Symptom Check Research Articles

Altered self-reported resting state mediates the effects of Mindfulness-Based Stress Reduction on mental health: a longitudinal path model analysis within a community-based randomized trial with 6-months follow-up.

A large body of randomized controlled trials (RCTs) has shown that mindfulness-based interventions are effective for improving mental health, but research is lacking in regards to the mechanisms of change. We aimed to investigate the mediating effects of self-reported altered resting state of Mindfulness-Based Stress Reduction (MBSR) on mental health, when provided as a universal intervention in a real-life context. Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in an RCT. The RCT took place in all five geographical regions of Denmark and included 110 schools and 191 schoolteachers. The schools were randomized 1:1 in each geographical region to intervention or a wait-list control group. The intervention was the standardized MBSR. Data were collected at baseline and after 3 and 6 months. The outcomes were perceived stress, measured by Cohen's Perceived Stress Scale (PSS), symptoms of anxiety and depression, measured by Hopkins Symptom Check List-5 (SCL-5), and well-being measured by WHO-5 Well-being Index (WHO-5). The mediator was resting state measured by the Amsterdam Resting State Questionnaire (ARSQ). Statistically significant mediated effects of altered ARSQ-subscales scores for Discontinuity of Mind, Planning, and Comfort were found for the MBSR effect on all outcomes; PSS, SCL-5 and WHO-5. Furthermore, statistically significant mediated effects of altered sleepiness subscale score of the effects on PSS and SCL-5 of MBSR were found. No statistically significant mediating effects of the subscales Theory of Mind, Self and Somatic Awareness for the MBSR intervention effect were found. The results support that the MBSR program can alter self-reported resting state, towards less mind wandering and more comfort, measured by the ARSQ, and that this may explain some of the mechanisms regarding the effectiveness of MBSR on mental health at 6 months, when provided as a universal intervention. The study provides insight into an active ingredient of how MBSR may improve mental health and well-being. It supports the suggestions that mindfulness meditation may be a sustainable way of training the mental health.Clinical trial registration:ClinicalTrials.gov, identifier NCT03886363.

Continuous theta-burst stimulation in patients with drug-resistant epilepsy: A single-blind placebo-controlled cross-over pilot study

ObjectivesTo evaluate the effect of continuous theta-burst stimulation (cTBS) in patients with drug-resistant epilepsy (DRE). MethodsTwelve patients with DRE (five with idiopathic generalized and seven with focal epilepsy) were included in this cross-over design study and randomized to either first sham or first active stimulation, each applied for 5 consecutive days. A round coil over the vertex was used in generalized epilepsy or a figure-of-8 coil over the “epileptogenic area” in focal epilepsy. Sham stimulation was given by placing the coil 90° perpendicular to the head. The number of seizures, electroencephalography findings, Quality of Life in Epilepsy Inventory (QOLIE-84), and Symptom Check List (SCL-90) scores evaluated during the 8–12 weeks before and after active and sham stimulations were compared statistically. ResultsEight patients could complete both active and sham stimulation periods of 5 days and two patients completed active stimulation sessions, without any significant adverse effects. The number of seizures significantly reduced after active cTBS, but not after sham stimulation, when compared with those recorded before the stimulation period. QOLIE scores were increased, but interictal epileptiform discharges and SCL-90 scores showed no difference after cTBS. Active stimulation was stopped in one patient after he experienced an aggravation of myoclonic seizures. ConclusionscTBS seemed to be relatively safe and gave promising results in reducing the frequency of seizures in patients with both generalized and focal DRE. This time-saving technique may ease the introduction of repetitive transcranial magnetic stimulation into the routine practice of busy epilepsy clinics.

Assessment of mental health status among Chinese nursing staff in the intensive care unit: a network analysis.

Nursing is the key group to provide healthcare services, and it is easy for nursing staff to develop mental health problems. The study aimed to evaluate prevalence of psychological symptoms in nurses working in an intensive care unit (ICU) and the inter-relationship of associations of psychological symptoms using network analysis. This study is a cross-sectional design study. The Chinese version of the Symptom Check List-90 (SCL-90) was used to measure the psychological status of ICU nurses. The network structure of psychological symptoms was characterised, and indices of 'Expected influence' were used to identify symptoms central to the network. Network stability was examined using a case-dropping bootstrap procedure. Multiple logistic regression analysis found those who had worked more than 15 years were less likely to experience positive psychological symptoms, whereas nurses working in emergency ICU and other ICUs, nurses working in departments with over 16 beds were more likely to develop psychological symptoms. In addition, 'Anxiety', 'Mental degeneration' and 'Depression' were central symptoms in the network. ICU nurses reported a high level of psychological symptoms, which may affect the quality of their work and worsen public health problems.

Impacts of Symptom Checkers for Laypersons' Self-diagnosis on Physicians in Primary Care: Scoping Review.

Symptom checkers (SCs) for laypersons' self-assessment and preliminary self-diagnosis are widely used by the public. Little is known about the impact of these tools on health care professionals (HCPs) in primary care and their work. This is relevant to understanding how technological changes might affect the working world and how this is linked to work-related psychosocial demands and resources for HCPs. This scoping review aimed to systematically explore the existing publications on the impacts of SCs on HCPs in primary care and to identify knowledge gaps. We used the Arksey and O'Malley framework. We based our search string on the participant, concept, and context scheme and searched PubMed (MEDLINE) and CINAHL in January and June 2021. We performed a reference search in August 2021 and a manual search in November 2021. We included publications of peer-reviewed journals that focused on artificial intelligence- or algorithm-based self-diagnosing apps and tools for laypersons and had primary care or nonclinical settings as a relevant context. The characteristics of these studies were described numerically. We used thematic analysis to identify core themes. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to report the study. Of the 2729 publications identified through initial and follow-up database searches, 43 full texts were screened for eligibility, of which 9 were included. Further 8 publications were included through manual search. Two publications were excluded after receiving feedback in the peer-review process. Fifteen publications were included in the final sample, which comprised 5 (33%) commentaries or nonresearch publications, 3 (20%) literature reviews, and 7 (47%) research publications. The earliest publications stemmed from 2015. We identified 5 themes. The theme finding prediagnosis comprised the comparison between SCs and physicians. We identified the performance of the diagnosis and the relevance of human factors as topics. In the theme layperson-technology relationship, we identified potentials for laypersons' empowerment and harm through SCs. Our analysis showed potential disruptions of the physician-patient relationship and uncontested roles of HCPs in the theme (impacts on) physician-patient relationship. In the theme impacts on HCPs' tasks, we described the reduction or increase in HCPs' workload. We identified potential transformations of HCPs' work and impacts on the health care system in the theme future role of SCs in health care. The scoping review approach was suitable for this new field of research. The heterogeneity of technologies and wordings was challenging. We identified research gaps in the literature regarding the impact of artificial intelligence- or algorithm-based self-diagnosing apps or tools on the work of HCPs in primary care. Further empirical studies on HCPs' lived experiences are needed, as the current literature depicts expectations rather than empirical findings.

Rehabilitation After Total Laryngectomy: An Integrated Protocol Remotely Delivered During COVID-19.

The aim of this paper was to evaluate the results of an integrated treatment delivered remotely to laryngectomized patients with voice prosthesis. Eighteen laryngectomized patients were treated remotely in groups co-led by a speech therapist and a psychologist ("Online Group"). The results were compared with those of 17 patients ("In-Person Group") previously studied. The two groups obtained comparable results on all parameters of the INFVo perceptual rating scale, in the DEP, ANX, PHO and HOS areas of the Symptom Check List-90-Revised questionnaire, and in the areas investigated by the WHOQOL-B questionnaire. The "In-Person Group" obtained statistically better results on the Italian Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire. Although the in-person treatment favored the acceptance of the new voice and the development of conversational skills, telerehabilitation guaranteed an adequate level of assistance in terms of voice acquisition, prevention of anxiety and depression, and recovery of a good QoL.

The Role of Mood Stabilizers in Children and Adolescents with Anorexia Nervosa: A 1-year Follow-Up, Propensity Score-Matched Study.

The existing literature on the use of mood stabilizers (MS) in children and adolescents with anorexia nervosa (AN) is limited, for the most part, to small case studies. This was an observational, naturalistic, propensity score-matched study. Subjects treated and not-treated with MS were compared by being matched via propensity score on age, sex, concurrent atypical antipsychotics, and concurrent antidepressants. General and AN-specific psychopathology was assessed with Symptom Check List-90-R, Beck Depression Inventory-II, Eating Disorders Inventory-3, and Body Uneasiness Test-A. Potential differences in admission-discharge modifications (body mass index (BMI), psychopathology) among the two groups were assessed. Finally, re-hospitalizations after 1-year follow-up were assessed with Kaplan-Meier analyses. The study enrolled 234 hospitalized patients (15.9+/-3.3 years; 26, 11.1% receiving MS). After propensity-score matching, 26 MS patients matched with 26 MS-not-treated subjects were included. MS were used for a mean of 126.1 (+/-87.3) days, and two cases of side effects were documented (alopecia and somnolence with valproate). No significant difference between MS-treated and not-treated patients emerged concerning admission-discharge improvements in BMI and AN-specific or general psychopathology. The cumulative survival from re-hospitalization at 12 months was 64,4% (95%-CI, 31.3-97.5) for MS and 58.7% (95%-CI, 22.2-95.2) for MS-not-treated subjects. No significant difference in survival rate emerged (hazard ratio, 0.04; Log-rank test: p=0.846). This propensity score-matched study expands on the scant existing evidence of the use and side effects of MS in children and adolescents with AN. These results should be assessed in wider longitudinal samples.

National norms of mental health for Denmark

Introduction To facilitate interpretation and clinical utility of patient-reported outcomes, normative data provide a reference for a person’s score on a particular outcome in relation to the general population. This study reports Danish general population norms for four mental health indicators, assessing social functioning (Sheehan Disability Scale, SDS) personal recovery (Brief INSPIRE-O), symptom burden (Symptom Check List-10, SCL-10) and subjective well-being (WHO-5). Methods The study was a cross-sectional survey study organized by the State’s statistical authority among the general population of adult Danish residents in Denmark, ranging in age between 18 to 79 years. Results A total of 8003 citizens were contacted including reminders from 2 March 2019 to 11 April 2019 by electronic letters, resulting in 2819 (35%) citizens providing complete responses. Female gender, higher age, Danish origin and living with a partner were associated with increased participation, and decreased participation was observed in male immigrants. We found a mean score of subjective well-being slightly lower than the population norm typically found in Danish general population studies. Elderly persons, Danes, and persons living with a partner reported better subjective mental health. Subjective well-being and personal recovery were positively correlated with social contacts and self-reported general health rating, and negatively correlated with social functioning and symptoms of depression and anxiety. Conclusion This normative data provides a reference for interpreting mental health status. Our findings indicate slightly poorer subjective mental health than previously found. There is a need for special attention to engaging male immigrants in studies on mental health in the general population.

Data as symptom: Doctors' responses to patient-provided data in general practice.

People are increasingly able to generate their own health data through new technologies such as wearables and online symptom checkers. However, generating data is one thing, interpreting them another. General practitioners (GPs) are likely to be the first to help with interpretations. Policymakers in the European Union are investing heavily in infrastructures to provide GPs access to patient measurements. But there may be a disconnect between policy ambitions and the everyday practices of GPs. To investigate this, we conducted semi-structured interviews with 23 Danish GPs. According to the GPs, patients relatively rarely bring data to them. GPs mostly remember three types of patient-generated data that patients bring to them for interpretation: heart and sleep measurements from wearables and results from online symptom checkers. However, they also spoke extensively about data work with patient queries concerning measurements from the GPs' own online Patient Reported Outcome system and online access to laboratory results. We juxtapose GP reflections on these five data types and between policy ambitions and everyday practices. These data require substantial recontextualization work before the GPs ascribe them evidential value and act on them. Even when they perceived as actionable, patient-provided data are not approached as measurements, as suggested by policy frameworks. Rather, GPs treat them as analogous to symptoms-that is to say, GPs treat patient-provided data as subjective evidence rather than authoritative measures. Drawing on Science and Technology Studies (STS) literature,we suggest that GPs must be part of the conversation with policy makers and digital entrepreneurs around when and how to integrate patient-generated data into healthcare infrastructures.

P175 Creating a social movement for change to transform care and drive down diagnostic delay in axial SpA

Abstract Background/Aims It should be possible for every person experiencing symptoms of axial SpA to receive a diagnosis within one year of symptom onset. In June 2021, NASS published a route map to achieve a gold standard time of one year. Starting from a current baseline average of 8.5 years, the achievement of this goal will require transformational change. Above all, to attain such a dramatic change in time to diagnosis, we must win hearts and minds, build a movement of people who want to work with us to create change, and demonstrate proof of concept for our ideas. Methods Our campaign is designed around two key considerations. Firstly, a broad theory of change that describes how we can create system-wide change. Secondly, an understanding of the patient journey from symptom onset to diagnosis by a rheumatologist. Our theory of change first builds a ‘burning platform’, setting out why action and change is needed; we will use this to influence the thinking and behaviour of the public, policy makers and health care professionals. We will use a range of levers to create change in care processes; these will result in earlier diagnosis. Our first impact report described our work and impact to date in implementing this theory of change. Results We have been successful in building the burning platform for change, including commissioning the first economic model of the economic costs of delayed diagnosis. We have brought these, and other new data, to the attention of Ministers, other parliamentarians, policymakers, and HCPs. We have influenced the funders of the National Early Inflammatory Arthritis Audit to include new datapoints on time to diagnosis so that, for the first time, we will have comprehensive national audit data to track changes in performance. We have supported the Best MSK Health Collaborative to embed our approach in a new national axial SpA patient pathway. We are working with 19 rheumatology departments to implement the gold standard through our Aspiring to Excellence programme, and our new cadre of 12 Champions in Primary Care will be working together to drive improvement in identification and referral of suspected axial SpA patients. We have presented our burning platform to conferences and regional SpA academies. We have demonstrated proof of concept in our public awareness campaign which has reached 1.5 million people through social media, with 900,000 people watching our campaign videos, and already 5,000 people completing the online symptom checker. Conclusion We are building a social movement for change. We are influencing the thinking and behaviour across rheumatology. We are starting to see tangible changes in care processes. We have more work to do to translate this into the achievement of a one year time to diagnosis. Disclosure J. Eddison: None. D. Webb: None. J. Hamilton: None. L. Marshall: None. F. MacAuley: None.

The Accuracy of WebMD Symptom Checker for Diagnosis of COVID-19 in Admitted Patients in Imam Hassan Hospital of Bojnurd

Background: Coronavirus has caused rapid disruption to daily life with significant morbidity and mortality. The infection spreads mainly through respiratory droplets expelled by infected individuals. Several web-based symptom checkers have been used to avoid unnecessary in-person visits during the pandemic. WebMD’s symptom checker contains a course of multiple-choice questions about symptoms. At last, a record of differential diagnoses is assembled.
 Methods: This study chose 105 hospitalized patients in the isolation ward. We entered the data about symptoms and comorbidities in the WebMD symptom checker to find the most probable diagnoses proposed by the website for 66 patients whose polymerase chain reaction (PCR) test was positive and investigated the frequency of initial symptoms, present symptoms, and chief complaints.
 Results: The average age was 47.41 ± 13.52. Of 66 patients, 23 were correctly diagnosed with coronavirus disease 2019 (COVID-19) as the first diagnosis with the WebMD symptom checker. In 41 cases, COVID-19 was one of the three main diagnoses. The most common initial symptoms were fever in 24%, sore throat in 12%, and myalgia in 12% of patients. The most common chief complaints were fever in 34% and dyspnea in 28% of patients. The most common present symptoms were myalgia in 81%, fever in 80%, fatigue in 75%, and dyspnea in 72% of patients.
 Conclusions: WebMD symptom checkers can act as a first tool first, to diagnose and, second, to avoid in-person physician visits. Moreover, it can be used for the first diagnosis in primary care health organizations. Myalgia can be considered one of the most common present symptoms.

Keratoconus and Personality Traits: A Case-Control Study.

The aim of this study was to delineate the personality traits of patients affected by keratoconus (KC) compared with a group of nonkeratoconic controls matched in age and sex. In this prospective interventional case-control study, 60 consecutive subjects (30 KC cases and 30 healthy controls), aged 18 to 30, were enrolled at the time of their first encounter at the ophthalmology unit of the Fondazione Policlinico "Tor Vergata", Roma. After completing the ophthalmic evaluation, participants were asked to respond to the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). A complete psychiatric assessment was performed, including the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-5); the Symptom Check List-90-Revised (SCL-90); the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Modified (TEMPS-M); and the NEO Five-Factor Inventory (NEO-FFI). Cases had lower quality of life than controls, as demonstrated by lower scores in all NEI VFQ-25 subdomains. Nine patients with KC (30.0%) were diagnosed by the SCID-5 with at least 1 cluster C personality disorder, resulting in a 9-fold increased risk compared with controls. Moreover, keratoconic patients showed a more pronounced psychosomatic symptomatology (SCL-90) and a characteristic neurotic temperament (TEMPS-M and NEO-FFI). Our results support the hypothesis that subjects with KC feature dysfunctional coping mechanisms and personality traits, which might already be present at the first clinical encounter. Ophthalmologists should question the mental and emotional status of patients with KC and be especially careful in managing these patients.

Clinical Values of Serum Uric Acid Levels in the Occurrence of Cognitive Impairment in Alcohol-Dependent Patients.

Studies have confirmed that uric acid is involved in the regulation of cognitive function. This study aimed to investigate the expression of serum uric acid in alcohol-dependent patients and evaluate its clinical diagnostic value for cognitive impairment. Blood sample was collected for assessment of serum uric acid levels. Montreal Cognitive Assessment Scale scores were obtained to assess cognitive function. Anxiety and depression scores on the Symptom Check List 90 scale were used to assess mental health status. The alcohol-dependent patients were divided into non-cognitive impairment and cognitive impairment groups according to Montreal Cognitive Assessment Scale score, and the serum uric acid levels of these groups were analyzed. The receiver operating characteristic curve evaluated the diagnostic value of serum uric acid in cognitive impairment patients. Pearson correlation coefficient evaluated the correlation between uric acid and Montreal Cognitive Assessment Scale score, anxiety score, and depression score. Multivariate logistic regression analyzed the association between each index and cognitive impairment in patients. Serum uric acid was higher in patients than in controls (P < .001). Uric acid was significantly increased in cognitive impairment patients than in non-cognitive impairment patients (P < .001). Serum uric acid has certain diagnostic value in patients with cognitive impairment. Anxiety score and depression score were positively correlated with uric acid level, while Montreal Cognitive Assessment Scale score was negatively correlated with uric acid. Additionally, serum uric acid, Montreal Cognitive Assessment Scale score, and anxiety and depression scores were the risk factors for cognitive impairment in patients (P < .05). The abnormal expression of uric acid has a high diagnostic accuracy for distinguishing cognitive impairment from non-cognitive impairment.

Alexithymia and mobile phone addiction among college students: Mediation by boredom proneness and anxiety

The current study explored the mediating role of boredom and anxiety on the relationship between alexithymia and mobile phone addiction among Chinese college students. Participants (n = 354; female = 49.7%, mean age = 19.30 years, SD = 1.28 years) completed the Toronto Alexithymia Scale, the Boredom Proneness Scale-Short Form, the Symptom Check List 90, and the Mobile Phone Addiction Index. Regression analysis showed that higher alexithymia was a risk for mobile phone addiction (MPA). Boredom proneness and anxiety mediated the relationship between alexithymia and mobile phone addiction. There were no significant sex differences in the mediating pathways between alexithymia, boredom proneness, anxiety and MPA. The current findings are consistent with the compensatory internet use theory. College student support services should formulate student social engagement interventions to improve healthy mobile phone use and reducing the risk for MPA.

Evaluating the Diagnostic Performance of Symptom Checkers: Clinical Vignette Study.

Medical self-diagnostic tools (or symptom checkers) are becoming an integral part of digital health and our daily lives, whereby patients are increasingly using them to identify the underlying causes of their symptoms. As such, it is essential to rigorously investigate and comprehensively report the diagnostic performance of symptom checkers using standard clinical and scientific approaches. This study aims to evaluate and report the accuracies of a few known and new symptom checkers using a standard and transparent methodology, which allows the scientific community to cross-validate and reproduce the reported results, a step much needed in health informatics. We propose a 4-stage experimentation methodology that capitalizes on the standard clinical vignette approach to evaluate 6 symptom checkers. To this end, we developed and peer-reviewed 400 vignettes, each approved by at least 5 out of 7 independent and experienced primary care physicians. To establish a frame of reference and interpret the results of symptom checkers accordingly, we further compared the best-performing symptom checker against 3 primary care physicians with an average experience of 16.6 (SD 9.42) years. To measure accuracy, we used 7 standard metrics, including M1 as a measure of a symptom checker's or a physician's ability to return a vignette's main diagnosis at the top of their differential list, F1-score as a trade-off measure between recall and precision, and Normalized Discounted Cumulative Gain (NDCG) as a measure of a differential list's ranking quality, among others. The diagnostic accuracies of the 6 tested symptom checkers vary significantly. For instance, the differences in the M1, F1-score, and NDCG results between the best-performing and worst-performing symptom checkers or ranges were 65.3%, 39.2%, and 74.2%, respectively. The same was observed among the participating human physicians, whereby the M1, F1-score, and NDCG ranges were 22.8%, 15.3%, and 21.3%, respectively. When compared against each other, physicians outperformed the best-performing symptom checker by an average of 1.2% using F1-score, whereas the best-performing symptom checker outperformed physicians by averages of 10.2% and 25.1% using M1 and NDCG, respectively. The performance variation between symptom checkers is substantial, suggesting that symptom checkers cannot be treated as a single entity. On a different note, the best-performing symptom checker was an artificial intelligence (AI)-based one, shedding light on the promise of AI in improving the diagnostic capabilities of symptom checkers, especially as AI keeps advancing exponentially.

Exploratory study: Evaluation of a symptom checker effectiveness for providing a diagnosis and evaluating the situation emergency compared to emergency physicians using simulated and standardized patients.

The overloading of health care systems is an international problem. In this context, new tools such as symptom checker (SC) are emerging to improve patient orientation and triage. This SC should be rigorously evaluated and we can take a cue from the way we evaluate medical students, using objective structured clinical examinations (OSCE) with simulated patients. The main objective of this study was to evaluate the efficiency of a symptom checker versus emergency physicians using OSCEs as an assessment method. We explored a method to evaluate the ability to set a diagnosis and evaluate the emergency of a situation with simulation. A panel of medical experts wrote 220 simulated patients cases. Each situation was played twice by an actor trained to the role: once for the SC, then for an emergency physician. Like a teleconsultation, only the patient's voice was accessible. We performed a prospective non-inferiority study. If primary analysis had failed to detect non-inferiority, we have planned a superiority analysis. The SC established only 30% of the main diagnosis as the emergency physician found 81% of these. The emergency physician was also superior compared to the SC in the suggestion of secondary diagnosis (92% versus 52%). In the matter of patient triage (vital emergency or not), there is still a medical superiority (96% versus 71%). We prove a non-inferiority of the SC compared to the physician in terms of interviewing time. We should use simulated patients instead of clinical cases in order to evaluate the effectiveness of SCs.

Sense of hope affects secondary school students' mental health: A moderated mediation model.

The study assesses the moderated mediation effect of sense of hope on the mental health of secondary school students. The Adult Dispositional Hope Scale (ADHS), Connor-Davidson Resilience Scale (CD-RISC), and the Symptom Check List 90 (SCL-90) were used to conduct a questionnaire survey on 1776 secondary school students. The results showed that total mental health scores of secondary school students were significantly negatively correlated with sense of hope and psychological resilience; sense of hope was significantly positively correlated with psychological resilience; sense of hope significantly and positively predicted the level of mental health of secondary school students, and psychological resilience played a mediating role in it; gender plays a moderating role in the relationship between sense of hope and psychological resilience. The study further revealed the mechanism of the effect of sense of hope on secondary school students' mental health, and provided suggestions for cultivating positive psychological qualities and promoting the mental health development of secondary school students.

Correlating global trends in COVID-19 cases with online symptom checker self-assessments.

Online symptom checkers are digital health solutions that provide a differential diagnosis based on a user's symptoms. During the coronavirus disease 2019 (COVID-19) pandemic, symptom checkers have become increasingly important due to physical distance constraints and reduced access to in-person medical consultations. Furthermore, various symptom checkers specialised in the assessment of COVID-19 infection have been produced. Assess the correlation between COVID-19 risk assessments from an online symptom checker and current trends in COVID-19 infections. Analyse whether those correlations are reflective of various country-wise quality of life measures. Lastly, determine whether the trends found in symptom checker assessments predict or lag relative to those of the COVID-19 infections. In this study, we compile the outcomes of COVID-19 risk assessments provided by the symptom checker Symptoma (www.symptoma.com) in 18 countries with suitably large user bases. We analyse this dataset's spatial and temporal features compared to the number of newly confirmed COVID-19 cases published by the respective countries. We find an average correlation of 0.342 between the number of Symptoma users assessed to have a high risk of a COVID-19 infection and the official COVID-19 infection numbers. Further, we show a significant relationship between that correlation and the self-reported health of a country. Lastly, we find that the symptom checker is, on average, ahead (median +3 days) of the official infection numbers for most countries. We show that online symptom checkers can capture the national-level trends in coronavirus infections. As such, they provide a valuable and unique information source in policymaking against pandemics, unrestricted by conventional resources.

Abstract TMP53: Prediction Of Acute Cerebrovascular Events Based On Patient Reported Symptoms

Introduction: Many patients fail to recognize the initial symptoms of TIA or stroke and delay seeking urgent medical care. Algorithms based on patient reported symptoms have the potential to improve patient decision making and care seeking behavior. Though machine learning (ML) based on clinical and imaging data has been used to predict stroke, little work has been done to create ML methods based on patient symptom data. We aimed to evaluate the efficacy of ML algorithms for prediction of stroke or TIA from data collected at presentation among patients admitted to an emergency department TIA/Stroke observational unit (ED-OU). Methods: Patients in a large, urban, academic ED admitted to the ED-OU for suspected TIA from 3/2013 - 2/2020 were included. A full medical workup, including blood work, EKG, vessel imaging, DWI MRI, and neurology consultation was performed. The outcome was a discharge diagnosis of stroke or TIA. Demographic data, symptomatology, past medical and surgical history, and relevant medication data was utilized to predict a stroke or TIA. After applying recursive feature selection (RFE), we utilized logistic regression (LR) to predict stroke/TIA diagnosis. Model performance was evaluated using accuracy, precision, and AUROC. Results: 1441 patients were included; (52.4% female; 23.4% non-white; 57.7% diagnosed with stroke/TIA). Average age was 62.5 (SD = 30.2). The most common presenting symptoms were headache, dizziness, slurred speech, visual disturbance, and aphasia.Our classifier predicted the diagnosis of a stroke/TIA with AUROC 0.705, Accuracy 0.717, Precision 0.722, Recall 0.802, NPV 0.709. Conclusions: These results show algorithms utilizing patient-reported symptoms and risk factors can predict TIA/stroke. ML-based algorithms could support improved patient decision making in seeking medical care and reduce delays, and such algorithms could be incorporated in symptom checker apps.

The effect of balneotherapy and physical therapy applied to patients with chronic lack pain on pain intensity, quality of life, disability and mental symptoms

Aims: The aim of present study was to evaluate effects of balneotherapy and physical therapy combination against only physical therapy on pain, guality of life, disability and psychological symptoms in chronic low back pain. Methods: Sixty patients with chronic low back pain were included in the study. Patients were divided into two groups: Balneotherapy and physical therapy group (n=30) and physical therapy group (n=30). Balneotherapy group hospitalized for 20 minutes a day every day for 3 weeks to balneotherapy sessions with 40°C thermomineral water and 5 days a week for 3 weeks to 15 sessions of physical therapy session. Physical therapy group recieved 5 days a week for 3 weeks to 15 sessions of physical therapy session in the treatment unit Both groups recieved ultrason treatment which has 1.5W/cm 2 dose and 1MHz frequency for 6 minutes, Transcutaneous Electrical Nerve Stimulation (TENS) (50-100 Hz) for 20 minutes and hot pack for 20 minutes as physical therapy. Patients in both groups were given a patient-based standardized lumbar exercise in addition to physical therapy. The following parameters were measured: Visual Analog Scale (VAS) for pain intensity, Short Form-36 (SF-36) to evaluate guality of life, Oswestry Disability lndex (ODI) to evaluate functional disability and Symptom Check List-90 to query psychological symptoms. First evaluations were done at the beginning of treatment and second evaluations were done at the end of treatment before and after treatment. Results: We observed more significant decrease in VAS scores in the group administered balneotherapy (FT+BT) and physical therapy compared with the group treated only physical therapy (FT) (p0,05). At the end of treatment in FT+BT group subscale of guality of life; Physical role limitations, mental health, pain and general health were significantly higher than the FT group (p0,05). In FT+BT group except social functioning and in FT group except vitality and general health, ali other dimensions of guality of life showed significant improvement (p0,05). Although pretreatment disability rate of FT+BT is more, in this group decline of scores were more (30.4% to 14.2%). When compared to before and after treatment scores on the SCL-90 sub-parameters in FT+BT individuals were significantly different in ali the sub-parameters but in FT group except phobic anxiety and paranoid ideation, found significant differences in other parameters (p0,05). In addition the decline of statistically significant decrease in the parameters was observed lesser extent in FT group compares to FT+BT group. Conclusions: In present study we observed that balneotherapy in addition to physical therapy against routin physical treatment program showed more decline in pain and functional disability, more increase in guality of life and more improvements in psychological symptoms in addition relationship between psychologic symptom scores and disability is stronger than the relationship between psychologic symptom scores and pain scores.

Mental health and psychosocial problems among laboratory technicians in response to the COVID-19 pandemic in Hebei, China

ObjectiveDuring the coronavirus disease 2019 (COVID-19) pandemic, an increased mental burden has been widely reported among medical health workers such as physicians and nurses. However, data on laboratory technicians exposed to COVID-19 have rarely been published. The aim of this study was to assess the magnitude of psychological symptoms among laboratory technicians and analyze potential risk factors associated with these symptoms. MethodsA cross-sectional online survey was performed via the Wenjuanxing platform (a professional online questionnaire platform) (https://www.wjx.cn/mobile/statnew.aspx) to investigate the mental health of laboratory technicians during the COVID-19 pandemic in Hebei, China from October 4, 2021, to November 3, 2021. The online questionnaire included demographic and occupational characteristics data of responders, and the Symptom Check List-90-Revised (SCL90-R)was used to quantify the magnitude of psychological symptoms among laboratory technicians. Participants' demographic and occupational characteristics were analyzed using descriptive statistical analyses. Chi-square tests were applied to compare the severity of each symptom between two or more groups. A binary logistic regression model was developed to identify the predictors of laboratory technicians’ mental health in response to the COVID-19 pandemic, and outcomes are presented as odds ratios and 95% confidence interval. Statistical analysis was performed using SPSS version 21 (SPSS, New Orchard Road, Armonk, New York, USA). ResultsA total of 3081 valid questionnaires were collected. Of these 3081 participants, 338 (11.0%) reported a total SCL90-R score >160, which indicated positive psychological symptoms. Among the 338 participants who reported psychological problems, most of them were mild symptoms. Several factors associated with mental health problems in laboratory technicians during COVID-19 were found, which include a history of physical and/or psychological problems (all 10 symptoms p < 0.001), more than 10 years of work experience (depression symptoms: OR = 2.350, p = 0.024; anxiety symptoms: OR = 2.642, p = 0.038), frontline work (depression symptoms: OR = 1.761, p = 0.001; anxiety symptoms: OR = 2.619, p < 0.001; hostility symptoms: OR = 1.913, p = 0.001), participant in more than 3 times large-scale SARS-CoV-2 screenings and more than 36 h per week in SARS-CoV-2 nucleic acid testing. ConclusionA portion of laboratory technicians reported experiencing varying levels of psychological burden. During the COVID-19 pandemic, multiple interventions should be developed and implemented to address existing psychosocial challenges and promote the mental health of laboratory technicians.