Moderate-severe Symptoms Research Articles

The Efficacy of Vortioxetine on Anhedonia in Patients With Major Depressive Disorder.

Background: Anhedonia is a common, persistent, and disabling phenomenon in treated adults with Major Depressive Disorder (MDD). Hitherto, relatively few antidepressant agents have been evaluated with respect to their effect on anhedonia in MDD.Methods: This is a post-hoc analysis of a primary study that sought to evaluate the sensitivity to change of the THINC-integrated tool (THINC-it) in MDD (ClinicalTrials.gov Identifier: NCT03053362). Adults meeting DSM-5 criteria for MDD with at least moderate depressive symptom severity [i.e., Montgomery Åsberg Depression Rating Scale (MADRS) total score ≥20] were eligible. Subjects were recruited between October 2017 and August 2018 in Toronto, Ontario at the Brain and Cognition Discovery Foundation. All subjects received open-label vortioxetine (10–20 mg/day, flexibly-dosed) for 8 weeks. Herein, the primary outcome of interest was the change from baseline to endpoint in the Snaith-Hamilton Pleasure Scale (SHAPS) total score, as well as the MADRS anhedonia factor. The mediational effects of improvements in anhedonia on general function and quality of life, as measured by the Sheehan Disability Scale (SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5), were secondarily assessed.Results: A total of 100 subjects with MDD were enrolled in the primary study and began treatment with vortioxetine. Vortioxetine significantly improved anhedonia as evidenced by significant baseline to endpoint improvements in SHAPS and MADRS anhedonia factor scores (p < 0.0001). Improvements in the SHAPS and the MADRS anhedonia factor correlated with improvements in general function (i.e., SDS) and quality of life (i.e., WHO-5) (p < 0.0001). Notably, improvements in anhedonia were found to mediate the association between improvements in overall depressive symptom severity (i.e., MADRS total score) and social functioning (i.e., social life component of the SDS) (p = 0.026).Conclusion: The unmet need in depression is to improve patient functioning and other patient-reported outcomes (e.g., quality of life). Antidepressant interventions capable of attenuating anhedonia as well as cognitive dysfunction in MDD may help in this regard, as improvement in these domains have been associated with improvement in psychosocial function and quality of life.

An Opportunity for Palliative Care: Symptom Burden in Patients with Amyloidosis (S872)

1.Evaluate symptom burden of patients undergoing treatment for amyloidosis.2.Justify the need for palliative specialists to be a part of standard of care for patients with amyloid.3.Propose a model for palliative care to be integrated with standard of care for patients with amyloidosis. Although significant symptom burden has been described in patients with amyloidosis, few studies have used a validated tool to assess symptom burden or severity. Amyloidosis has many similarities to cancer; prognosis is poor, multiple organs may be involved, and treatment toxicities are common. To evaluate baseline symptom severity using the Edmonton Symptom Assessment System (ESAS), and the change in total symptom burden between outpatient hematology-oncology clinic visits in patients with amyloidosis. Retrospective chart review of 48 consecutive patients with amyloidosis presenting to a cancer center outpatient clinic. ESAS and Total Symptom Distress Scores (TSDS) representing the combined physical, emotional, and well-being intensities were reported at each visit. Individual ESAS scores ≥4 were considered moderate to severe intensity. The minimal clinically important difference (MCID) was calculated for TSDS between first and second visits. Based on past research cutoffs used were ≥+3/90 for improvement and ≤-4/90 for deterioration. Patients being co-managed with at least one appointment with palliative care (PC) during the study period, were noted. Baseline ESAS scores were collected on 48 patients with 31 also receiving a second. At baseline 34 (71%) had at least one or more moderate-severe symptoms. Fatigue in 23 (48 %) and insomnia 42% were most common. The MCID for TSDS showed 35% of patients improved while 35% showed deterioration. Only 6 (13%) of patients received palliative care. Many patients with amyloidosis experience high symptom burden, and although the majority report moderate/ severe fatigue, and insomnia, few are co-managed by PC. About one third had improved symptom burden at their second visit.

Negative mood induction: Affective reactivity in recurrent, but not persistent depression.

BackgroundDespite the high clinical and epidemiological relevance of persistent depression, little is known about its specific psychopathology and whether it is distinct from recurrent depression. Depression in general has been associated with blunted affective reactivity but the evidence from previous studies is inconsistent. Here, we asked whether affective reactivity might differ between persistent and recurrent depression.MethodsTwenty patients with persistent depression, 20 patients with recurrent depression and 20 healthy controls (HC) were recruited. Both patient groups showed moderate symptom severity. All participants underwent a sad mood induction procedure. Affective reactivity was assessed with the Positive and Negative Affect Schedule (PANAS) before and after mood induction.ResultsWe found a striking difference in affective reactivity between patient groups. While the persistent group showed blunted reactivity to mood induction, the recurrent group demonstrated an affective response that was comparable to HC, with an increase in negative and a decrease in positive affect. Blunted affective reactivity was thus specifically associated with persistent in contrast to recurrent depression.ConclusionsThese results highlight affective reactivity as an important psychopathological feature that differs between the two patient groups. Preserved affective reactivity to emotional stimuli in the recurrent group might reflect a resilience factor against persistence of depression.

The Correlation Between SNOT-22 and Visual Analogue Scale in the Assessment of Symptom Severity in Chronic Rhinosinusitis

Chronic rhinosinusitis is an inflammatory process involving the sinonasal mucosa, lasting 12 weeks or longer. It is often characterized by a complex of debilitating symptoms usually classified into minor and major symptoms. Estimating symptom/ disease severity using structured questionnaires can be challenging. This is especially so in rural areas where a combination of low literacy levels and language barrier may present communication difficulties. In view of the aforementioned challenges, it has become imperative to explore the correlation between the 22- item sino-nasal outcome test (SNOT-22) and a simpler means of evaluating symptom severity in chronic rhinosinusitis; hence this study. To determine the correlation between SNOT-22 and visual analogue scale (VAS) questionnaire scoring of symptom severity in chronic rhinosinusitis. This was a twelve month prospective cross sectional study of fifty- two consecutive newly diagnosed adult patients with chronic rhinosinusitis. Age of patients ranged from 19 – 91 years. Male to female ratio was 1: 1.26. There was a significant positive correlation between VAS and SNOT-22 in moderate and high symptom severity in patients with CRS. This study found a positive correlation between SNOT-22 and VAS scoring of disease severity in moderate and severe diseases and an insignificant correlation between these two instruments in mild disease. VAS can be used as a guide to symptom severity in the pre-treatment patients with CRS.

A cross-sectional, population-based survey of U.S. adults with symptoms of chronic rhinosinusitis.

Background: Chronic rhinosinusitis (CRS) is believed to create a substantial population-level disease burden in the United States due to its high prevalence and significant disease morbidity, but many studies of CRS epidemiology are based on administrative or historical record sources rather than primary population sources. Objective: To characterize CRS symptoms, burden, and patient characteristics by using a primary U.S. population-based representative sample. Methods: A demographically and geographically representative sample of 10,336 U.S. adults recruited from a general panel of 4.3 million were obtained by using three-stage randomization. Data collected included a range of respondent-reported CRS symptoms, symptom impact and severity, symptom duration, and treatment. Results: Approximately 11.5% of the respondents (n = 1189) reported defining symptom and duration criteria for CRS. A previous diagnosis of nasal polyps was reported by ∼10% of this population. The remaining respondents reported severe (7.3%) or moderate (3.1%) symptom severity. The most frequently reported defining symptoms were nasal congestion and/or obstruction (94-97%) and drainage (89-92%). CRS participants reported a high average degree of symptom burden (e.g., on a 0-10 scale, 8.2 for CRS with nasal polyps, 8.4 for CRS without nasal polyps with severe symptoms, and 6.4 for CRS without nasal polyps with moderate symptoms). The participants with CRS reported high health-care use for CRS, adverse effects of CRS symptoms on multiple areas of daily life, and high dissatisfaction with currently available treatments. Conclusion: More than 10% of the general U.S. adult population have CRS symptoms. Most report severe symptoms, lack of satisfaction with current treatment options, and a substantial adverse impact on daily functioning.

Capturing Rest-Activity Profiles in Schizophrenia Using Wearable and Mobile Technologies: Development, Implementation, Feasibility, and Acceptability of a Remote Monitoring Platform.

BackgroundThere is growing interest in the potential for wearable and mobile devices to deliver clinically relevant information in real-world contexts. However, there is limited information on their acceptability and barriers to long-term use in people living with psychosis.ObjectiveThis study aimed to describe the development, implementation, feasibility, acceptability, and user experiences of the Sleepsight platform, which harnesses consumer wearable devices and smartphones for the passive and unobtrusive capture of sleep and rest-activity profiles in people with schizophrenia living in their homes.MethodsA total of 15 outpatients with a diagnosis of schizophrenia used a consumer wrist-worn device and smartphone to continuously and remotely gather rest-activity profiles over 2 months. Once-daily sleep and self-rated symptom diaries were also collected via a smartphone app. Adherence with the devices and smartphone app, end-of-study user experiences, and agreement between subjective and objective sleep measures were analyzed. Thresholds for acceptability were set at a wear time or diary response rate of 70% or greater.ResultsOverall, 14 out of 15 participants completed the study. In individuals with a mild to moderate symptom severity at baseline (mean total Positive and Negative Syndrome Scale score 58.4 [SD 14.4]), we demonstrated high rates of engagement with the wearable device (all participants meeting acceptability criteria), sleep diary, and symptom diary (93% and 86% meeting criteria, respectively), with negative symptoms being associated with lower diary completion rate. The end-of-study usability and acceptability questionnaire and qualitative analysis identified facilitators and barriers to long-term use, and paranoia with study devices was not a significant barrier to engagement. Comparison between sleep diary and wearable estimated sleep times showed good correspondence (ρ=0.50, P<.001).ConclusionsExtended use of wearable and mobile technologies are acceptable to people with schizophrenia living in a community setting. In the future, these technologies may allow predictive, objective markers of clinical status, including early markers of impending relapse.

FA02.03: TIMING OF REFLUX ESOPHAGITIS (RE) AND BARRET’S ESOPHAGUS (BE) DEVELOPMENT IN PATIENTS AFFECTED BY GERD AFTER HELLER MYOTOMY FOR ESOPHAGEAL ACHALASIA

Abstract Background In order to acquire data on development of RE and BE in patients affected by GERD after Heller myotomy, we investigated a group of these patients who had long term endoscopic follow up. Data acquired in this group and in a group of patients affected by primary GERD and BE were compared. Methods In 1973 our group established a research protocol and data base to include patients affected by esophageal diseases observed since 1955 and successively, who were followed up according to defined protocols. A semi quantitative Visick modified scale (RS0 absence; RS3 maximal severity) was adopted for evaluation of reflux symptoms. Among 465 achalasia patients submitted to Heller myotomy in the period 1955–2016, 42 (57.14% men, median age 50 years IQR 44–58 years) post operatively complained grade RS2–3 reflux symptoms and had long term endoscopic/histologic follow up; 42 patients affected by typical GERD and Barret's esophagus, selected according to age and sex with the ‘Frequency matching’ process formed the control group. Results Twenty-six patients were submitted to Heller myotomy without antireflux procedure between 1955 and 1977, 16 to Heller-Dor successively. Patients experienced moderate-severe (SR2–3) GER symptoms after a median period of 20 months (IQR 10–86.5 months) since myotomy; in 100% RE was detected after a median period of 34.5 months (IQR 19.25–56.5 months), in 47.61% BE after a median period of 80 months (IQR 52–123 months) since GER symptoms onset. In primary GERD group, in the absence of medical therapy all patients complained of SR2–3 GER symptoms, RE was diagnosed after a median period of 72.5 months (IQR 59.25–120 months) and BE after a median period of 128 months (IQR 91–163.75 months) since GER symptoms onset. Time for RE (P &lt; 0.001) and BE (P = 0.002) development in achalasia patients was significantly shorter with respect to timing in GERD population. Conclusion In achalasia patients myotomy induced Barret's esophagus occurs much earlier than in typical GERD patients. This information should be considered for the treatment of post Heller GERD and for selection of candidates to POEM. Disclosure All authors have declared no conflicts of interest.

Phenotypic screening of cowpea (Vigna unguiculata (L.) walp) genotypes for resistance to cowpea viral diseases

Viruses are a major constraint to cowpea production in sub-Saharan Africa. Host plant resistance is the most effective and reliable method of managing viral diseases. In order to identify the source of resistance or tolerance, 38 cowpea genotypes were screened for virus infection under field conditions during the 2016 wet and dry seasons. The experiment was laid out in a randomized complete block design with four replications in both seasons. Disease severity was assessed fortnightly based on disease symptom using 1-5 visual scale (1=symptomless, and 5= very severe symptom). The cowpea genotypes exhibited varying reactions to viral infections with mean disease incidence ranging from 17.7% in the fourth week to 29.2% in the eighth week for the wet season and from 34.4% to 53.1% for the fourth and eighth week, respectively in the dry season. Symptoms observed were leaf mosaic (86.7%), leaf mottling (86.7%), chlorotic spots (34.2%), vein clearing (28.9%), leaf curl (26.3%), necrotic lesions (15.8%) and stunting (10.5%). Symptom severity in the rainy season ranged from symptomless (severity score of 1) in IT10K-819-4 and IT07K-297-13 to moderate symptom (severity score of 2.9) in Apagbaala. However, in the dry season, the symptom severity score ranged from 1.11 (mild symptom) in Marfo Tuya to a score of 2.4 (moderate symptom) in IT07K-298-9, thus demonstrating a significant genotype x season interaction effect. Incidence and severity were significantly higher in the dry season than in the rainy season. There was a strong positive correlation between the disease incidence and disease severity as well as AUDPC and no correlation between the cowpea incidence and the seed yield and plant height in the wet season. There was a negative correlation between the incidence and plant height in the dry season. Six genotypes (IT07-210-1-1, IT07K-297-13, IT08K-193- 14, IT09-456, IT10K-817-3 and IT10K-819-4) exhibited mild symptoms and gave high yields in both seasons, thus demonstrating a stable G x E interaction effect. These disease resistant genotypes could be evaluated further before release to farmers. Keywords: Area Under Disease Progress Curve, Host resistance, Vigna unguiculata, Viral diseases

Bothersome menopausal symptoms amongst postmenopausal Iranian women

Objectives: This study was undertaken to determine the impact of menopause on middle-eastern women.Methods: This was a cross-sectional study of 1520 women, aged 40–64 years, living in Sari, Northern Iran, recruited by multistage cluster sampling between October 2016 and April 2017. All women completed the Menopause Quality of Life Questionnaire (MENQOL) and Beck Depression Inventory-II (BDI-II).Results: Of all the women, 54.5% were perimenopausal or postmenopausal. The prevalences of any vasomotor symptom (VMS) and moderate-severely bothersome VMS were greatest for postmenopausal women aged <55 years (66.4%, 95% confidence interval (CI) 59.9–72.3% and 13.5%, 95% CI 9.6–18.6%, respectively). Having moderate-severe VMS was associated with moderate-severe depressive symptoms (adjusted odds ratio (AOR) 2.9; 95% CI 1.6–5.2; p < 0.001). Symptoms of vulvovaginal atrophy (VVA) were reported by 41.1% (95% CI 37.4–45.0%) of perimenopausal and postmenopausal women, with 22.9% (95% CI 19.8–26.3%) reporting their symptoms as moderate-severely bothersome. In women with moderate-severe VMS, the proportion with both moderate-severe depressive symptoms and moderate-severe VVA symptoms (12.1%) was four times that in women with no or mild VMS (3.3%) (p < 0.001).Conclusion: One in seven perimenopausal and postmenopausal women has moderate-severely bothersome VMS and few women receive appropriate therapy. The reporting of moderate-severe VMS should alert clinicians to the likelihood of significant concurrent VVA and depressive symptoms.

How group singing facilitates recovery from the symptoms of postnatal depression: a comparative qualitative study

BackgroundPrevious research has demonstrated that making music can enhance positive emotions as well as support positive psychological functioning. However, studies tend to be limited by lack of comparison with other psychosocial interventions. This study builds on a three-arm randomised controlled trial (RCT) that demonstrated that group singing for mothers and babies, but not group creative play, can lead to faster recovery from moderate-severe symptoms of postnatal depression than usual care. The aim was to elucidate the mechanisms of the group singing intervention in order to account for its recovery properties.MethodsQualitative research was conducted with 54 mothers who had experienced symptoms of postnatal depression. Mothers completed a 10-week programme of either group singing or group creative play as part of the wider RCT study. Data were collected via a series of 10 semi-structured focus groups conducted at the end of each 10-week programme. These were designed to elicit subjective and constructed experiences of the singing and play interventions and were analysed inductively for emergent themes.ResultsFive distinctive features of the group singing emerged: (i) providing an authentic, social and multicultural creative experience, (ii) ability to calm babies; (iii) providing immersive ‘me time’ for mothers; (iv) facilitating a sense of achievement and identity; (v) enhancing mother-infant bond.ConclusionsCommunity group singing interventions may reduce symptoms of postnatal depression through facilitating a functional emotional response rooted in the needs of new motherhood. These features are of relevance to others seeking to implement creative interventions for maternal mental health.Trial registrationNCT02526407. Registered 18 August 2015.

Salivary Inflammatory Markers in Trichotillomania: A Pilot Study

Background: Immune dysregulation has been hypothesized to be important in the development and pathophysiology of compulsive disorders such as obsessive compulsive disorder (OCD), which has a high comorbid overlap with trichotillomania (both are OC-related disorders). The role of inflammation in the pathophysiology of trichotillomania has garnered little research to date. Methods: Individuals with trichotillomania provided saliva sample for analysis of inflammatory cytokines. Additionally, these participants were examined on a variety of demographic variables (including body mass index [BMI], previously found to relate to inflammation) along with clinical measures (symptom severity, functioning, and comorbidity). Results: Thirty-one participants, mean age of 24.7 (±10.2) years, 27 (87.1%) females were ­included. The mean score on the Massachusetts General Hospital Hair Pulling Scale was 15.7 (±4.2), reflective of moderate symptom severity. Compared to normative data, the mean inflammatory marker levels in the trichotillomania sample had the following Z scores: interleukin-1β (IL-1β) Z = –0.26, IL-6 Z = –0.39, IL-8 Z = –0.32, and tumor necrosis factor-α Z = –0.83. Levels of inflammatory markers did not correlate significantly with BMI, depressive mood, symptom severity, or disability. Conclusions: The relatively low level of inflammatory saliva cytokines observed in the current study (negative z scores versus normative data with medium effect sizes) indicates that evaluation of blood inflammatory levels in trichotillomania versus matched controls would be valuable in future work. If a hypoinflammatory state is confirmed ­using blood samples, this would differentiate trichotillomania from other mental disorders (such as OCD, schizophrenia, and depression), which have typically been linked with high inflammatory measures in the literature, at least in some cases.

Anxiety and its predictive value for pain and regular analgesic intake after lumbar disc surgery - a prospective observational longitudinal study

BackgroundOngoing pain after surgery is a major problem and influences recovery and the quality of life of the patient. Associations between anxiety and their impact on postoperative pain after herniated disc surgery have been reported, but the results are inconsistent. The aim of the present longitudinal study was to evaluate the predictive value of preoperative anxiety for postoperative ongoing pain and prolonged analgesic intake after herniated disc surgery.Methods106 patients with lumbar disc herniation were evaluated in the study. Anxiety was measured with the Generalized Anxiety Disorder 7-Item Scale (GAD-7) before surgery. Pain intensity was assessed on a numeric rating scale (NRS) at baseline, 6-weeks and 6-months after surgery. Regression analysis was performed to identify independent predictors of pain and regular utilization of analgesics up to 6 months after surgery while controlling for confounding variables.Results42.5% of the patients were rated as anxiety cases (sum scores GAD-7 > 5), mean scores of anxiety showed mild to moderate symptom severity, and 43% suffered from chronic pain before surgery. Six months after surgery, 55.6% of the patients indicated pain levels of 4/10 (NRS) or higher and about 40% still took pain medication on a regular basis, regardless of their preoperative classification as anxiety-case (37.7% and 41.5%). The preoperative pain level was statistically significant for ongoing postsurgical pain in all four analyses (p < 0.001). With binary logistic regression analyses, preoperative pain intensity, but neither demographic factors nor preoperative anxiety, was identified as predictor for postoperative pain and need for analgesic medication up to 6 months after lumbar disc surgery.ConclusionWe found no evidence for the presence of anxiety before disc surgery being a prognostic factor for ongoing pain and regular postoperative intake of analgesics. Only preoperative pain intensity was predictive for increased pain and continued need for analgesic medication up to 6 months after lumbar disc surgery.Trial registrationClinicaltrials.gov NCT01488617. Registered 6 December 2011.

Association of thrombocytosis with COPD morbidity: the SPIROMICS and COPDGene cohorts

BackgroundThrombocytosis has been associated with COPD prevalence and increased all-cause mortality in patients with acute exacerbation of COPD (AECOPD); but whether it is associated with morbidity in stable COPD is unknown. This study aims to determine the association of thrombocytosis with COPD morbidity including reported AECOPD, respiratory symptoms and exercise capacity.MethodsParticipants with COPD were included from two multi-center observational studies (SPIROMICS and COPDGene). Cross-sectional associations of thrombocytosis (platelet count ≥350 × 109/L) with AECOPD during prior year (none vs. any), exertional dyspnea (modified Medical Research Council (mMRC) score ≥ 2), COPD Assessment Test (CAT) score ≥ 10, six-minute-walk distance (6MWD), and St. George Respiratory questionnaire (SGRQ) were modeled using multivariable logistic or linear regression. A pooled effect estimate for thrombocytosis was produced using meta-analysis of data from both studies.ResultsThrombocytosis was present in 124/1820 (6.8%) SPIROMICS participants and 111/2185 (5.1%) COPDGene participants. In meta-analysis thrombocytosis was associated with any AECOPD (adjusted odds ratio [aOR] 1.5; 95% confidence interval [95% CI]: 1.1–2.0), severe AECOPD (aOR 1.5; 95% CI: 1.1–2.2), dyspnea (mMRC ≥ 2 aOR 1.4; 95% CI: 1.0–1.9), respiratory symptoms (CAT ≥ 10 aOR 1.6; 95% CI: 1.1–2.4), and higher SGRQ score (β 2.7; 95% CI: 0.5, 5). Thrombocytosis was also associated with classification into Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D (aOR 1.7 95% CI: 1.2–2.4).ConclusionsThrombocytosis was associated with higher likelihood of prior exacerbation and worse symptoms. Platelet count, a commonly measured clinical assay, may be a biomarker for moderate-severe COPD symptoms, guide disease classification and intensity of treatment. Future longitudinal studies investigating the role of platelets in COPD progression may be warranted.Trial registrationClinicalTrials.gov: NCT01969344 (SPIROMICS) and NCT00608764 (COPDGene).

The relationship between asthma and depression in a community-based sample

ABSTRACTObjective: Asthma is an increasingly prevalent disease that is associated with substantial physical and financial burdens. Additionally, asthma is linked to psychiatric disorders. This study examines the relationship between asthma diagnosis, current depressive symptoms, and lifetime psychiatric disorder history in a large, community-based sample. Methods: We analyzed data from 2168 participants in the Dallas Heart Study, a large, diverse, community-based sample of people designed to be representative of the Dallas County population. Logistic regressions analyzing the relationship between asthma diagnosis and history of a psychiatric disorder, as well as between asthma diagnosis and the Quick Inventory of Depressive Symptomatology (QIDS) scores were performed, controlling for demographic data. Results: 13.4% of the sample had an asthma diagnosis. Asthma diagnosis was significantly associated with a history of nervous, emotional, or mental health disorder diagnosis [OR 1.810 (95% CI 1.280–2.559) p = 0.001], and with QIDS scores consistent with moderate or greater current depressive symptom severity [OR 1.586 (95%CI 1.106–2.274) p = 0.012]. The relationships were not moderated by age, gender, race, smoking status, or Body Mass Index. Conclusions: A diagnosis of asthma may be associated with current clinically significant levels of depressive symptoms and a lifetime psychiatric disorder. The current report adds to the existing literature in this area by assessing both current and lifetime symptoms and by using a large and diverse population. The findings highlight the clinical importance of considering the possibility of psychiatric illness in asthma patients and suggest further research in this area is needed.

Effect of singing interventions on symptoms of postnatal depression: three-arm randomised controlled trial.

This study assessed whether a novel psychosocial intervention could reduce symptoms of postnatal depression (PND) in the first 40 weeks post-birth. Analyses were carried out of 134 mothers with symptoms of PND randomised into 10 weeks of group singing workshops or group play workshops for them and their babies, or usual care (trial registration: NCT02526407). Overall, among all mothers with symptoms of PND, there was a non-significant faster improvement in symptoms in the singing group (F 4,262 = 1.66, P = 0.16, η 2 = 0.012). When isolating mothers with moderate-severe symptoms of PND, this result became significant, with a faster improvement in symptoms in the singing group (F 3.9,139.8 = 2.74, P = 0.033, η 2 = 0.028). Declaration of interest None.

Screening for depression in young Indigenous people: building on a unique community initiative.

Gurriny Yealamucka Health Service Aboriginal Corporation (GYHSAC) is an Indigenous community-controlled health organisation providing comprehensive primary care to the people of Yarrabah in far north Queensland, Australia. GYHSAC conducts an annual Young Person's Health Check (YPC) for people aged 15-25 years based on the Medical Benefits Schedule Item 715. However, the YPC is constantly evolving to meet the needs of the community, and in 2016, in response to concerns about psychological risk among Indigenous youth, GYHSAC teamed up with James Cook University to trial an adapted PHQ-9 depression screening tool (aPHQ-9) as part of the YPC. This study describes the 2016 YPC event, reports the prevalence of depressive symptoms, examines local issues related to the use of the screening tool and proposes recommendations for future health screening. Experienced health professionals conducted the aPHQ-9 assessment in a private area of the clinic. One-in-five young people were found to have moderate-severe symptoms or self-harm ideation in the previous 2 weeks; they were referred to the mental health service. The aPHQ-9 screening process was found to be straightforward and well accepted by staff and youth. Importantly, it provided valuable 'space' to facilitate communication on sensitive issues and was a conduit for speedy referral and follow up by trained staff. Based on our experience, we recommend dedicated depression screening in future routine community health checks for young people and adults.

A cross-sectional, population-based survey of U.S. adults with symptoms of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is believed to create a substantial population-level disease burden in the UnitedStates due to its high prevalence and significant disease morbidity, but many studies of CRS epidemiology are based onadministrative or historical record sources rather than primary population sources. To characterize CRS symptoms, burden, and patient characteristics by using a primary U.S. population- basedrepresentative sample. A demographically and geographically representative sample of 10,336 U.S. adults recruited from a general panelof 4.3 million were obtained by using three-stage randomization. Data collected included a range of respondent-reported CRSsymptoms, symptom impact and severity, symptom duration, and treatment. Approximately 11.5% of the respondents (n = 1189) reported defining symptom and duration criteria for CRS. Aprevious diagnosis of nasal polyps was reported by 10% of this population. The remaining respondents reported severe (7.3%)or moderate (3.1%) symptom severity. The most frequently reported defining symptoms were nasal congestion and/orobstruction (94-97%) and drainage (89-92%). CRS participants reported a high average degree of symptom burden (e.g., ona 0-10 scale, 8.2 for CRS with nasal polyps, 8.4 for CRS without nasal polyps with severe symptoms, and 6.4 for CRS withoutnasal polyps with moderate symptoms). The participants with CRS reported high health-care use for CRS, adverse effects of CRS symptoms on multiple areas of daily life, and high dissatisfaction with currently available treatments. More than 10% of the general U.S. adult population have CRS symptoms. Most report severe symptoms, lack of satisfaction with current treatment options, and a substantial adverse impact on daily functioning.

The association between adherence and outcome in an Internet intervention for depression

BackgroundAdherence to Internet interventions is often reported to be rather low and this might adversely impact the effectiveness of these interventions. We investigated if patient characteristics are associated with adherence, and if adherence is associated with treatment outcome in a large RCT of an Internet intervention for depression, the EVIDENT trial. MethodsPatients were randomized to either care as usual (CAU) or CAU plus the Internet intervention Deprexis. A total of 509 participants with mild to moderate depressive symptoms were included in the intervention group and of interest for the present study. We assessed depression symptoms pre and post intervention (12 weeks). Patient characteristics, a self-rating screening for mental disorders, attitudes towards online interventions, and quality of life were assessed before randomization. ResultsAdherence in this study was good with on average seven hours of usage time and eight number of sessions spent with the intervention. Some of the patient characteristics (age, sex, depressive symptoms, and confidence in the effectiveness of the program) predicted higher number of sessions in different models (explaining in total between 15 and 25% of variance). Older age (β = .16) and higher depressive symptoms (β = .15) were associated with higher usage duration. Higher adherence to the program predicted a greater symptom reduction in depressive symptoms over 12 weeks (number of sessions: β = .13, usage duration: β = .14), however, this prediction could mostly be explained by receiving guidance (β = .27 and .26). LimitationsReceiving guidance and symptom severity at baseline were confounded since only participants with a moderate symptom severity at baseline received e-mail support. Therefore no firm conclusions can be drawn from the association we observed between baseline symptom severity and usage intensity. ConclusionsWe conclude that older age was associated with adherence and adherence was positively associated with outcome. The effects we have found were small however suggesting that adherence might also be influenced by further variables.

Chronic rhinosinusitis: the correlation between symptom severity score and findings on plain radiographs of the paranasal sinuses

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic rhinosinusitis (CRS) is a common clinical problem with often refractory symptoms. Though computed tomography scan of the paranasal sinuses (PNS) is the radiological gold standard for confirming the diagnosis of CRS, it is not readily available and affordable in developing countries. Hence plain radiographs are heavily relied upon to confirm the diagnosis of CRS. The reliability and adequacy of plain sinus radiographs in combination with disease specific questionnaires in the management of CRS is still debatable. The objectives of the study were to determine the correlation between symptom severity score and findings on plain radiograph of the PNS in adult patients with CRS.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was an eight month prospective cross sectional study (April-November, 2014) of Fifty- two consecutive newly diagnosed adult patients with CRS. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Age of patients ranged from 19–91 years. Male to female ratio was 1:1.26. There was significant positive correlation between high and moderate symptom severity score (severe and moderate disease) with findings on plain radiograph of the PNS (p=0.032 and 0.048 respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The overall symptom severity score of CRS correlates with findings on the plain radiographs of patients with CRS especially in severe and moderate disease. &lt;/p&gt;

Identifying the hidden burden of allergic rhinitis (AR) in community pharmacy: a global phenomenon

BackgroundPatients with allergic rhinitis often trivialise their condition, self-manage inappropriately, and would benefit from health care intervention. The primary point of health care contact for these self-managing allergic rhinitis patients is the community pharmacy. With the majority of allergic rhinitis treatments being available for purchase over the counter, without health care professional contact, we know little about how the patients self-manage. This study aims to identify the burden of allergic rhinitis in the community pharmacy and to identify key opportunity for intervention.MethodsPharmacy customers, who purchased nasal treatment in a community pharmacy, were approached with a research-administered questionnaire that collected data on medical history, symptoms and products purchased for the treatment of nasal symptoms.ResultsOf the 296 participants, 69.9% self-managed with over-the-counter medications; with 68% experiencing allergic rhinitis symptoms and only 44.3% of this subgroup had a doctor’s diagnosis. Nasal congestion (73.6%) was most commonly experienced and oral antihistamines were most commonly purchased (44.3%), indicating a pattern of suboptimal management. A third of participants (36.5%) experienced moderate-severe symptoms, persistently, which impacted on their daily living. Medication selection was mainly based on pharmacy customers’ perceptions of medication effectiveness (47.6%).ConclusionA majority of participants that self-selected over-the-counter medications have symptoms consistent with allergic rhinitis, with almost half not having received a diagnosis. Medication purchasing patterns suggest that sub-optimal therapeutic decisions made by participants, even when they are experiencing significant symptoms. This study uncovers the hidden burden of allergic rhinitis in the community pharmacy and a missed opportunity to intervene and refer if necessary. Patients need to be guided through appropriate treatment as this study showed that many should be referred to a medical practitioner.