Symptom Inquiry Research Articles

QOL-05. MEMANTINE FOR PREVENTION OF COGNITIVE LATE EFFECTS IN CHILDREN RECEIVING CRANIAL RADIATION THERAPY FOR FOCAL BRAIN TUMORS: A PILOT STUDY

Abstract BACKGROUND Childhood brain tumor survivors treated with cranial irradiation are at significant risk for cognitive late effects that negatively impact quality of life. Memantine (an NMDA receptor antagonist), taken during radiotherapy for brain metastases in adults, resulted in reduced cognitive declines. This is the first investigation of feasibility, acceptability, and preliminary efficacy of memantine for reducing cognitive late effects in children undergoing radiation therapy. METHODS In a randomized, double-blind, controlled trial (MEMCRT; NCT03194906) children took memantine (20 mg/d) or placebo for 12 weeks. During the medication phase, participants received weekly phone calls to assess adherence using pill counts and monitor side effects using the SAFTEE structured interview. At baseline, 6 weeks (end of radiation therapy), and 12 weeks (end of medication), participants completed a brief battery of cognitive measures. RESULTS 30 patients (age at irradiation=11.93±2.87; 47% male) were included; memantine (n=16) and placebo (n=14) groups did not differ in age, sex, race, socioeconomic status or baseline IQ (ps>.26). Study participation (71% of those approached) and medication adherence (88% completed 12 weeks, with 97% of medication taken) were high. Side effects were minimal (only one CTCAE≥ 3; headache in the placebo group) with no difference between groups in change in side effect severity from baseline to any medication week, across any symptom inquiry (ps>.23). At 12 weeks, Cohen’s d effect sizes (ES) indicate the memantine group had better performance on measures of processing speed (Cogstate Identification ES=.61), academic fluency (Woodcock Johnson-IV Reading Fluency ES=.45; Math Fluency ES=.81), and fatigue (PedsQL Multidimensional Fatigue Scale ES=.72). CONCLUSIONS Study findings indicate memantine used as a neuroprotectant during radiation therapy for children with focal brain tumors is feasible and acceptable, with preliminary evidence for better cognitive outcomes that require validation in a larger, definitive trial.

Diagnosis and Treatment of a Case of Maxillary Cleft in a Cat Associated with Pulmonary Emphysema

Maxillary cleft in cats often occurs due to high-altitude falls, resulting in trauma and pulmonary emphysema. Clinically, it is characterized by oral and nasal bleeding and is classified into congenital and acquired types, with its etiology being related to husbandry practices. This paper presents a case of maxillary cleft in a cat associated with pulmonary emphysema. After initial symptom observation and inquiry, a definitive diagnosis was made through clinical examination, laboratory tests, and X-ray imaging. Treatment involving medication and surgery was administered, followed by an evaluation of its effectiveness. Given the limited literature on this condition and its increasing incidence, this case contributes to the guidance of diagnosis and treatment for cats with maxillary cleft associated with pneumothorax.

Intelligent Diagnostic System Development based on Artificial Intelligence Technology

Intelligent diagnosis is an important scenario in smart healthcare, with conversational diagnostic scenarios being the most common. The process of collecting symptom information through conversations with users and inferring diseases based on symptoms. Through a dialogue based diagnostic system, it can meet some of the medical consultation needs of residents, thereby freeing doctors from some basic consultations and greatly alleviating the shortage of medical resources. In the actual diagnosis process, the symptoms reported by patients are often insufficient to support accurate diagnosis. It is necessary to ask the user if they have any other symptoms through dialogue to form a diagnostic conclusion. Existing research mainly adopts reinforcement learning methods, which gradually learn the dialogue process between traditional Chinese medicine students and patients in real medical scenarios, and obtain strategies for symptom inquiry and disease diagnosis. Despite the advantages of reinforcement learning in dealing with temporal decision problems, the diagnostic accuracy is still low and data dependency is strong. In this article, a medical dialogue robot architecture based on medical dialogue diagnosis technology, medical knowledge graph technology, and "inference machine" technology is proposed to build an intelligent diagnosis architecture. Secondly, in terms of algorithm, this article proposes a disease diagnosis algorithm based on Naive Bayes Classification and a symptom screening algorithm based on symptom set differences for symptom query process, This algorithm increases the interpretability of diagnostic results by simulating the questioning and diagnostic process of doctors, and combines it with the medical dialogue robot architecture to achieve intelligent diagnosis throughout the entire process.

Towards Causality-Aware Inferring: A Sequential Discriminative Approach for Medical Diagnosis.

Medical diagnosis assistant (MDA) aims to build an interactive diagnostic agent to sequentially inquire about symptoms for discriminating diseases. However, since the dialogue records for building a patient simulator are collected passively, the collected records might be deteriorated by some task-unrelated biases, such as the preference of the collectors. These biases might hinder the diagnostic agent to capture transportable knowledge from the simulator. This work identifies and resolves two representative non-causal biases, i.e., (i) default-answer bias and (ii) distributional inquiry bias. Specifically, Bias (i) originates from the patient simulator which tries to answer the unrecorded inquiries with some biased default answers. To eliminate this bias and improve upon a well-known causal inference technique, i.e., propensity score matching, we propose a novel propensity latent matching in building a patient simulator to effectively answer unrecorded inquiries; Bias (ii) inherently comes along with the passively collected data that the agent might learn by remembering what to inquire within the training data while not able to generalize to the out-of-distribution cases. To this end, we propose a progressive assurance agent, which includes the dual processes accounting for symptom inquiry and disease diagnosis respectively. The diagnosis process pictures the patient mentally and probabilistically by intervention to eliminate the effect of the inquiry behavior. And the inquiry process is driven by the diagnosis process to inquire about symptoms to enhance the diagnostic confidence which alters as the patient distribution changes. In this cooperative manner, our proposed agent can improve upon the out-of-distribution generalization significantly. Extensive experiments demonstrate that our framework achieves new state-of-the-art performance and possesses the advantage of transportability. The source code is available at https://github.com/junfanlin/CAMAD.

DxFormer: a decoupled automatic diagnostic system based on decoder-encoder transformer with dense symptom representations.

Symptom-based automatic diagnostic system queries the patient's potential symptoms through continuous interaction with the patient and makes predictions about possible diseases. A few studies use reinforcement learning (RL) to learn the optimal policy from the joint action space of symptoms and diseases. However, existing RL (or Non-RL) methods focus on disease diagnosis while ignoring the importance of symptom inquiry. Although these systems have achieved considerable diagnostic accuracy, they are still far below its performance upper bound due to few turns of interaction with patients and insufficient performance of symptom inquiry. To address this problem, we propose a new automatic diagnostic framework called DxFormer, which decouples symptom inquiry and disease diagnosis, so that these two modules can be independently optimized. The transition from symptom inquiry to disease diagnosis is parametrically determined by the stopping criteria. In DxFormer, we treat each symptom as a token, and formalize the symptom inquiry and disease diagnosis to a language generation model and a sequence classification model, respectively. We use the inverted version of Transformer, i.e. the decoder-encoder structure, to learn the representation of symptoms by jointly optimizing the reinforce reward and cross-entropy loss. We conduct experiments on three real-world medical dialogue datasets, and the experimental results verify the feasibility of increasing diagnostic accuracy by improving symptom recall. Our model overcomes the shortcomings of previous RL-based methods. By decoupling symptom query from the process of diagnosis, DxFormer greatly improves the symptom recall and achieves the state-of-the-art diagnostic accuracy. Both code and data are available at https://github.com/lemuria-wchen/DxFormer. Supplementary data are available at Bioinformatics online.

Diaformer: Automatic Diagnosis via Symptoms Sequence Generation

Automatic diagnosis has attracted increasing attention but remains challenging due to multi-step reasoning. Recent works usually address it by reinforcement learning methods. However, these methods show low efficiency and require task-specific reward functions. Considering the conversation between doctor and patient allows doctors to probe for symptoms and make diagnoses, the diagnosis process can be naturally seen as the generation of a sequence including symptoms and diagnoses. Inspired by this, we reformulate automatic diagnosis as a symptoms Sequence Generation (SG) task and propose a simple but effective automatic Diagnosis model based on Transformer (Diaformer). We firstly design the symptom attention framework to learn the generation of symptom inquiry and the disease diagnosis. To alleviate the discrepancy between sequential generation and disorder of implicit symptoms, we further design three orderless training mechanisms. Experiments on three public datasets show that our model outperforms baselines on disease diagnosis by 1%, 6% and 11.5% with the highest training efficiency. Detailed analysis on symptom inquiry prediction demonstrates that the potential of applying symptoms sequence generation for automatic diagnosis.

Laryngospasm in amyotrophic lateral sclerosis.

Laryngospasm is an involuntary, sustained closure of sphincter musculature that leads to an unpleasant subjective experience of dyspnea and choking. It is an underreported symptom in amyotrophic lateral sclerosis (ALS). In this study we aimed to better characterize the prevalence and clinical characteristics of laryngospasm in ALS patients. The medical records of 571 patients with ALS followed between 2008 and 2018 were searched for evidence of laryngospasm. A total of 23 patients with laryngospasm were identified and the data related to patient and laryngospasm characteristics were extracted. Laryngospasm was reported in 4% of ALS patients. Females comprised 57% of patients and their mean age was 63.4 years. Laryngospasm frequently manifested in patients with moderate bulbar dysfunction and seemed independent of respiratory function. Among laryngospasm patients, 26% were cigarette smokers and 13% had a history of gastroesophageal reflux. The most common reported trigger was excessive saliva irritating the vocal cords (35%) followed by eating a meal (17%). There was significant variation in laryngospasm frequency (up to 5 per hour) and duration (seconds to minutes). Most patients could not identify an effective coping mechanism, although 13% reported that drinking water was effective. Despite its low prevalence in ALS, laryngospasm should be included in the symptom inquiry. The present findings may improve patient care through increased recognition of the clinical features of laryngospasm in ALS patients, identifying a link between laryngospasm and moderate bulbar dysfunction, and highlighting trigger avoidance as a management strategy. Additional research is required to understand the pathophysiology and optimal treatment.

Prostate Cancer with Bone Metastases: Addressing Chronic Pain from the Perspective of the Radiation Oncology Nurse Practitioner.

To discuss the symptom burden experienced among patients with castrate-resistant prostate cancer and bone metastases and the role of the oncology nurse practitioner in evaluation for palliative radiotherapy. These include PubMed, international consensus documents, and clinician experience. Men with advanced prostate cancer may live for several years after diagnosis of bone metastases; however, pain and other difficult symptoms are problematic. Pain is effectively treated with palliative radiotherapy, but careful assessment and intervention of other difficult symptoms must be addressed over time. Nurse practitioners in radiation oncology should be well-versed in the disease trajectory of this patient population. Careful symptom inquiry and comprehensive physical examination is a key responsibility. Palliative radiotherapy, alongside analgesics and supportive care measures, can effectively reduce symptoms and improve quality of life in men with prostate cancer metastatic to bone.

Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa

BackgroundSouth Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care...

Changes in Neuroanesthesia Practice During the Early Stages of the COVID-19 Pandemic: Experiences From a Single Center in China.

Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, is highly contagious. Global medical systems have been heavily impacted by the COVID-19 pandemic. Although the majority of patients with intracranial disease require time-sensitive surgery, how to conduct neurosurgery and prevent and control nosocomial infection during a pandemic is challenging. We retrospectively reviewed the clinical data of patients undergoing neurosurgical and neurointerventional procedures at Beijing Tiantan Hospital, China during the early stages of the COVID-19 pandemic between January 21 and July 31, 2020. A 3-level system of COVID-19 risk was established based on medical conditions, epidemiologic, and symptom inquiry and the results of triage. A transitional unit was established for patients in whom COVID-19 had not been ruled out on admission to hospital. A total of 4025 patients underwent neurosurgery during the study period, including 768 emergent and 3257 nonemergent procedures. Of these patients, 3722 were low-risk for COVID-19, 303 were moderate-risk, and none were high-risk. In addition, 1419 patients underwent neurointerventional procedures, including 114 emergent and 1305 nonemergent interventions, of which 1339 were low-risk patients, 80 were moderate-risk and none were high-risk. A total of 895 patients (neurosurgical and neurointerventional) were admitted to the transitional unit. Forty-five patients were diagnosed with COVID-19 and transferred to the COVID-19 designated hospital. There were no cases of COVID-19 nosocomial infections among surgical patients or health care workers. On the basis of our single-center experience, developing a full screening protocol for COVID-19, establishing a risk level, and using a transitional unit for those with unknown COVID-19 status are effective measures to provide a safe environment for patients and health care workers.

Smoking Cessation Improves the Symptoms and the Findings of Laryngeal Irritation.

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS (P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study (P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

A proposal for augmenting the measurement of index events in PTSD assessment using event centrality

ABSTRACTBACKGROUND: Standard practice in assessing and diagnosing posttraumatic stress disorder (PTSD) entails identifying a single “worst” index event as the basis for symptom inquiry. Determining a single event can be challenging for clinicians and clients when multiple traumas are considered equally distressing. Additionally, it can be difficult to distinguish potential index events based on distress given the cumulative effect of repeated trauma exposure. This calls for the development of approaches that build on existing selection methods (e.g., worst event method).OBJECTIVE/CONCLUSIONS: In this article, we propose an innovative approach for identifying and measuring index events that utilizes the construct of event centrality to expand the parameters by which index events are selected. Event centrality assesses the degree to which traumatic events are perceived as integral to one’s personal identity and worldviews. Given its role in the etiology and maintenance of PTSD symptoms, this construct also approximates the emotional impact of trauma. Incorporating validated measures of event centrality into PTSD assessments would provide an objective strategy for identifying index events in a way that may increase the reliability of diagnosis. Our proposed strategy may also have a positive impact on the therapeutic process and treatment outcomes.

A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe.

Ten districts and three cities in Zimbabwe. To compare the yield and relative cost of identifying a case of tuberculosis (TB) using the three WHO-recommended algorithms (WHO2b, symptom inquiry only; WHO2d, chest X-ray [CXR] after a positive symptom inquiry; WHO3b, CXR only) and the Zimbabwe active case finding (ZimACF) algorithm (symptom inquiry plus CXR) to everyone. Cross-sectional study using data from the ZimACF project. A total of 38 574 people were screened from April to December 2017; 488 (1.3%) were diagnosed with TB using the ZimACF algorithm. Fewer TB cases would have been diagnosed with the WHO-recommended algorithms. This ranged from 7% fewer (34 cases) with WHO3b, 18% fewer (88 cases) with WHO2b and 25% fewer (122 cases) with WHO2d. The need for CXR ranged from 36% (WHO2d) to 100% (WHO3b). The need for bacteriological confirmation ranged from 7% (WHO2d) to 40% (ZimACF). The relative cost per case of TB diagnosed ranged from US$180 with WHO3b to US$565 for the ZimACF algorithm. The ZimACF algorithm had the highest case yield, but at a much higher cost per case than the WHO algorithms. It is possible to switch to algorithm WHO3b, but the trade-off between cost and yield needs to be reviewed by the Zimbabwean National TB Programme.

TabPRO trial: Tablet-based real-time detection of patient-reported outcomes during adjuvant outpatient chemotherapy for breast cancer.

TPS9640 Background: Current symptom inquiry during adjuvant chemotherapy is based on symptom reporting at regular intervals, usually at the start of the subsequent cycle of chemotherapy or by telep...

Population-based prevalence survey of tuberculosis in the Tigray region of Ethiopia

BackgroundPopulation based prevalence survey is an important epidemiological index to measure the burden of tuberculosis (TB) disease and monitor progress towards TB control in high burden countries like Ethiopia. This study was aimed to estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) in the Tigray region of Ethiopia.MethodsSixteen rural and urban villages were randomly selected in a stratified multistage cluster sampling. Individuals aged 15 years and older were screened by symptom inquiry for PTB. Those individuals who were symptomatic of PTB provided two sputum samples for smear microscopy, culture and molecular typing.ResultsThe study covering 4,765 households screened a total of 12,175 individuals aged 15 years and above. The overall weighted prevalence of bacteriologically confirmed PTB in the Tigray region of Ethiopia was found to be 216/100,000 (95% CI: 202.08, 230.76) while the weighted prevalence of smear-positive PTB was 169/100,000 (95% CI: 155.53, 181.60). The prevalence of bacteriologically confirmed TB was higher amongst males (352/100 000; 95% CI: 339.05, 364.52) than females (162/100 000; 95% CI: 153.60, 171.17) and among rural (222/100,000; 95% CI: 212.77-231.53) as compared to urban residents (193/100,000; 95% CI: 183.39-203.59).ConclusionsThis study found a relatively higher prevalence smear-positive PTB in the region than in a same period nationwide survey and identified a significant number of undetected PTB cases. The urgency for improved TB case detection and intensified community awareness is emphasized.

Tuberculosis screening and treatment compliance in human immunodeficiency virus patients

This study aims to evaluate compliance of HIV patients to TB screening and treatment, identifying determinants for non-compliance.We reviewed clinical records of all HIV infected patients first attended in a Portuguese-Infectious-Unit from 2007 to 2010 (152 patients). Screening included: symptom inquiry, chest X-ray, TST/IGRA. In 2008 a protocol was established with a TB outpatient clinic allowing patients to choose where to perform screening (decentralization).All patients were offered screening; 69 (45.4%) accepted. Before decentralization, out of 78 patients, 20 (25%) accepted screening. After decentralization, out of 64 patients, 49 (76.6%) accepted screening. Decentralization was associated with higher levels of acceptance (p<0.001), having an AIDS-defining-disease (p=0.002) and being older (p=0.04) was associated with lower screening acceptance. LTBI was diagnosed in 14 and active-TB in 18 cases; 14 cases of active-TB were later diagnosed during hospital appointments. For active-TB, being on HAART was related with treatment adherence (p=0.03).In this population, improving health care access was important for screening compliance.

Adesão ao rastreio e tratamento da tuberculose em doentes infetados com o vírus da imunodeficiência humana

This study aims to evaluate compliance of HIV patients to TB screening and treatment, identifying determinants for non-compliance.We reviewed clinical records of all HIV infected patients first attended in a Portuguese-Infectious-Unit from 2007-2010 (152 patients). Screening included: symptom inquiry, chest x-ray, TST/IGRA. In 2008 a protocol was established with a TB outpatient clinic allowing patients to choose where to perform screening (decentralization).All patients were offered screening, 69 (45.4%) accepted. Before decentralization, out of 78 patients, 20 (25%) accepted screening. After decentralization, out of 64 patients, 49 (76.6%) accepted screening. Decentralization was associated with higher levels of acceptance (p<0.001), having an AIDS-defining-disease (p=0.002) and being older (p=0.04) was associated with lower screening acceptance. LTBI was diagnosed in 14 and active-TB in 18 cases; 14 cases of active-TB were later diagnosed during hospital appointments. For active-TB, being on HAART was related with treatment adherence (p=0.03).In this population, improving health care access was important for screening compliance.

High sensitivity C-reactive protein levels in chronic rhinosinusitis and allergic rhinitis

In this study we evaluated the relationship between peripheral blood high sensitivity C-reactive protein (hs-CRP) levels with allergic rhinitis and chronic rhinosinusitis (CRS) with or without nasal polyps. The study included 100 patients who were divided into four groups each 25 patients; as follows: allergic rhinitis (group 1), CRS with nasal polyps (group 2), CRS without nasal polyps (group 3), and controls (group 4) who were non-smokers. All patients underwent a detailed symptom enquiry, physical examination, and investigations including a complete blood count and radiograph of the paranasal sinuses. The hs-CRP was measured in all the patients by a semi quantitative assay using the latex enhanced immunonephelometric test. There was no statistically significant difference in the levels of hs-CRP between the group 1, group 2, and group 3 by the control group respectively (p=0.861, p=0.7196, and p=0.127). Allergic rhinitis, CRS with nasal polyps and CRS without nasal polyp groups compared with the control group were statistically not significant differences in the hs-CRP levels with peripheral blood.

Physical and Psychological Symptoms and Risk of Virologic Rebound Among Patients With Virologic Suppression on Antiretroviral Therapy

We examined the association of self-reported physical and psychological symptoms with subsequent virologic rebound among patients with viral suppression on combination antiretroviral therapy (cART). We included 188 HIV patients from a routine London clinic, who completed a questionnaire on heath/treatment issues in 2005, and were on cART, with viral load (VL) < 50 c/mL. Symptom measures were based on the Memorial Symptom Assessment Scale Short Form, and additional questions: (1) physical symptom score; (2) psychological symptom score; (3) global symptom score; (4) total number of symptoms; (5) anxiety/depression; and (6) suicidal thoughts. Associations with time to (1) VL > 200 c/mL and (2) VL > 50 c/mL were assessed, considering each symptom measure separately. Of 188 patients, 22 experienced VL > 200 c/mL and 46 experienced VL > 50 c/mL (median follow-up: 2.2 years). Risk of VL > 200 c/mL was increased 4- to 5-fold for the highest versus lowest tertiles for the symptom scores (measures 1-3) and total number of symptoms (measure 4), and almost 4-fold for anxiety/depression (measure 5). Associations remained after adjustment for demographic and treatment-related factors (P = 0.006 to P = 0.050, measures 1-5), and were little attenuated after additional adjustment for subject-reported nonadherence (P = 0.011 to P = 0.072). There was a weaker, nonsignificant association with suicidal thoughts (measure 6). For risk of VL > 50 c/mL, all symptom measures were positively associated with rebound risk (P = 0.019 to P = 0.053, measures 1-6, adjusted for demographic and treatment-related factors; P = 0.022 to P = 0.084 after additional adjustment for nonadherence). Among patients on successful cART, physical and psychological symptoms were strongly predictive of viral rebound. Simple symptom inquiry may be valuable in the clinical setting to identify patients at risk of treatment failure, and provide opportunity for intervention.

Childhood Trauma and Emotional Reactivity to Hypothetical Media Events

To the Editor: Early adverse events in childhood, including abuse, may be associated with hypothalamic-pituitary-adrenal axis hyperresponsiveness1,2 as well as emotional and psychophysiologic reactivity3–5 (eg, hyperreactivity with the observation of negative images6). Indeed, emotional hyperreactivity is one of the potential findings in bona fide posttraumatic stress disorder (PTSD).7 In this study, we examined emotional responses to positive, negative, and neutral forms of hypothetical media events as a function of history of childhood trauma. Method. Participants were male and female outpatients, aged 18 or older, being seen for outpatient medical care by residents in internal medicine. Exclusion criteria were cognitive (eg, dementia), medical (eg, pain), or intellectual impairment that would preclude the successful completion of a survey booklet. Respondents (N = 70) consisted of 18 men and 52 women, ranging in age from 18 to 84 years (mean = 41.31, SD = 15.46). Most participants were white (91.4%, n = 64), with 3 being African American, 2 hispanic, and 1 Native American. Only 11.4% (n = 8) had not graduated from high school; 54.3% (n = 38) had earned a high school diploma, 15.7% (n = 11) had completed some college coursework but not a degree, 11.4% (n = 8) had earned an undergraduate degree, and 7.1% (n = 5) had earned a graduate degree. During the appointment, patients were invited into the project as time allowed (ie, a sample of convenience). Participants completed a 6-page research booklet that explored demographic information and emotional reactions to 21 author-developed hypothetical media events. Each item was assessed by the respondent as negative or positive. Then, using a 5-point Likert-style scale, respondents were asked to rate the intensity of their emotional reaction to each event from “very minimal” to “very strong.” Finally, with yes/no response options, participants were asked about any childhood history (ie, before age 12) of sexual, physical, or emotional abuse; the witnessing of violence; and/or physical neglect. Each form of abuse was followed by a brief explanation or definition. Results. To create scales for the media items corresponding to positive, negative, and neutral forms of media events, respondents’ ratings were subjected to factor analysis. Based on these results, as well as examination of scale reliabilities with and without potential items, 3 such scales were constructed (ie, positive items, negative items, and neutral items), each comprising 5 items (see Table 1). Table 1. Categorization of Hypothetical Media Items The positive items (1, 3, 5, 6, 14) demonstrated an internal consistency coefficient (α) of .85, and each item was rated as positive by 83%–92% of respondents. The negative items (2, 7, 13, 15, 21) demonstrated an internal consistency coefficient (α) of .94, and each item was rated as negative by 67%–80% of respondents. The neutral items (9, 10, 12, 19, 20) demonstrated an internal consistency coefficient (α) of .84, and each item was rated as positive by 59%–86% of respondents. We next calculated the correlations between the number of different forms of childhood trauma experienced and ratings of the intensity of emotional reactions to positive (r = 0.16, P < .24), negative (r = 0.24, P < .08), and neutral (r = 0.37, P < .01) media events. The mean rating of the neutral items by participants with no childhood trauma was 1.68, whereas it was 2.34 for those with at least one form of childhood trauma. Note that while the absolute differences are relatively small in magnitude from a clinical perspective, they provide some modest sense of subtle between-group differences. These findings support the current literature by indicating that traumatized individuals may display hyperreactive responses to environmental stimuli. However, a novel finding is that participants demonstrated overreactivity only to neutral or possibly ambiguous events. Previous literature indicates a likely overreactivity to negative events, as in PTSD. Perhaps less traumatized individuals show different patterns of reactivity (eg, hyperresponses to ambiguous stimuli), which is potentially relevant for clinicians working in the field of trauma. The limitations of this study include the small sample size, the self-report nature of the data, and the use of a nonstandardized assessment of childhood trauma. However, these are unexpected and novel findings, and they provide some potential direction for the clinician in terms of symptom inquiry and treatment.