) or land-based exercise session (land-based exercise group). The efficacy of the three programs was tested by comparing changes in physical and mental functioning and quality of life from pre- until post-intervention. Twenty-six (41%) patients were allocated to the control group, 21 (33%) to the hydrotherapy-group and 16 (26%) to the land-based exercise group. The results show no differences in any outcome between the three groups. Comparing the two exercise programs with three supervised sessions, results show a significantly larger improvement in the self-reported moderate (median (IQR) +1240 (412;3330) vs. +50(-1088;1125);p=0.020) and total physical activity level (+2982 (878;5457) vs. +370(-576;1718);p=0.008) in the hydrotherapy-group compared to the land-based exercise group. The opposite was found for the outcome ‘physical symptoms’, a subscale from the health-related quality of life questionnaire with a larger improvement in the land-based exercise group compared to the hydrotherapy-group (+3(0.6;4.8) vs. +0.6(-0.8;2.1); p=0.008). In conclusion, the results of this pilot study indicate that adding a third weekly supervised session to a 12-week exercise program consisting of already two weekly supervised sessions had no added value for the improvement of physical and mental functioning and quality of life after breast cancer treatment. If a third supervised session is organized, hydrotherapy may be a valuable exercise modality since moderate and total physical activity levels seem to improve more compared to an exercise program with three supervised land-based exercise sessions. For self-reported physical symptoms although, a land-based exercise program seems more beneficial. Because of the limited sample size and pilot study design all obtained findings need to be interpreted with caution.

Socioeconomic Differences in the Association Between Bullying Behaviors and Mental Health in Canadian Adolescents.

Bullying and poverty are each associated with poor health in adolescents. We examined socioeconomic differences in the association of bullying and health. The 2017/2018 Canadian Health Behaviour of School-aged Children study surveyed 21,750 youth (9-18 years). We used linear regression models to investigate interactive effects of bullying involvement (traditional and cyberbullying) and socioeconomic position (SEP) on self-reported life satisfaction, psychological symptoms, and physical symptoms. Involvement in either form of bullying, as a perpetrator or a target, was associated with worse health and well-being compared to uninvolved youths. Associations of victimization via conventional bullying with low life satisfaction (b=-.33 [-.61, .05]), more psychological symptoms (b=.83 [.27, 1.38]), and more somatic symptoms (b=.56 [.14, .98]) were stronger at lower SEP. Socioeconomic disadvantage intensifies the association between bullying victimization and poor health. The intersections of victimization and poverty pose a significant health risk to adolescents.

Longitudinal associations of anticholinergic medications on cognition and possible mitigating role of physical activity.

Many older adults take at least one prescription medication with anticholinergic (ACH) activity, which can impact the central nervous system and can lead to cognitive decline and impairment especially in an aging population susceptible to cognitive changes. We examined this relationship between ACH burden and cognitive function in middle-aged and older adults. We further determined if increased activity levels mitigated the relationships between ACH burden and cognition. Data from The Reasons for Geographic and Racial Differences in Stroke project were used. We included 20,575 adults aged ≥45 years with longitudinal cognitive testing. The anticholinergic cognitive burden (ACB) scale was used to assess for ACH use and overall burden. Cognitive data included an overall composite score, a memory, and verbal fluency composites. Mixed effects models were conducted to determine if cognitive function worsened over time for participants with higher ACB (>3) scores. The full model adjusted for age, sex, race, education, diabetes, hypertension, cardiovascular disease, congestive heart failure, and dyslipidemia, self-reported physical activity (PA) and depressive symptoms. A significant relationship between ACH burden and composite cognitive scores was found (p= <0.001), with those with higher ACB showing more rapid cognitive decline over time. There was an effect of age for participants with higher ACB (>3) scores and ACB as a continuous variable. Baseline PA level was associated with less cognitive decline over time and this effect was greater in older cohorts. We observed an effect of ACHs on cognition in adults ≥45 years old that worsened with age. ACH users showed more cognitive effects, whereas PA emerged as a possible mitigating factor.

Mental and physical health correlates of the psychological impact of the first wave of COVID-19 among general population of Pakistan.

The primary aim was to assess the role of mental and physical health of COVID-19 and its psychological impact in the general population of Pakistan during the first wave of COVID-19. It was hypothesized that there would be a significant predictive association among socio-demographic variables, psychological impact and mental health status resulting from COVID-19, and poor self-reported physical health would be significantly associated with adverse psychological impact and poor mental health status because of COVID-19. A cross-sectional survey research design was used in which 1,361 respondents were sampled online during lockdown imposed in the country. The Impact of Events Scale-Revised (IES-R) was used to assess the psychological impact of COVID-19, and the Depression Anxiety Stress Scales (DASS-21) was used to assess participants' mental health status. 18% of the respondents reported moderate to severe event-specific distress, 22.6% reported moderate to severely extreme depression, 29% reported moderate to extreme anxiety, and 12.1% reported moderate to extreme stress. Female gender, having graduate-level education, currently studying, and self-reported physical symptoms (persistent fever, chills, headache, cough, breathing difficulty, dizziness, and sore throat) were significantly associated with higher levels of psychological impact exhibited through higher scores on the IES-R and poorer mental health status exhibited through higher scores on the DASS-21 (Depression, Anxiety, and Stress Subscales).

The Effects of Objective Push-Type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: mHealth Intervention Trial Using a Health Care Internet of Things System.

BackgroundSleep is beneficial for physical and mental health. Several mobile and wearable sleep-tracking devices have been developed, and personalized sleep feedback is the most common functionality among these devices. To date, no study has implemented an objective push-type feedback message and investigated the characteristics of habitual sleep behavior and diurnal symptoms when receiving sleep feedback.ObjectiveWe conducted a mobile health intervention trial to examine whether sending objective push-type sleep feedback changes the self-reported mood, physical symptoms, and sleep behavior of Japanese office workers.MethodsIn total, 31 office workers (mean age 42.3, SD 7.9 years; male-to-female ratio 21:10) participated in a 2-arm intervention trial from November 30 to December 19, 2020. The participants were instructed to indicate their momentary mood and physical symptoms (depressive mood, anxiety, stress, sleepiness, fatigue, and neck and shoulder stiffness) 5 times a day using a smartphone app. In addition, daily work performance was rated once a day after work. They were randomly assigned to either a feedback or control group, wherein they did or did not receive messages about their sleep status on the app every morning, respectively. All participants wore activity monitors on their nondominant wrists, through which objective sleep data were registered on the web on a server. On the basis of the estimated sleep data on the server, personalized sleep feedback messages were generated and sent to the participants in the feedback group using the app. These processes were fully automated.ResultsUsing hierarchical statistical models, we examined the differences in the statistical properties of sleep variables (sleep duration and midpoint of sleep) and daily work performance over the trial period. Group differences in the diurnal slopes for mood and physical symptoms were examined using a linear mixed effect model. We found a significant group difference among within-individual residuals at the midpoint of sleep (expected a posteriori for the difference: −15, 95% credible interval −26 to −4 min), suggesting more stable sleep timing in the feedback group. However, there were no significant group differences in daily work performance. We also found significant group differences in the diurnal slopes for sleepiness (P<.001), fatigue (P=.002), and neck and shoulder stiffness (P<.001), which was largely due to better scores in the feedback group at wake-up time relative to those in the control group.ConclusionsThis is the first mobile health study to demonstrate that objective push-type sleep feedback improves sleep timing of and physical symptoms in healthy office workers. Future research should incorporate specific behavioral instructions intended to improve sleep habits and examine the effectiveness of these instructions.

Psychometric Properties of the Functional Impairment Checklist (FIC) as a Disease-Specific Patient-Reported Outcome Measure (PROM) in Previously Hospitalized COVID-19 Survivors with Long-COVID.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is associated with a plethora of long-lasting symptoms (long-COVID). The presence of long-COVID symptoms causes decreased functionality. This study described the psychometric properties of the Functional Impairment Checklist (FIC), a disease-specific patient-reported outcome measure (PROM) used for evaluating the functional consequences of SARS in previously hospitalized COVID-19 survivors with long-COVID symptoms. The LONG-COVID-EXP-CM is a multicenter cohort study including patients hospitalized with COVID-19 during the first wave of the pandemic in five hospitals in Madrid. A total of 1969 (age: 61 ± 16 years, 46.4% women) COVID-19 survivors with long-COVID completed the FIC at a long-term follow-up after hospitalization (mean: 8.4 ± 1.5 months). Internal consistency (Cronbach alpha value), reliability (item-internal consistency, item-discriminant validity), construct validity (exploratory factor analysis), floor effect and ceiling effect were calculated. The mean time for fulfilling the FIC was 62 ± 11 s. The Cronbach’s alpha values reflecting the internal consistency reliability were 0.864 for FIC-symptoms and 0.845 for FIC-disability. The correlation coefficient between the FIC-symptoms and FIC-disability scale was good (r: 0.676). The ceiling effect ranged from 2.29% to 9.02%, whereas the floor effect ranged from 38.56% to 80.19%. The exploratory factor analysis showed factor loadings from 0.514 to 0.866, supporting good construct validity. Women exhibited greater limitations in all physical symptoms and disability-related domains of the FIC compared with men (all, p < 0.001). Further, younger patients (those aged <45 years) self-reported lower physical symptoms and disability-related domains than older patients. In conclusion, this study indicates that the FIC has good psychometric properties to be used as a specific-disease PROM to measure function and disability in COVID-19 survivors with long-COVID.

A brief report relating physical activity and depressive symptoms in women during the COVID-19 pandemic

Purpose.The purpose of this study was to investigate the association between self-reported physical activity and depressive symptoms in US women during the COVID-19 pandemic.Methods.A quantitative self-report online survey was administered to adult women (&lt;i&gt;n&lt;/i&gt; &gt; 800) in the United States during the COVID-19 pandemic in 2020. Physical activity was measured for frequency, intensity, and duration by using Likert scales, along with descriptive measures of types of activity. The Beck Depression Inventory II was applied to assess depressive symptoms.Results.The Beck Depression Inventory II score of participants not engaging in physical activity (&lt;i&gt;b&lt;/i&gt; = 13.344, SE = 0.593, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) was greater than that of participants engaging in physical activity. No difference in depression score was found in relation to physical activity intensity or duration, which suggests that these have no meaningful effect on depression symptoms.Conclusions.All types of self-rated physical activity (low-cost, low-risk activity) taken together are associated with lower depression in women during the COVID-19 pandemic.

Factors Associated With Physical and Psychological Health Outcomes Among Inmate Women in Portugal

This study aims to identify the variables associated with self-reported physical and psychological symptoms and the perceived health status of inmate women in Portugal. Data collection took place in two female Portuguese prisons and participated in the study 232 women. Physical symptomatology was associated with having children, physical abuse in childhood, a higher number of chronic diseases, and anxiety. Older women, the experience of sexual abuse, and chronic diseases were associated with a worse perception of physical health. Psychological symptoms were higher in women that reported substance abuse before prison, chronic diseases, anxiety, and depression. Finally, a combination of the prior variables (sexual abuse, anxiety, and depression) and three additional variables (lower education level, not having contact with mental health services before prison, and being already sentenced) was associated with worse perceptions of mental health conditions. These findings can be used as a platform for future research, as well as a tool for prison policy regarding the particular gender health needs of inmate women.

The association between physical activity and psychological well-being in a sample of medicine and health sciences students: a pilot study

Currently, the global physical activity guidelines are based on reducing the risk for mental disorders. More physical activity can decrease the risk for depression by up to 45%. Nevertheless, students of medicine and health sciences are more likely to develop a depression or an anxiety disorder and there is inconsistent evidence regarding the association between self-reported physical activity levels and depressive symptoms in adults. The objective of this study was to evaluate the correlates of anxiety, depression and habitual physical activity in medicine and health sciences students. A questionnaire survey method was employed to carry out this research in March 2020. In all, students (n = 174) of medicine and health sciences of Vilnius University were investigated. Based on present study data, 51.7% of the subjects did not get enough regular physical activity in Lithuania. Almost every third student was diagnosed with case-level anxiety and 4.6% of persons were found with case-level depression. The association between the habitual physical activity and anxiety disorder and/or depression prevalence in medicine and health students could not be explained by the total physical activity score (Adjusted odds ratio (AOR) 0.9; p = 0.914 and AOR 0.7; p = 0.695) or the separate scores of the components such as work index (AOR 2.8; p = 0.201 and AOR 5.4; p = 0.127), sport index (AOR 0.8; p = 0.711 and AOR 1; p = 0.963), leisure-time index of physical activity (AOR 0.7; p = 0.37 and AOR 0.6; p = 0.541).

Positive expressive writing as a tool for alleviating burnout and enhancing wellbeing in teachers and other full-time workers

Teachers are an occupational group particularly prone to suffering from burnout, a condition caused by chronic stress from work overload. Burnout is a risk factor for adverse psychological and physical health, thus it is important to test the efficacy of tools and techniques for alleviating burnout and enhancing job satisfaction. One potentially suitable technique is positive expressive writing. In the present study, we investigated the effects of a positive writing intervention on burnout, job satisfaction, anxiety, perceived stress and self-reported physical symptoms and compared these effects in teachers and other full-time workers.A group of teachers (n = 35) and a group of non-teachers (n = 31) who worked full-time in other professions were randomly allocated to complete either three consecutive days of positive expressive writing, or writing about a more neutral topic, online, 20 minutes per day, for three consecutive days State anxiety declined to a greater extent for participants in the positive writing condition compared to the neutral writing condition. Positive writing also conferred benefits on some aspects of job satisfaction, but not burnout. There were no specific benefits for teachers compared to non-teachers. The present study is the first to observe that positive expressive writing may be a useful technique for enhancing job satisfaction in full-time workers.

Pre-Injury headache and post-traumatic headache in patients with mild traumatic brain injury: neuropsychological, psychiatric, and post-concussion symptom outcomes

ABSTRACT Primary Objective Headache, both before and after injury, has been associated with worse outcome following mild traumatic brain injury (MTBI). This study examined whether three MTBI patient groups – no headache (reported no pre-/post-injury headache), pre-injury headache (reported pre-injury headache, nearly all of whom also reported post-injury headache), and post-traumatic headache only (denied pre-injury headache and reported post-injury headache) – differed in acute-to-subacute outcomes. Research Design Cross-sectional observational study. Methods and Procedures Patients within 21 days of a MTBI (n = 291) completed neuropsychological tests and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Main Outcomes and Results Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and participants with post-traumatic headache only reported greater change in self-reported physical and cognitive symptoms than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache only. Conclusions The pre-injury headache and post-traumatic headache only groups did not meaningfully differ in outcome within 21 days of MTBI, but they had worse physical and cognitive symptoms than participants with no headache. Future research should assess whether differences in outcome emerge further from injury and whether specific headache subtypes are differentially associated with outcome.

Do Patient Personality Traits and Self-Reported Physical and Psychosocial Symptoms Help to Predict Hallux Valgus Surgery Outcomes?

As many as 10% of patients remain unsatisfied after hallux valgus surgery. We explored the effects of patient personality traits and other preoperative patient characteristics on patient-reported outcomes following surgery. Eighty consecutive adult patients (mean age 45 ± 14 years, 91% female [73/80]) undergoing scarf bunionectomy at our practice were prospectively enrolled from January 2016 to January 2017 and followed for 12 months. Predictor variables included preoperative physical and psychosocial complaints (determined via Brief Battery for Health Improvement-2 questionnaire), patient aggression level, and personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness). Primary outcome measures included the Foot and Ankle Outcome Score (FAOS) with its 5 subscales, and patient satisfaction. Multiple multivariable regression models were used to determine preoperative patient characteristics associated with FAOS outcome and satisfaction at 12 months. Seventy subjects (70/80, 87.5%) completed the study. All patients experienced technically successful surgery. In the multivariable regression analyses, none of the combinations of potentially important predictor variables explained more than 19.8% of the variance in any of the 5 FAOS subscales at 12 months (range: 6.1%-19.8%). Furthermore, no predictor was associated with patient satisfaction in either the univariate or multivariable analyses. We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery. As healthcare delivery in the United States has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.

Patient-Reported Outcomes-Guided Adaptive Radiation Therapy for Head and Neck Cancer.

PurposeTo identify which patient-reported outcomes (PROs) may be most improved through adaptive radiation therapy (ART) with the goal of reducing toxicity incidence among head and neck cancer patients.MethodsOne hundred fifty-five head and neck cancer patients receiving radical VMAT (chemo)radiotherapy (66-70 Gy in 30-35 fractions) completed the MD Anderson Symptom Inventory, MD Anderson Dysphagia Inventory (MDADI), and Xerostomia Questionnaire while attending routine follow-up clinics between June-October 2019. Hierarchical clustering characterized symptom endorsement. Conventional statistical approaches indicated associations between dose and commonly reported symptoms. These associations, and the potential benefit of interfractional dose corrections, were further explored via logistic regression.ResultsRadiotherapy-related symptoms were commonly reported (dry mouth, difficulty swallowing/chewing). Clustering identified three patient subgroups reporting: none/mild symptoms for most items (60.6% of patients); moderate/severe symptoms affecting some aspects of general well-being (32.9%); and moderate/severe symptom reporting for most items (6.5%). Clusters of PRO items broadly consisted of acute toxicities, general well-being, and head and neck-specific symptoms (xerostomia, dysphagia). Dose-PRO relationships were strongest between delivered pharyngeal constrictor Dmean and patient-reported dysphagia, with MDADI composite scores (mean ± SD) of 25.7 ± 18.9 for patients with Dmean <50 Gy vs. 32.4 ± 17.1 with Dmean ≥50 Gy. Based on logistic regression models, during-treatment dose corrections back to planned values may confer ≥5% decrease in the absolute risk of self-reported physical dysphagia symptoms ≥1 year post-treatment in 1.2% of patients, with a ≥5% decrease in relative risk in 23.3% of patients.ConclusionsPatient-reported dysphagia symptoms are strongly associated with delivered dose to the pharyngeal constrictor. Dysphagia-focused ART may provide the greatest toxicity benefit to head and neck cancer patients, and represent a potential new direction for ART, given that the existing ART literature has focused almost exclusively on xerostomia reduction.