Symptom Screening Research Articles

Detection of Interstitial Lung Disease in Rheumatoid Arthritis by Thoracic Ultrasound: A Diagnostic Test Accuracy Study.

To determine the diagnostic accuracy of thoracic ultrasound (TUS) for detecting interstitial lung disease (ILD) in rheumatoid arthritis (RA) with respiratory symptoms. Individuals with RA visiting rheumatologic outpatient clinics in the Region of Southern Denmark were systematically screened for dyspnea, cough, recurrent pneumonia, prior severe pneumonia, or a chest x-ray indicating interstitial abnormalities. Eighty participants with a positive screening were consecutively included. Individuals were not eligible if they had a chest high-resolution computed tomography (HRCT) less than 12 months ago or were already diagnosed with ILD. A blinded TUS expert evaluated TUS, and TUS was registered as positive for ILD if at least 10 B-lines or bilateral thickened and fragmented pleura were present. The primary outcomes were TUS's sensitivity, specificity, and positive predictive value and negative predictive value. An ILD-specialized thoracic radiologist assessed HRCT, followed by a multidisciplinary team discussion, which was the reference standard. The accepted window of HRCT was less than 30 days after TUS was performed. A total of 77 participants received HRCT less than 30 days after TUS, and 23 (30%) were diagnosed with ILD. TUS had a sensitivity of 82.6% (95% confidence interval [CI] 61.2%-95.0%) and a specificity of 51.9% (95% CI 37.8%-65.7%), corresponding to a positive predictive value of 42.2% (95% CI 27.7%-57.8%) and a negative predictive value of 87.5% (95% CI 71.0%-96.5%). To our knowledge, this prospective study is the first to use respiratory symptoms in RA as inclusion criteria. Systematic screening for respiratory symptoms combined with TUS can reduce the diagnostic delay of ILD in RA.

The mediating role of psychological resilience, anger, and hostility in university students’ attachment styles and life satisfaction

This study examined the function of psychological resilience, anger, and hostility as mediators in the connection between attachment styles and life satisfaction among university students in Turkey. The sample size of the study was 326 university students, consisting of 218 (66.9 %) females and 108 (33.1 %) males. The mean age was 21.4 and the standard deviation of the statistic for their age was 2.7. The distribution of the sample according to grade level was as follows: first year, 92 (28.2 %) second, 152 (46.6 %) third, 46 (14.1 %) and fourth, 36 (11.1 %). The Three-Dimensional Attachment Styles Scale, Satisfaction with Life Scale, Brief Psychological Resilience Scale, and Symptom Screening List were used to collect data. The study’s findings indicate that secure attachment, anxious attachment, psychological resilience, anger, and hostility are statistically significant determinants of life satisfaction. Bootstrapping analysis revealed that psychological resilience, as well as anger and hostility, partially mediated the association between secure and anxious attachment styles and life satisfaction. These results improve our understanding of the underlying mechanisms between attachment styles and life satisfaction by considering the roles of hostility and psychological resilience. We can design prevention and intervention programs to enhance psychological resilience and reduce hostility, thereby reducing the impact of anxious attachment on life satisfaction. Similarly, interventions to increase the impact of secure attachment on life satisfaction can focus on developing psychological resilience and reducing hostility.

Development of tuberculosis treatment decision algorithms in children below 5 years hospitalised with severe acute malnutrition in Zambia and Uganda: a prospective diagnostic cohort study

In children with severe acute malnutrition (SAM) tuberculosis is common, challenging to diagnose, and often fatal. We developed tuberculosis treatment decision algorithms (TDAs) for children under the age of 5 years with SAM. In this prospective diagnostic study, we enrolled and followed up children aged <60 months hospitalised with SAM at three tertiary hospitals in Zambia and Uganda from 4 November 2019 to 20 June 2022. We included children aged 2-59 months with SAM as defined by WHO and hospitalised following the WHO clinical criteria. We excluded children with current or history of antituberculosis treatment within the preceding 3 months. They underwent tuberculosis symptom screening, clinical assessment, chest X-ray, abdominal ultrasound, Xpert MTB/RIF Ultra (Ultra) and culture on respiratory and stool samples with 6 months follow-up. Tuberculosis was retrospectively defined using the 2015 standard case definition for childhood tuberculosis. We used logistic regression to develop diagnostic prediction models for a one-step diagnosis and a two-step screening and diagnostic approaches. We derived scores from models using WHO-recommended thresholds for sensitivity and proposed TDAs. This study is registered with ClinicalTrials.gov, NCT04240990. Of 1906 children hospitalised with SAM during the study period, 1230 were screened, 1152 were eligible and 603 were enrolled. Of the 603 children enrolled-median age 15 (inter-quartile range (IQR): 11-20) months and 65 (11.0%) living with HIV-114 (18.9%) were diagnosed with tuberculosis, including 51 (8.5%) with microbiological confirmation and 104 (17.2%) initiated treatment at a median of 6(IQR: 2-10) days after inclusion. 108 children were retrospectively classified as having tuberculosis resulting in a prevalence of 17.9% (95% confidence intervals (CI): 15.1; 21.2). 75 (69.4%) children with tuberculosis reported cough of any duration, 32 (29.6%) cough ≥2 weeks and 11 (10.2%) tuberculosis contact history. 535 children had complete data and were included in the diagnostic prediction model. The one-step diagnostic model had 15 predictors, including Ultra, clinical, radiographic, and abdominal features, an area under the receiving operating curve (AUROC) of 0.910, and derived TDA sensitivity of 86.14% (95% CI: 78.07-91.56) and specificity of 80.88% (95% CI: 76.91-84.30). The two-step model had AUROCs of 0.750 and 0.912 for screening and diagnosis, respectively, and derived combined TDA sensitivity of 79.21% (95% CI: 70.30-85.98) and a specificity of 83.64% (95% CI: 79.87-86.82). Tuberculosis prevalence was high among hospitalised children with SAM, with atypical clinical features. TDAs achieved satisfactory diagnostic accuracy and could be used to improve diagnosis in this vulnerable group. Unitaid.

PCR175 Screening for Anxiety and Depressive Symptoms in Adolescents With Complex Health Conditions From a Longitudinal Registry Study in Los Angeles County: Comparative Performance of the EQ-5D-5L and PedsQL

PCR175 Screening for Anxiety and Depressive Symptoms in Adolescents With Complex Health Conditions From a Longitudinal Registry Study in Los Angeles County: Comparative Performance of the EQ-5D-5L and PedsQL

Association between depressive symptoms and cardiovascular diseases in the Korean geriatric population: A nationwide retrospective cohort study

IntroductionDepression has emerged as a modifiable risk factor for cardiovascular disease (CVD). However, evidence on whether depressive symptoms measured using a self-report questionnaire are associated with CVD incidence is scarce. Therefore, we aimed to investigate the association between depressive symptoms and CVD risk using data from national health examinations and insurance claim records. MethodsThis retrospective cohort study included participants who underwent the Korean National Screening Program for Transitional Ages at age 66 years between 2007 and 2017. The presence of depressive symptoms was defined as affirmative responses to any of three questions (loss of activities and interests, worthlessness, and hopelessness) selected from the Geriatric Depression Scale. Incident composite CVD event included myocardial infarction, stroke, heart failure, and CVD death. The association between depressive symptoms and CVD risk was evaluated using hazard ratios (HRs) and 95 % confidence intervals (CIs) estimated with Cox proportional hazards models. ResultsAmong 88,765 participants (48.5 % women) aged 66 years, 4036 incident CVD events occurred during a mean follow-up of 6.8 years. Participants with depressive symptoms had a significantly higher risk of CVD than those without depressive symptoms (adjusted HR = 1.16 [95 % CI: 1.07–1.24]). The three individual depressive symptoms showed similar associations with CVD risk (loss of activities and interests, adjusted HR = 1.17 [95 % CI: 1.08–1.26]; worthlessness, 1.15 [1.03–1.29]; hopelessness, 1.13 [1.01–1.26]). LimitationsThe study was limited to participants aged 66 years. Despite extensive adjustment for potential confounders and multiple sensitivity analyses, residual confounding and reverse causality could not be ruled out. ConclusionThe presence of depressive symptoms was associated with an increased risk of CVD. Screening for depressive symptoms in the general population may effectively mitigate the burden of CVD.

Mediators and Predictors of Peritraumatic Dissociation after Devastating Consecutive Earthquakes: The role of social support

Objective: Dissociation involves the tendency to detach from one's environment, own body and mental states. This study aimed to evaluate the frequency of psychiatric symptoms, coping strategies with earthquake stress and the relationship between peritraumatic dissociation one month after two earthquakes that occurred 9 hours apart on 6th February 2023 in Turkey. Method: In this cross-sectional, an online questionnaire distributed through social media groups was filled by 786 university students studying in Adana, including Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Coping Strategies with Earthquake Stress Scale, and Brief Symptom Inventory. Results: The peritraumatic dissociation showed a weak negative relationship with religious coping strategy and a very weak positive relationship with seeking social support. Obsessive-compulsivity (β=0.650), anxiety (β=0.572), depression (β=-0.316, i.e., negatively), phobic anxiety (β=0.390), positive symptom distress index (β=-1.888), social support (β=0.597) sub-dimensions were found to be important predictors of PDEQ in the linear regression model (explanatory power R2=0.379) with obsessive-compulsivity (30.9%) being the most contributing factor. Peritraumatic dissociation scores were significantly higher in females and in those with damage or destruction in their homes. Mediation analysis revealed that depression indirectly increased the dissociation score, i.e., by decreasing the seeking social support scores, the latter being found to mediate peritraumatic dissociation. Discussion: The most important predictor of peritraumatic dissociation was obsessive-compulsivity symptoms, with the highest risk in those with more anxiety symptoms and who sought more social support. Therefore, social support is suggested to accompany early symptom screening after the earthquake to reduce outcomes like post-traumatic stress disorders. Keywords: Earthquake; Post-Traumatic Stress Disorder; Peritraumatic Dissociative Experiences Questionnaire; Coping Strategies with Earthquake Stress Scale; Brief Symptom Inventory

Pharmacists' Role in Global TB Elimination: Practices, Pitfalls, and Potential.

Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists are well equipped to serve a unique role in the pathway to provide education about TB. Previous systematic reviews emphasize pharmacists' role in treating TB; however, pharmacists can and do play much broader roles in overall TB elimination efforts. Five researchers searched five electronic databases (PubMed, PsychInfo, CINAHL, Academic Search Premier, and Embase). Search terms included pharmacy, pharmacist, tuberculosis, antitubercular agents, supply, distribution, and drug therapy. Inclusion criteria were studies published from 2010 through March 2023, in English or Spanish, addressed a specific TB-related role for pharmacists/pharmacies, and were peer-reviewed. Exclusion criteria included pharmacology, pharmacokinetics, clinical trials on drug efficacy, and editorials. Two researchers conducted each level of review; for discordance, a third researcher reviewed, and a decision was reached by consensus. Roles were extracted and cross-referenced with traditional pharmaceutical care steps. Of the initial 682 hits, 133 were duplicates. After further review, we excluded 514 records, leaving 37 articles for full extraction. We found nine roles for pharmacists in TB prevention and classified them as implemented, not implemented, or recommended. These roles were: (1) TB symptom screening; (2) Referring to TB care systems; (3) TB testing; (4) Dispensing TB medication correctly and/or directly observed therapy; (5) Counseling; (6) Looking to reduce socioeconomic barriers; (7) Procurement of TB medications; (8) Quality assurance of TB medications; (9) Maintaining and using pharmacy data systems. Pharmacists are well situated to play a vital role in the global fight against TB. Findings suggested pharmacists in many settings have already expanded their roles related to TB elimination beyond traditional pharmaceutical care. Still others need to increase the understanding of TB procurement and treatment, their power to improve TB care, and their contributions to data systems that serve population health. Pharmacy curricula should increase TB-related training to better equip future pharmacists to contribute to TB elimination.

Well-Child Visits for Early Detection and Management of Maternal Postpartum Hypertensive Disorders

Innovative approaches are needed to address the increasing rate of postpartum morbidity and mortality associated with hypertensive disorders. To determine whether assessing maternal blood pressure (BP) and associated symptoms at time of well-child visits is associated with increased detection of postpartum preeclampsia and need for hospitalization for medical management. This is a pre-post quality improvement (QI) study. Individuals who attended the well-child visits between preimplementation (December 2017 to December 2018) were compared with individuals who enrolled after the implementation of the QI program (March 2019 to December 2019). Individuals were enrolled at an academic pediatric clinic. Eligible participants included birth mothers who delivered at the hospital and brought their newborn for well-child check at 2 days, 2 weeks, and 2 months. A total of 620 individuals were screened in the preintervention cohort and 680 individuals were screened in the QI program. Data was analyzed from March to July 2022. BP evaluation and preeclampsia symptoms screening were performed at the time of the well-child visit. A management algorithm-with criteria for routine or early postpartum visits, or prompt referral to the obstetric emergency department-was followed. Readmission due to postpartum preeclampsia. Comparisons across groups were performed using a Fisher exact test for categorical variables, and t tests or Mann-Whitney tests for continuous variables. A total of 595 individuals (mean [SD] age, 27.2 [6.1] years) were eligible for analysis in the preintervention cohort and 565 individuals (mean [SD] age, 27.0 [5.8] years) were eligible in the postintervention cohort. Baseline demographic information including age, race and ethnicity, body mass index, nulliparity, and factors associated with increased risk for preeclampsia were not significantly different in the preintervention cohort and postintervention QI program. The rate of readmission for postpartum preeclampsia differed significantly in the preintervention cohort (13 individuals [2.1%]) and the postintervention cohort (29 individuals [5.6%]) (P = .007). In the postintervention QI cohort, there was a significantly earlier time frame of readmission (median [IQR] 10.0 [10.0-11.0] days post partum for preintervention vs 7.0 [6.0-10.5] days post partum for postintervention; P = .001). In both time periods, a total of 42 patients were readmitted due to postpartum preeclampsia, of which 21 (50%) had de novo postpartum preeclampsia. This QI program allowed for increased and earlier readmission due to postpartum preeclampsia. Further studies confirming generalizability and mitigating associated adverse outcomes are needed.

Association of Problematic Internet Use With Psychotic Experiences and Depression in Adolescents: A Cohort Study.

Problematic internet use (PIU) is prevalent among adolescents. Past research suggested cross-sectional associations between PIU and psychotic experiences, but little information is available on the longitudinal association. We hypothesized that PIU in adolescence may be longitudinally associated with psychotic experiences, adjusting for confounders. We analyzed a random sample of adolescents in the Tokyo Teen Cohort to examine how PIU at ages 10 (2012-2015), 12 (2014-2017), and 16 (2019-2021) was associated with mental health issues at age 16. PIU was evaluated by the modified Compulsive Internet Use Scale, psychotic experiences by the Adolescent Psychotic-like Symptom Screener, and depression by the Short Mood and Feelings Questionnaire. We also examined the mediating role of social withdrawal. We analyzed 3171 adolescents; 151 reported psychotic experiences and 327 reported depression at age 16. Compared with the lowest tertile PIU group, the highest tertile PIU group at age 12 showed an increased adjusted risk of psychotic experiences (RD 3.3%, 95% CI 2.9%-3.7%; RR 1.65, 95% CI 1.55-1.73) and depression (RD 5.9%, 95% CI 5.5%-6.3%; RR 1.61, 95% CI 1.55-1.68) at age 16. PIU at age 16 showed analogous results, while PIU at age 10 suggested a smaller impact. Social withdrawal mediated 9.4%-29.0% of the association between PIU and psychotic experiences. PIU is longitudinally associated with psychotic experiences and depression in adolescents. Further longitudinal and intervention studies are warranted to provide robust public health implications and foster a safer digital future.

Improving symptom screening rates for patients with head and neck cancer.

e23246 Background: Effective symptom management in cancer care relies on regular and accurate reporting using validated patient-reported outcome measures (PROMs), such as the Edmonton Symptom Assessment System (ESAS). The ESAS measures nine common cancer symptoms, rating them on a scale from 0 to 10 to improve monitoring and communication regarding patient symptoms and prevent adverse outcomes such as emergency department visits. There is a need to enhance completion rates to ensure that head and neck cancer (HNC) symptoms are effectively addressed. High completion rates provide valuable data for cancer centers and clinicians to intervene early and support patients through their cancer journey. This makes it an important target for quality improvement (QI) with wide-ranging implications for patient outcomes and care quality. Our objectives were to: Investigate underlying reasons for poor ESAS completion rates. Lay the groundwork for strategic interventions aimed at bolstering symptom screening among HNC patients. Methods: This was a QI project targeting the HNC patient population at a regional cancer centre (RCC). Our approach included stakeholder engagement meetings alongside the expertise of QI specialists. Comprehensive data collection was conducted to analyze symptom screening rates and identify potential barriers to ESAS completion. We tracked ESAS completion on weekly HNC clinic days from 2022-2023 via manual and automated chart abstraction. Patient, staff, and volunteer interviews, along with direct clinic observations, provided data for Ishikawa diagrams, facilitating a root cause analysis. Results: We identified a marked decline in ESAS completion rates, steadily decreasing from an average of 29.4% during the 2022-2023 fiscal year to an average of 7.6% between April-November 2023, with rates dropping as low as 3.3% in September 2023. Root cause analysis pinpointed several barriers to ESAS completion, including the transition from paper-based assessments used during the pandemic to electronic formats, low patient awareness of the purpose of symptom screening, perceived lack of value in screening by patients and staff, and the absence of direct guidance from staff in helping patients complete their ESAS. Variable communication practices and inconsistencies in registration staff directing patients to kiosks was also observed. Improving infrastructure and support for volunteer services was identified as a potential solution, which may optimize their effectiveness in symptom screening roles. Conclusions: The project has laid the foundation for targeted QI interventions aimed at improving ESAS screening adherence. By addressing the identified barriers, this work endeavors to re-engage patients in active symptom reporting and to integrate this critical aspect of care into the daily routine of the outpatient hospital setting, thereby enhancing the overall management of HNC symptoms.

Tuberculosis preventive treatment among the household contacts of tuberculosis patients – Coverage and correlates in a block of Murshidabad district, West Bengal: A cross-sectional study

BackgroundIndia started implementing tuberculosis preventive treatment (TPT) among all household contacts of Tuberculosis (TB) cases, as a globally accepted strategy for elimination of TB. ObjectivesWe aimed to assess the extent of TPT coverage and adherence; ascertain the reasons for non-initiation and non-adherence; and to determine the correlates of coverage. MethodsWe conducted a cross-sectional study in a block of Murshidabad district, West Bengal during September–November’2023. A calculated sample of 301 eligible household contacts of ‘index cases’ (microbiologically-confirmed drug-sensitive pulmonary TB) registered during October’22 to March’23 were studied. We interviewed the participants/respondents with pre-designed schedule and prior informed consent. Descriptive and inferential statistics were applied through Statistical Package for Social Sciences (version 20). ResultsOf 301 contacts, 179(59.5%) individually traced/counseled at the household; 238 (79.1%) were screened for TB symptoms. TPT initiation was 74.8% (225/301) with 47.1% within seven days of treatment initiation of index case; TPT not offered by health personnel (59.2%) being major reason for non-initiation. Completion rate with adherence to full course was 69.3% (156/225); perceived lack of need (50.7%) and migration (21.7%) being major reasons for non-adherence. Overall coverage of full course TPT among total eligible contacts was only 51.8% (156/301). On multivariable logistic regression; male gender (aOR = 1.982; 95% CI = 1.004–3.915), contacts with individual tracing/counseling (aOR = 13.507; 95% CI = 6.781–26.906) and who had symptoms screening (aOR = 5.694; 95% CI = 2.223–14.587) predicted significantly higher TPT coverage. ConclusionCascade of care indicators for TPT remains suboptimal in the area and indicates need for further strengthening of programmatic aspects of its implementation.

Impact of early phase study enrollment for pediatric oncology patients on symptom burden and quality of life (QOL): Early report of trial-in-progress results.

e23195 Background: Pediatric patients with relapsed or refractory malignancy have few options. The quality of life (QoL) impact for enrolling in a phase I or II trial compared to those not participating is unknown. This information is invaluable to the consenting process as well as to clinical trial design. The primary aim was to determine if those enrolled on a phase I or II trial had lower scores on the Symptom Screening in Pediatrics Tool (SSPedi) total score compared to those not enrolled on a trial. Methods: This Canadian multi-site study had nine sites open for accrual. SSPedi was calculated based on patient reports for 8-18 years and parent-proxy reports for all children. The total score is the sum of 15 items’ 4 Likert scale scores, score ranges from 0 to 60 (worst possible). Scores from baseline, 4 weeks and 8 weeks of those enrolled on an early phase trial were compared to those who did not enroll in such trials. Results: Of the 54 49 patients, 21 (43%) patients were enrolled on an early phase trial and 28 (57%) patients were not enrolled in a study. For those enrolled on the study at enrollment time, 4 weeks and 8 weeks time points, the total SSPedi score for the participant mean was 11.1 (SD 8.1), 9.2 (SD 6.3) and 10.1 (8.3) respectively compared to those not enrolled on a study with mean scores at the same time points of 13.8 (SD 8.6), 13.5 (SD 9.4), and 15.4 (SD 12.6). Conclusions: These results suggest that it is feasible to evaluate patients enrolled and not enrolled on early phase trials, and to compare their symptom experience. Further efforts will focus on more recruitment and using the PedsQL 3.0 Acute Cancer Module to further define differences in QoL. The results suggest that those enrolled in an early phase trial had an improved quality of life compared to those non-enrolled. This research is supported through granting from the C17 Council and Kindred Foundation. [Table: see text]

Impact of online learning during COVID-19 pandemic on digital device related ocular health

ObjectiveThe aim of this study was to evaluate the impact of the COVID-19 pandemic on ocular health related to digital device usage among university students in Lebanon. DesignA cross-sectional design was utilized to examine the association between the pandemic and ocular health. ParticipantsA total of 255 university students in Lebanon participated in the study, selected based on their enrollment during the pandemic. MethodsAn online survey assessed participants' digital device usage, awareness of digital eye strain, and experienced symptoms. The study addressed the relationship between symptom frequency and screen time, especially in their connection to the pandemic and online learning. ResultsPrior to the pandemic, the majority of participants (73.0 %) were unaware of digital eye strain. Following the transition to online learning, nearly half of the participants (47.0 %) reported using digital devices for 12 or more hours. The majority (92.0 %) experienced a substantial increase in daily digital device usage for learning, with an average increase of 3–5 h. Symptoms of digital eye strain, including headache, burning of eyes, blurry vision, sensitivity to light, worsening of vision and dryness of the eyes intensified in both frequency and severity during the pandemic and online learning period. ConclusionsThe study emphasizes the importance of promoting healthy habits and implementing preventive measures to reduce the prevalence of digital eye strain symptoms among university students. Healthcare professionals and public health authorities should educate individuals on strategies to alleviate digital eye strain, considering the persistent reliance on digital devices beyond the pandemic.

Patient reported symptoms after cancer diagnosis and the risk of short- and long-term severe mental health events among adolescents and young adults (AYA): A population-based study.

12019 Background: AYA with cancer are a vulnerable sub-population at risk of adverse mental health outcomes during and after cancer treatment. Tools to identify AYA at highest risk are required to guide screening and interventions. In a population-based cohort of AYA with cancer, we determined whether self-reported symptoms were associated with subsequent short- and long-term severe mental health events (SMHE). Methods: All Ontario, Canada AYA diagnosed with cancer aged 15-29 between 2010-2018 were identified and linked to healthcare databases, including one capturing self-reported Edmonton Symptom Assessment System (ESAS) scores at cancer-related visits. Scores for depression, anxiety, and poor well-being were categorized as not measured, mild (0-3), moderate (4-6), or severe (7-9). SMHE were defined as emergency room visits or hospitalizations for mental health reasons. First, we used Cox proportional hazard models to determine the association of ESAS scores (time-varying variable) with subsequent SMHE. Second, among 5-year survivors, we determined the association of maximum ESAS score within the first year of diagnosis with long-term SMHE (i.e. starting at 5 years from cancer diagnosis). All analyses were adjusted for patient and disease variables, including mental healthcare use prior to cancer diagnosis. Results: 5,435 AYA met inclusion criteria. Median age at cancer diagnosis was 25 years [interquartile range 22-27]. Hematologic cancers were most common (1,748; 32.2%). Symptom severity was associated with subsequent SMHE risk. For example, AYA reporting severe anxiety were at more than three-fold higher risk of SMHE compared to those reporting mild anxiety [adjusted hazard ratio (aHR) 3.6, 95th confidence interval (CI) 1.9-6.7; p &lt; 0.001]. Similar risk was seen among AYA reporting severe vs. mild depression (aHR 3.5, 1.7-7.3; p &lt; 0.001). Among 3,518 (64.7%) 5-year survivors, symptom severity also predicted long-term SMHE. For example, starting at 5 years post cancer diagnosis, the subsequent 3-year cumulative incidence of a SMHE among those who reported severe depression at any time during the first year post cancer diagnosis was 10.5% (95CI 6.9-15.9) compared to 2.4% (95CI 1.7-3.3) among those who only reported mild depression (aHR 3.0, 95CI 1.8-4.9; p &lt; 0.0001). Similar results were seen pertaining to severe anxiety and severe impact on well-being. AYA endorsing severe anxiety represented 13.1% of the cohort but accounted for 25.8% of AYA experiencing SMHEs during the first three years of survivorship. Conclusions: Systematic symptom screening in the first year after cancer diagnosis identifies a proportion of AYA at high risk of both short and long-term SMHE who may benefit from targeted screening and interventions. Future work will determine whether interventions during cancer treatment mitigate this risk.

Relationships between trauma types and psychotic symptoms: A network analysis of patients with psychotic disorders in a large, multi-country study in East Africa

BackgroundThe link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms. MethodsWe conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific psychotic symptoms were connected. We used an Ising model to estimate the network connections and bridge centrality statistics to identify nodes that may influence trauma types and psychotic symptoms. ResultsThe trauma type “exposure to a war zone” had the highest bridge strength, betweenness, and closeness. The psychotic symptom “odd or unusual beliefs” had the second highest bridge strength. Exposure to a war zone was directly connected to visual hallucinations, odd or unusual beliefs, passivity phenomena, and disorganized speech. Odd or unusual beliefs were directly connected to transportation accidents, physical assault, war, and witnessing sudden accidental death. ConclusionSpecific trauma types and psychotic symptoms may interact bidirectionally. Screening for psychotic symptoms in patients with war-related trauma and evaluating lifetime trauma in patients with odd or unusual beliefs in clinical care may be considered points of intervention to limit stimulating additional psychotic symptoms and trauma exposure. This work reaffirms the importance of trauma-informed care for patients with psychotic disorders.

La prise en charge de la commotion cérébrale au Judo/Jujitsu/Ne Waza : recommandations de la commission médicale de la Fédération Française de Judo

France Judo (the French Judo Federation) has introduced a protocol for dealing with concussion, which can occur either as a result of a fall on the tatami or as a result of strangulation. France Judo has set up online or face-to-face training for all those involved with judoka, whether in competition or during training. The training includes the following elements: explaining concussion, screening for symptoms, initial management and medical follow-up of concussion according to age and level, temporary blocking of the federal licence on the federal website. Several field and follow-up sheets have been drawn up to help all those involved in the field and in medical follow-up.

Trouble with the curve: the 90-9-1 rule to measure volitional participation inequalities among Royal Canadian Mounted Police cadets during training.

The Royal Canadian Mounted Police (RCMP) Study includes longitudinal multimodal assessments of RCMP cadets from pre-training (i.e., starting the Cadet Training Program [CTP]) to post-deployment and for five years thereafter. The data allow for investigating the multidimensionality of volitional participation in digital health data collection frameworks within serial data collection platforms and the impact of participation inequalities by classifying cadets using the 90-9-1 rule. By classifying cadets as Lurkers, Contributors, and Superusers formally described by the 90-9-1 rule, where 90% of actors do not participate, 9% seldom contribute, and 1% contribute substantially allows for the assessing of relationships between participation inequalities in self-monitoring behaviors as well as whether mental health disorder symptoms at pre-training (i.e., starting the CTP) were associated with subsequent participation. Participants were asked to complete a Full Assessment prior to their training at CTP, as well as short daily surveys throughout their training. Participation frequency was described using a process where participants were rank ordered by the number of daily surveys completed and classified into one of three categories. Full assessment surveys completed prior to their training at CTP included screening tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and panic disorder (PD). The Kruskal-Wallis H test was used to assess differences in participation rates between mental health disorder symptom screening groups for each measure at pre-training, and Spearman's Rho was used to test for associations amongst self-reported Full Assessment screening tool responses and the number of daily surveys completed during CTP. There were 18557 daily survey records collected from 772 participants. The rank-ordering of cadets by the number of daily surveys completed produced three categories in line with the 90-9-1 rule: Superusers who were the top 1% of cadets (n=8) and produced 6.4% of all recordings; Contributors who were the next 9% of cadets (n=68) and produced 49.2% of the recordings; and Lurkers who were the next 90% of cadets (n=695) and produced 44.4% of daily survey recordings. Lurkers had the largest proportion of positive screens for self-reported mental health disorders at pre-training. The creation of highly individualized, population-based mental health injury programs has been limited by an incomplete understanding of the causal relationships between protective factors and mental health. Disproportionate rates of disengagement from persons who screen positive for mental health disorders further compounds the difficulty in understanding the relationships between training programs and mental health. The current results suggest persons with mental health challenges may be less likely to engage in some forms of proactive mental health training. The current results also provide useful information about participation, adherence, and engagement that can be used to inform evidence-based paradigm shifts in health-related data collection in occupational populations.

P.114 The impact of screening for anxious and depressive symptoms on the outcome of patients with a mild traumatic brain injury

Background: An estimated 27-69 million individuals worldwide sustain a mild Traumatic Brain Injury (mTBI) each year, making it an important public health concern. Many victims experience post-injury neuropsychological issues such as anxiety and depression, which are associated with more post-concussive symptoms and worse functional outcomes. We sought to determine a systematic process to document the presence of anxiety and depression symptoms in mTBI patients to prevent negative impacts on their recovery. Methods: We administered the Generalized Anxiety Disorder-7 (GAD-7) and Center for Epidemiologic Studies Depression Scale Revised (CESDR-10) questionnaires, no more than three months after injury, to screen for these symptoms. A retrospective chart review was performed for 328 patients from the Montreal General Hospital mTBI Clinic who either received these questionnaires (N=143, Mage=40.36, SDage=15.557, Nfemale=90, Nmale=53) or did not (N=185, Mage=41.17, SDage=16.449, Nfemale=114, Nmale=71). The number of interventions received between groups were compared using ANOVA. Results: Patients who received the questionnaires (M=1.34, SD=0.978) were referred to significantly more interventions than those who did not (M=0.90, SD=0.876, p&lt;0.001) and the rate of referral positively correlated with GAD-7 and CESDR-10 scores. Conclusions: Screening for symptoms of anxiety and depression post mTBI helps clinicians refer patients to the appropriate resources, which in turn should improve outcome.

#1137 Association between cognitive function, depressive symptoms and quality of life in older patients with severely reduced GFR and kidney failure

Abstract Background and Aims Impaired cognitive function and reduced health-related quality of life (HRQoL) are common in older patients with chronic kidney disease (CKD) with severely reduced GFR and kidney failure. Older patients with CKD often regard HRQoL as a health priority, but it is unknown whether cognitive function associates with HRQoL and whether depressive symptoms mediate this association. We therefore aim to examine the association between cognitive function and HRQoL, and explore the mediating role of depressive symptoms. Method Patients aged 65 years and older with an eGFR between 20 and 10 mL/min/1.73 m2 participating in the ongoing DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (DIALOGICA) study were included. Cognitive function, depressive symptoms and HRQoL were assessed using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS-15) and Twelve-Item Short Form Health Survey (SF-12) questionnaire, respectively. The SF-12 yields a Mental Component Summary (MCS) score and Physical Component Summary score (PCS). We created a diagram of the hypothesized direct and indirect pathways between cognition and HRQoL, with depressive symptoms as the purported mediator (Fig. 1). We used cross-sectional multivariable linear regression analyses to examine the association between cognitive function and both mental and physical HRQoL, and multivariable mediation analyses to explore the role of depressive symptoms. Results In total, 403 patients were included with a mean age of 76.5 years, with a standard deviation (SD) of 5.8 and a mean eGFR of 14.5 mL/min/1.73 m2 (SD 3.0). A majority of patients were male (71.5%). Cognitive function associated significantly with mental HRQoL (adjusted β 0.30, 95% confidence interval (CI) 0.05; 0.55, p 0.021), but not with physical HRQoL (adjusted β 0.18, 95% CI −0.09; 0.44, p 0.20). The mediation effect of depressive symptoms between cognitive function and MCS remained significant after adjustment (indirect effect 0.15, 95% CI 0.04; 0.26). Thus, lower cognitive function was associated with lower mental HRQoL, which was partly mediated by corresponding increases in depressive symptoms. Conclusion Cognitive function is associated with mental HRQoL, but not with physical HRQoL in older patients with severely reduced GFR and kidney failure. This association is partially mediated by depressive symptoms. These findings underline the importance of screening for cognitive impairment and depressive symptoms in this population and may increase the understanding of what potentially affects HRQoL. As HRQoL is seen as a health priority, further research should explore whether cognitive interventions or treatment of depressive symptoms result in improvement of HRQoL in this population.

Retrospective study on the emotional status of healthcare workers in a COVID-19 field hospital in Oman.

To combat the overwhelming demand for medical services and care during the COVID-19 Pandemic, the Sultanate of Oman launched the COVID-19 Field Hospital in 2020, designed to respond and alleviate the burden on the medical infrastructure. Several studies globally and from the Middle East suggested that frontline healthcare workers (HCW) were at risk of developing markers of psychological distress. It was further understood through research findings that HCW were resilient during times of crisis. However, there is a dearth in studies evaluating the emotional status of frontline HCW posted in the COVID-19 field hospitals in Gulf Countries, including Oman. This study attempts to shed light on the emotional status of HCW that were on the frontlines in the field hospital in the Sultanate of Oman. This study aims to quantify and evaluate the emotional status of HCW in the frontline field hospital by screening for symptoms of depression, anxiety, and sleep quality. The data was collected by a local private mental healthcare facility as part of digital feedback to design and implement supportive strategies. Data was collected between September 2021 and October 2021 from 121 HCW in the COVID-19 Field hospital in Oman via 'WhatsApp'. Chi square and binary logistic regression tests were administered to evaluate the data. The participants comprised of 63.6% females and 79.3% were between 30 and 39 years of age. Majority of the participants (65.2%) described themselves as 'financially unstable' and possess an average of 7.5 years of work experience. Of the participants 73.6% of the HCW were based solely in the field hospital for 6-9 months at the time of the survey. Majority of the participants denied the presence of emotional distress expressed through depression (92.6%), anxiety (92.6%) and poor quality of sleep (59.5%). The findings of the present study reflect the HCW ability to cope during challenging situations likely owing to a variety of environmental, social and personal protective factors. The findings of this study can translate into further research on identifying and addressing stressors and targeting the enhancement of protective factors to safeguard the well-being of HCW.