Symptom Categories Research Articles

A Prospective Observational Study on Assessment of Prescribing Pattern and Effectiveness of Psychotropic Medication on Schizophrenia in a Tertiary Care Hospital

Abstract: Aim: Schizophrenia is a chronic mental disorder that is related to poor physical health, early death and severe functional impairment. Schizophrenia is a worldwide condition that affects 1% of the population. It refers to a category of symptoms that involve disorganized and bizarre thinking, delusions, hallucinations, inappropriate affect and poor psychosocial functioning. Aim/Background: The main aim of the study is to assess the prescribing pattern and effectiveness of psychotropic medication on schizophrenia. Materials and Methods: Patient data was collected using data collection form which included the demographic details, mental status examination, diagnosis and medications. Assessment of prescription pattern was done by analyzing the prescription of 30 patients. Effectiveness was evaluated using PANSS SCALE. Results: A total of 30 patients with schizophrenia were studied. Anti-psychotics were prescribed to 27 (90%) of the patients. Anti-depressants were prescribed to 5 (16.7%) patients. Mood stabilizers were prescribed to 2 (6.7%) patients. Tranquilizers/hypnotics were prescribed to 8 (26.7%) patients. Anti- cholinergic were prescribed to 11 (36.7%) patients. Other psychiatry drugs were prescribed to 4 (13.3%) patients. There was a significant reduction in PANSS score before and after treatment. This shows that psychotropic medication are effective in treating patients with schizophrenia. Conclusion: The present study concludes that antipsychotics are the most prescribed drugs in schizophrenia followed by anticholinergic. Psychotropic medications are effective in treating schizophrenia as it was proved by PANSS score analysis. The study report also showed that the impact of drug therapy was more effective in males than in females as it shows a significant improvement in the symptoms of schizophrenia. Keywords: Effectiveness, Prescription pattern, Gender, Polypharmacy, PANSS and Schizophrenia.

Longitudinal Measurement Invariance of the Depression Anxiety Stress Scale (DASS-21) in Filipino Adolescents

The Depression Anxiety and Stress Scale-21 (DASS-21) is a commonly used screener of mental health symptoms, and researchers continue to study the scale’s psychometric properties in different cultures and age groups. We tested the longitudinal measurement invariance of the DASS-21 across two time points on a sample of 312 Filipino adolescents. The confirmatory factor analysis indicated adequate fit between the hypothesized three-factor solution and the data from the adolescent sample. The DASS-21 also exhibited strict longitudinal invariance, and the subscales also displayed adequate reliability in the two time points. The results are the first demonstration of longitudinal invariance with a Filipino sample and provide evidence that DASS-21 can be useful in both screening and in monitoring severity of different categories of symptoms over time, particularly among school-based Filipino youth.

Incidence of SARS-Cov-2 in Patients Attending a Tertiary Care Hospital during Second Wave in Mahabubnagar, India- A Retrospective Study

Introduction: In the year 2020, infectious outbreak in Wuhan city of China with SARS-CoV-2 and its rapid spread to most countries in the world lead to the pandemic. Ramping up the testing infrastructure played an important role in containing the spread of SARS-CoV-2 among people in a district. In this view, virology laboratory was set-up at Government Medical College, Mahabubnagar, Telangana in October 2020. In the beginning of COVID -19 in India, samples collected in Mahabubnagar for detection of SARS-CoV-2 were sent to a Virology lab which was 100 km away from the district. Aim: The aim of this study was to observe the demographic details and the different variants of SARS-CoV-2. Materials and Methods: A retrospective study was performed on the nasopharyngeal swab samples received for a period of one year (November 2020 to October 2021) at Government Medical College, Mahabubnagar, Telangana using rtRT PCR as a method of diagnosis. The total samples recieved at the laboratory were 28221 out of which 28146 samples were included in the study. In addition, a total of 15 positive samples were sent to Centre for DNA Fingerprinting and Diagnostics (CDFD) for RNA sequencing to identify the variants of SARS-CoV-2. Demographic details were noted from the Indian council of Medical Research (ICMR) sample referral form. The data was analysed and presented as numbers and percentages. Results: 28146 samples were accepted and tested. Among these, 5749 samples were tested positive (20.42%). Males were predominant with 60.54% and 27.50% of the patients were in the age group of 21-30 years. Out of 5749, 43.75% of the patients were tested for the ILI symptoms (category 9). Fever was the most common symptom and most of the positive cases during the second wave in India were due to delta variant. Conclusion: In this study, delta was the only variant observed during the peak of second wave in Mahabubnagar district, Telangana.

FATORES ASSOCIADOS À AUTOAVALIAÇÃO DA SAÚDE NEGATIVA DE MULHERES DE MEIA-IDADE

ABSTRACT Objective: To evaluate factors associated with negative self-rated health among middle-aged women treated at a climacteric outpatient clinic. Method: This is a cross-sectional, analytical study conducted with 116 women assisted in the period between March 2015 and March 2020 at the climacteric outpatient clinic of a university hospital in Cuiabá, MT, Brazil. Data were collected through telephone interviews from October 2020 to January 2021, using a questionnaire containing questions about sociodemographic, health and psychosocial data. Self-rated health was checked by asking the subjects how they rated their health. The association measure used was the prevalence ratio and 95% confidence intervals (95%CI). Poisson’s multiple regression was used in the multivariate analysis. Results: Most middle-aged women in this study (54.3%) had negative self-rated health. The factor associated with the outcome was menopausal symptoms (p< 0.001), identified in the severe menopausal symptoms category PR= 2.95 (95%CI 1.4-6.3). Conclusion: The higher prevalence of negative self-rated health among the women in this study is probably related to the life stage they are experiencing. Menopausal symptoms are associated with women’s perception of health due to their discomfort and consequent impact on their lives.

EFFECTS OF DEPRESSIVE SYMPTOMS ON COGNITIVE BEHAVIORAL INTERVENTIONS WITH CUSTODIAL GRANDMOTHERS

Abstract Over 25% of custodial grandmothers report elevated depressive symptoms, which may affect situational appraisals and learning/retaining new information, and thus the effectiveness of cognitive-behavioral interventions. We examined the effect of depressive symptoms on self-appraised stress and reward associated with caregiving to co-residential grandchildren in a sample of 342 grandmothers who participated in a nationwide behavioral RCT testing two methods of stress reduction. Participants completed a baseline questionnaire, one of 2 cognitive-behavioral interventions (guided journaling or journaling with Resourcefulness Skills Training ©), and 3 subsequent questionnaires over 6 months. We analyzed self-appraised stress and reward with RM-ANOVAs to evaluate whether level of depressive symptoms (CES-D below-16, 16-29, 30+) affected the effectiveness of each arm with regard to self-appraised stress and reward. We found differences by depressive symptom category and interaction effects of depressive symptoms by arm in self-appraised stress. The below-16 group had relatively constant appraised stress over time, but the 16-29 and 30+ groups had significant decreases in stress over time. The Resourcefulness Skills Training © group had an average decrease in stress of .68 over time compared to .2 points for the journal-only group; there were no intervention effects in the below-16 group. The highest symptom group showed a stronger effect for the journal-only intervention, perhaps reflecting the challenges in learning and applying new skills. Self-appraised reward increased over time across groups. Participants' level of depressive symptoms have significant effects on the effectiveness of interventions and should be taken into consideration when designing studies and analyzing effectiveness.

Potential roles of oxidative distress on neurodegeneration in Parkinson's disease with neuropsychiatric symptoms.

Neuropsychiatric symptoms (NPSs) belong to a category of non-motor symptoms of Parkinson's disease (PD), which seriously compromise the quality of life and prognosis of PD. This study focused on the correlations between NPSs, free radicals, neuroinflammatory factors, and neuropathological proteins in cerebrospinal fluid (CSF) in patients with PD, aiming to provide insights into the potential mechanisms and therapeutic target for PD with NPSs (PD-NPSs). In total, 129 patients with PD were enrolled and assessed by the Neuropsychiatric Symptoms Inventory (NPI); they were divided into the PD-NPSs group (75 patients) and PD with no NPSs (PD-nNPSs) group (54 patients). The levels of hydrogen peroxide (H2O2) and nitric oxide (NO), and hydroxyl radical (·OH), anti-oxidative enzyme, neuroinflammatory factors, and neuropathological proteins in CSF from patients with PD were measured. The levels of the above variables were compared between PD-NPSs and PD-nNPSs groups, and correlation analyses among the above variables were conducted. (1) The levels of H2O2 and NO in CSF from the PD-NPSs group were significantly elevated compared with the PD-nNPSs group (p = 0.001), and NPI score positively correlated with the levels of H2O2 and NO (r = 0.283, P = 0.001; r = 0.231, P = 0.008). Reversely, total superoxide dismutase (tSOD) activity in CSF from the PD-NPSs group was significantly reduced compared with the PD-nNPSs group (p = 0.011), and negatively correlated with NPI score (r = -0.185, p = 0.036). (2) The tumor necrosis factor (TNF)-α level in CSF from the PD-NPSs group was significantly decreased compared with the PD-nNPSs group (p = 0.002) and negatively correlated with NPI score (r = -0.211, p = 0.016). (3) The total tau (T-tau) level in CSF from the PD-NPSs group was significantly higher than in the PD-nNPSs group (p = 0.014) and positively correlated with the NPI score (r = 0.167, p = 0.060). (4) The levels of H2O2 and NO positively correlated with the T-tau level in CSF from the PD-NPSs group (r = 0.183, p = 0.039; r = 0.251, P = 0.004), and the levels of TNF-α and T-tau showed a negative correlation (r = -0.163, p = 0.067). Oxidative distress characterized by the elevations of H2O2 and NO levels may closely correlate with the neurodegeneration in brain regions related to PD-NPSs. Thus, therapeutic antioxidants may become an important target for PD-NPSs therapy.

Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD.

A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.

Registered prodromal symptoms of out-of-hospital cardiac arrest among patients calling the medical helpline services

BackgroundEarly identification of warning symptoms among out-of-hospital cardiac arrest (OHCA) patients remains challenging. Thus, we examined the registered prodromal symptoms of patients who called medical helpline services within 30-days before OHCA.MethodsPatients unwitnessed by emergency medical services (EMS) aged ≥18 years during their OHCA were identified from the Danish Cardiac Arrest Registry (2014–2018) and linked to phone records from the 24-h emergency helpline (1−1−2) and out-of-hours medical helpline (1813-Medical Helpline) in Copenhagen before the arrest. The registered symptoms were categorized into chest pain; breathing problems; central nervous system (CNS)-related/unconsciousness; abdominal/back/urinary; psychiatric/addiction; infection/fever; trauma/exposure; and unspecified (diverse from the beforementioned categories). Analyses were divided by the time-period of calls (0-7 days/8-30 days preceding OHCA) and call type (1–1-2/1813-Medical Helpline).ResultsOf all OHCA patients, 18% (974/5442) called helpline services (males 56%, median age 76 years[Q1-Q3:65–84]). Among these, 816 had 1145 calls with registered symptoms. The most common symptom categories (except for unspecified, 33%) were breathing problems (17%), trauma/exposure (17%), CNS/unconsciousness (15%), abdominal/back/urinary (12%), and chest pain (9%). Most patients (61%) called 1813-Medical Helpline, especially for abdominal/back/urinary (17%). Patients calling 1–1-2 had breathing problems (24%) and CNS/unconsciousness (23%). Nearly half of the patients called within 7 days before their OHCA, and CNS/unconsciousness (19%) was the most registered. The unspecified category remained the most common during both time periods (32%;33%) and call type (24%;39%).ConclusionsAmong patients who called medical helplines services up to 30-days before their OHCA, besides symptoms being highly varied (unspecified (33%)), breathing problems (17%) were the most registered symptom-specific category.

A simple and rapid focal seizure screening tool in resource-limited setting

Background & Objective: A substantial proportion of patients were managed by general clinicians in resource-limited settings. Therefore, we aim to develop a simple and rapid focal seizure screening tool that can assist non-neurologists in seizure classification. Methods: We conducted a self-administered qualitative questionnaire study on seizure manifestation developed based on the validated comprehensive questionnaires by Reutens et al. for clinical diagnosis of seizures. Logistic regression analyses were conducted to determine the features of seizure which form the items of a focal seizure screening tool. A receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal cut-off score. Results: Among the 199 subjects, 145 (73%) had focal seizures. Three categories of symptoms, i.e., (i) aura (fear, déjà vu, and epigastric aura), (ii) unilateral motor phenomena, and (iii) oral automatism, are significantly associated with the diagnosis of focal seizure. The logistic regression model containing these 3 items / features was statistically significant, χ2 (3, N=199) = 22.93, p<0.001, and correctly classified 71.4% of cases. A focal seizure screening tool was developed by assigning a score of 1 to each category of symptoms. The area under the curve of ROC curve is 0.706 (95% CI: 0.629-0.783), p<0.001. A score of ≥2 is the most optimal cut-off with a sensitivity of 50.3%, specificity of 85.2%, positive predictive value (PPV) of 91.0%, and negative predictive value (NPV) of 41.8%. Conclusion: A simple and rapid self-administered focal seizure screening tool was established with high specificity and PPV.

Prevalence of neuropsychiatric symptoms is greater in early‐ than late‐onset Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms (NPS) present early in the disease course of Alzheimer’s disease (AD), increase in severity over time, and significantly affect patient and family quality of life. However, less clear is whether NPS may be more prevalent in early‐onset AD (EOAD) compared to late‐onset AD (LOAD).MethodData were obtained from the National Alzheimer’s Coordinating Center database. Baseline data from two groups – those with AD and those with a CDR of 0 at all visits (i.e., cognitively unimpaired [CU]) – were used for this analysis. Baseline was defined as the first time the individual was diagnosed with impaired cognition (AD) or the first evaluation (CU). Participants who completed the Neuropsychiatric Inventory Questionnaire were included. Participants who had additional neurological, systemic, psychiatric, or medical disease that could have significantly contributed to cognitive impairment were excluded. The AD group was divided into EOAD (< 65) or LOAD (≥65). The CU group was divided into early CU (< 65) or late CU (≥65) groups by age at evaluation.Multiple logistic regression models were run for each NPS to examine its association with symptom onset (early or late), AD vs. CU, and onset*ADvsCU. All models were adjusted for sex, education, and disease severity (CDR‐SB). To explore the potential for medications to mask group differences, exploratory models were also run for each NPI symptom adjusting for psychotropic medication use.ResultEOAD had higher rates of NPS than LOAD in almost all symptom categories (Figure 1). EOAD had significantly higher rates of elation, nighttime behavior and appetite/eating problems than LOAD relative to their CU age groups (p< 0.05). Younger age (age < 65) was associated with significantly higher prevalence of depression, anxiety, irritability, apathy, agitation, motor disturbance, and disinhibition (Table 1). Including medication use in these models did not change significance of results except for agitation (Table 1).ConclusionEOAD is associated with greater NPS burden than LOAD, and psychotropic medication use does not mitigate this association. Greater NPS load may significantly increase caregiver burden in this group. Future explorations will compare the association between disease progression and NPS severity in EOAD and LOAD.

Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms.

Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.

The Generation of a Lung Cancer Health Factor Distribution Using Patient Graphs Constructed From Electronic Medical Records: Retrospective Study.

Electronic medical records (EMRs) of patients with lung cancer (LC) capture a variety of health factors. Understanding the distribution of these factors will help identify key factors for risk prediction in preventive screening for LC. We aimed to generate an integrated biomedical graph from EMR data and Unified Medical Language System (UMLS) ontology for LC, and to generate an LC health factor distribution from a hospital EMR of approximately 1 million patients. The data were collected from 2 sets of 1397 patients with and those without LC. A patient-centered health factor graph was plotted with 108,000 standardized data, and a graph database was generated to integrate the graphs of patient health factors and the UMLS ontology. With the patient graph, we calculated the connection delta ratio (CDR) for each of the health factors to measure the relative strength of the factor's relationship to LC. The patient graph had 93,000 relations between the 2794 patient nodes and 650 factor nodes. An LC graph with 187 related biomedical concepts and 188 horizontal biomedical relations was plotted and linked to the patient graph. Searching the integrated biomedical graph with any number or category of health factors resulted in graphical representations of relationships between patients and factors, while searches using any patient presented the patient's health factors from the EMR and the LC knowledge graph (KG) from the UMLS in the same graph. Sorting the health factors by CDR in descending order generated a distribution of health factors for LC. The top 70 CDR-ranked factors of disease, symptom, medical history, observation, and laboratory test categories were verified to be concordant with those found in the literature. By collecting standardized data of thousands of patients with and those without LC from the EMR, it was possible to generate a hospital-wide patient-centered health factor graph for graph search and presentation. The patient graph could be integrated with the UMLS KG for LC and thus enable hospitals to bring continuously updated international standard biomedical KGs from the UMLS for clinical use in hospitals. CDR analysis of the graph of patients with LC generated a CDR-sorted distribution of health factors, in which the top CDR-ranked health factors were concordant with the literature. The resulting distribution of LC health factors can be used to help personalize risk evaluation and preventive screening recommendations.

Testing the longitudinal effect of metacognitive beliefs on the trajectory of work ability

There is increasing need to identify factors that contribute to poor work ability with an aim to prevent work related problems such as sick leave and disability pension. In the Metacognitive Control System model, dysfunctional metacognitive beliefs are seen as an underlying factor in psychological vulnerability beyond disorder, and recent studies have reported that metacognitions are associated with work ability and work status. In the present study, we set out to test if there is a prospective relationship between dysfunctional metacognitions and self-assessed work ability. Individuals in working age (M = 37.19; SD = 10.31) participated in a four-timepoint self-report survey (N = 528; 75% females) separated by six weeks between each timepoint. Baseline gender differences and differences between participants by job status were conducted using t-test and one-way ANOVA, respectively. Latent growth curve with covariates assessed the impact of dysfunctional metacognitions on work ability across the four timepoints. Males reported higher work ability. Participants in fulltime job also reported higher work ability followed by those in part-time job, jobseekers, sick leave up to 12 months, and sick leave > 12 months, respectively. Dysfunctional metacognitions predicted work ability over time when controlling for gender, age, physical health status, and three common categories of emotional distress symptoms. This finding suggest that dysfunctional metacognitions are a prospective predictor of work ability beyond health status and implies that these beliefs should be targeted with a view to increasing work ability and thus potentially reduce risk for sick leave and other work-related problems.

Presyndromic surveillance for improved detection of emerging public health threats.

Existing public health surveillance systems that rely on predefined symptom categories, or syndromes, are effective at monitoring known illnesses, but there is a critical need for innovation in "presyndromic" surveillance that detects biothreats with rare or previously unseen symptomology. We introduce a data-driven, automated machine learning approach for presyndromic surveillance that learns newly emerging syndromes from free-text emergency department chief complaints, identifies localized case clusters among subpopulations, and incorporates practitioner feedback to automatically distinguish between relevant and irrelevant clusters, thus providing personalized, actionable decision support. Blinded evaluations by New York City's Department of Health and Mental Hygiene demonstrate that our approach identifies more events of public health interest and achieves a lower false-positive rate compared to a state-of-the-art baseline.

Surveillance with Electronic PROs and ctDNA in p16+ Oropharynx Cancer: Lessons from the Prospective FOCUS Registry (Follow Up for HPV-Related Oropharynx Cancer Concentrated on Symptom Change)

<h3>Purpose/Objective(s)</h3> Optimal surveillance algorithms are not well defined in p16+ oropharynx cancer. Prior work suggests that recurrences are rarely detected during routine clinical follow up but we previously have shown a minimal clinically important difference (MCID) in PRO symptoms may be sensitive for detection of treatment failure. We instituted a prospective registry incorporating electronic PROs (ePRO) and blood ctDNA into surveillance. Primary objective was feasibility of electronic survey administration and compliance, with noncompliance defined as failure to complete 2 consecutive surveys. <h3>Materials/Methods</h3> Eligibility included stage I-III p16+ oropharynx cancer 3-38 months post definitive therapy and negative 3mo PET (HUM00183387). EORTC QLQ30/HN35 were collected by email monthly and blood HPV ctDNA was drawn every 3 months. <h3>Results</h3> Since 1/2021, 85 patients have been enrolled, of which 63 completed electronic consent while 24 patients were lost due to disinterest (3/24), technological challenges (3/24) and unable to be contacted by phone (18/24). Of the 63 consented patients, 41 (65%) were compliant (C) and 22 (35%) noncompliant (non-C) in answering monthly surveys, with a median follow up of 7.9 months and a median 7.5 surveys/participant. There was no difference in frequency of standard clinic-based follow up between C and non-C patients (p=0.97). Non-C patients were older (mean age 66.2 vs 60.5, p=0.007) and more likely to be enrolled in Medicare/Medicaid (54.5% vs 22%, p=0.009). There were no significant differences in baseline reported ePRO subscales at 1 month among C and non-C patients, suggesting that patient perception of QOL did not impact initial survey participation. Longitudinal ePRO analysis revealed that 29/53 patients with analyzable data reported a MCID change in at least 1/8 prespecified symptom categories, however there was no correlation between change in patients' perceived symptoms and continued survey compliance (p =0.9). 67 patients (79%) had ctDNA collected, with 151 post-treatment tests and a mean of 1.9 tests per patient. Five tests were detectable: 3 "indeterminate" values followed by undetectable tests, 1 detectable in a patient currently NED, and 1 detectable in a patient with recurrence. To date, there are 2 recurrences in this registry. <h3>Conclusion</h3> Patient participation in longitudinal ePROs was challenging in our cohort particularly among elderly patients, with only 65% compliance; however, about half of patients reported clinically meaningful MCID changes in at least 1/8 subcategories. This presents an opportunity for future studies to assess whether intervention upon reported MCID changes may impact compliance or post treatment QOL. ctDNA collection is feasible and may be incorporated into future surveillance algorithms given high patient compliance.

Mental well-being of healthcare workers in two hospital districts with differing COVID-19 incidence

Abstract Objectives Healthcare systems and healthcare workers have been under considerable strain during the COVID-19 pandemic in many countries. Our study aimed to assess the mental well-being of Finnish healthcare workers from two hospital districts with differing COVID-19 incidence rates (HUS, Hospital district of Helsinki and Uusimaa/Helsinki University Hospital; and Kymsote, Social and Health services in Kymenlaakso region) during the first wave of the COVID-19 pandemic in spring 2020. Material and methods The data of this prospective survey study was collected during summer 2020, and a total of 996 healthcare workers (HUS N = 862, Kymsote N = 134) participated. Mental health symptoms were self-reported, and symptom criteria followed ICD-10 classification, excluding duration criteria. We divided participants into symptom categories “often/sometimes” (those who met the diagnostic criteria), and “rarely/never” (those not meeting the diagnostic criteria), and compared these groups to sociodemographic factors and factors related to work, workload, and well-being. Results Despite differences in COVID-19 incidence, the degree of mental health symptoms did not differ between HUS and Kymsote districts (p = 1). A significant relationship was found between self-reported diagnostic mental health symptoms and experiences of insufficient instructions for protection against COVID-19 (in HUS cohort, p &amp;lt; 0.001), insufficient recovery from work (p &amp;lt; 0.001), and subjective increased workload (p &amp;lt; 0.001). Conclusions These findings show the importance of sufficient, well-designed instructions for protection from SARS-CoV-2 for healthcare workers, indicating their need to feel safe and protected at work. The workload of healthcare workers should be carefully monitored to keep it moderate and ensure their adequate recovery from work. Sufficient control of the epidemic to keep the burden of the healthcare system as low as possible is essential for healthcare workers’ well-being. Key messages

A Content Analysis of Self-report Child Anxiety Measures.

A clear understanding of the item content of psychological assessments is critical but often overlooked. This study describes the content overlap of seven commonly used and psychometrically validated measures of anxiety among children and adolescents. Symptom codes were created for all items across measures and items were sorted by these codes, which all fell into specific symptom categories. We conducted two analyses of all items: a "bottom-up" content categorization approach, which used symptom categories that were developed during this study, and a "top-down" DSM-5 categorization which mapped items onto symptoms of anxiety disorders in the DSM-5. Findings reveal a weak mean overlap across the included measures of youth anxiety. This suggests that the scope of anxiety measures should be carefully considered when designing studies, interpreting research, or assessing youth in clinical practice. Further research is needed to develop and establish a coding scheme for a more objective, comprehensive content analysis.

Categorizing individuals based on the severity of Visual Vertigo Analogue Scale symptoms.

The Visual Vertigo Analogue Scale (VVAS) assesses visual vertigo. Instead of the original scoring methods (positive VVAS > 1), we propose categorizing patients as having No (0), Mild (0.1-40), Moderate (40.01-70), or Severe (70.01-100) symptoms. Our primary aim was to validate an alternative interpretation of the VVAS by exploring the relationship between categories of visual vertigo symptoms and measures of activity and participation, dizziness handicap, anxiety, and depression. We aimed to describe the severity of visual vertigo reported by patients in different vestibular diagnostic categories. Participants with vestibular disorders (n = 250) completed the VVAS, Vestibular Activities and Participation (VAP) Measure, Dizziness Handicap Inventory (DHI), and the Hospital Anxiety and Depression Scale (HADS). Patients with central disorders were more symptomatic than those with peripheral vestibular disorders. As evaluated by one-way ANOVA, the scores on the VAP, HADS, and DHI significantly differed among mild, moderate, severe, and no visual vertigo categories (p < 0.001). As VVAS severity increased, activity and participation decreased (r = 0.582, p < 0.001); dizziness handicap increased (r = 0.597, p < 0.001, n = 199); anxiety increased (r = 0.405, p < 0.001); and depression increased (r = 0.521, p < 0.001). The findings of this study support the use of an alternative VVAS interpretation method of categorizing symptoms as none, mild, moderate, and severe visual vertigo.

Comparative Safety of the BNT162b2 Messenger RNA COVID-19 Vaccine vs Other Approved Vaccines in Children Younger Than 5 Years

SARS-CoV-2 vaccines are authorized for use in most age groups. The safety of SARS-CoV-2 vaccines is unknown in children younger than 5 years. To retrospectively evaluate the safety of the BNT162b2 vaccine used off-label in children younger than 5 years compared with the safety of non-SARS-CoV-2 vaccines in the same sample. This investigator-initiated retrospective cohort study included parents or caregivers who registered children for SARS-CoV-2 vaccination in outpatient care facilities in Germany. The study was performed as an authenticated online survey. A total of 19 000 email addresses were contacted from vaccination registration databases between April 14 and May 9, 2022. Inclusion criteria were child age younger than 5 years at the first BNT162b2 vaccination and use of a correct authentication code to prove invitation. Off-label BNT162b2 vaccination and on-label non-SARS-CoV-2 vaccinations. Reported short-term safety data of 1 to 3 doses of 3 to 10 μg BNT162b2 in children from birth to younger than 60 months are presented. Coprimary outcomes were the frequencies of 11 categories of symptoms after vaccination with bivariate analyses and regression models adjusting for age, sex, weight, and height. The study included 7806 children (median age, 3 years [IQR, 2-4 years]; 3824 [49.0%] female) who were followed up of for a mean (SD) of 91.4 (38.8) days since first BNT162b2 vaccination (survey response rate, 41.1%). A 10-μg dosage was more frequently associated with local injection-site symptoms compared with lower dosages. In the active-comparator analysis, the probability of any symptoms (odds ratio [OR], 1.62; 95% CI, 1.43-1.84), local symptoms (OR, 1.68; 95% CI, 1.38-2.05), musculoskeletal symptoms (OR, 2.55; 95% CI, 1.32-4.94), dermatologic symptoms (OR, 2.18; 95% CI, 10.7-4.45), or otolaryngologic symptoms (OR, 6.37; 95% CI, 1.50-27.09) were modestly elevated after BNT162b2 compared with non-SARS-CoV-2 vaccines, whereas the probabilities of general symptoms (OR, 0.77; 95% CI, 0.63-0.95) and fever (OR, 0.42; 95% CI, 0.32-0.55) were lower after BNT162b2. Symptoms requiring hospitalization (n = 10) were reported only at BNT162b2 dosages above 3 μg. In this cohort study, the symptoms reported after BNT162b2 administration were comparable overall to those for on-label non-SARS-CoV-2 vaccines in this cohort of children younger than 5 years. The present data may be used together with prospective licensure studies of BNT162b2 efficacy and safety and could help guide expert recommendations about BNT162b2 vaccinations in this age group.

The role of depression in secondary HIV transmission among people who inject drugs in Vietnam: A mathematical modeling analysis.

Among people who inject drugs (PWID), depression burden is high and may interfere with HIV prevention efforts. Although depression is known to affect injecting behaviors and HIV treatment, its overall impact on HIV transmission has not been quantified. Using mathematical modeling, we sought to estimate secondary HIV transmissions and identify differences by depression among PWID. We analyzed longitudinal data from 455 PWID living with HIV in Vietnam during 2009-2013. Using a Bernoulli process model with individual-level viral load and behavioral data from baseline and 6-month follow-up visits, we estimated secondary HIV transmission events from participants to their potentially susceptible injecting partners. To evaluate differences by depression, we compared modeled transmissions per 1,000 PWID across depressive symptom categories (severe, mild, or no symptoms) in the three months before each visit. We estimated a median of 41.2 (2.5th, 97.5th percentiles: 33.2-49.2) secondary transmissions from all reported acts of sharing injection equipment with 833 injecting partners in the three months before baseline. Nearly half (41%) of modeled transmissions arose from fewer than 5% of participants in that period. Modeled transmissions per 1,000 PWID in that period were highest for severe depressive symptoms (100.4, 80.6-120.2) vs. mild (87.0, 68.2-109.4) or no symptoms (78.9, 63.4-94.1). Transmission estimates fell to near-zero at the 6-month visit. Secondary transmissions were predicted to increase with depression severity, although most arose from a small number of participants. Our findings suggest that effective depression interventions could have the important added benefit of reducing HIV transmission among PWID.