Severe Symptoms Research Articles

The Acceptability and Effects of Internet-Based Cognitive Behavioral Therapy on Depressive Symptoms and Remission in 13- to 17-Year-Old Adolescents: A Systematic Review and Meta-Analysis.

This study aimed to evaluate the acceptability and effects of internet-based cognitive behavioral therapy (iCBT) or CBT-oriented interventions compared with control groups on depressive symptoms, remission of depression, and quality of life (QOL) in adolescents. We searched English and Chinese databases for randomized controlled trials up to October 10, 2024 that investigated the effects of iCBT compared with controls in adolescents exhibiting elevated depressive symptoms or diagnosed with depression. Standardized mean differences (SMDs), relative risks (RRs), and 95% confidence intervals were applied to evaluate the pooled effects of outcomes. A total of 19 RCTs involving 3574 cases were included in this study. We found small effects on depressive symptoms severity at different time points (posttest: SMD = -0.49 [-0.66, -0.33]; 3-month follow-up [FU3]: SMD = -0.21 [-0.30, -0.11]; FU6: SMD = -0.18 [-0.35, -0.02]; FU12: SMD = -0.38 [-0.56, -0.20]). We also found a significant effect in depression remission rate at the posttest (RR = 1.74 [1.36, 2.21]) and a significant effect in QOL at the posttest (SMD = 0.30 [0.07, 0.54]). However, the result regarding acceptability was nonsignificant (RR = 1.22 [0.76, 1.97]). No significant publication bias was found in these results. iCBT or internet-based CBT-oriented interventions can effectively reduce depressive symptom severity and improve depression remission rate and QOL in depressed adolescents. These results are preliminary and require further validation through future systematic reviews.

"Short" Versus "Long" Duration of Untreated Psychosis in People with First-Episode Psychosis: A Systematic Review and Meta-Analysis of Baseline Status and Follow-Up Outcomes.

Duration of untreated psychosis (DUP) has been linked to worse mental health outcomes in psychotic disorders. We meta-analytically studied the relationship between "long" vs. "short" DUP and mental health outcomes. This PRISMA/MOOSE-compliant meta-analysis searched for nonoverlapping individual studies from database inception until November 01, 2023, reporting data from author-defined "short"/"long" DUP (according to author's definition) in patients with first-episode psychosis (FEP). We compared differences between "short"/"long" DUP groups at baseline and/or follow-up in continuous and binary outcomes. We conducted random-effects meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO: CRD42023479321). From 16,055 citations, 34 studies were included (n = 6,425, age = 27.5 ± 7.1 years, males = 60.4%, white = 70.2%, DUP: mean = 60.8 ± 43.8 weeks, median = 52.5, interquartile range = 31.3, 68.0 weeks, follow-up = 19.2 ± 35.0 months). The definition of "short"/"long" varies significantly between the studies. Compared to "short" DUP (mean = 10.2 ± 11.2 weeks), "long" DUP (mean = 58.8 ± 76.4 weeks) was associated with higher baseline Positive and Negative Syndrome Scale (PANSS) negative (k = 14, ES = 0.45, 95%CI = 0.16, 0.74) and Scale for the Assessment of Negative Symptoms (k = 7, ES = 0.29, 95%CI = 0.11, 0.47) scores, lower remission (k = 7, OR = 0.40, 95%CI = 0.24, 0.67) and more suicide attempts (k = 4, OR = 2.01, 95%CI = 1.36, 2.96). At follow-up, compared to "short" DUP, "long" DUP was associated with lower Global Assessment of Functioning (k = 4, ES = -0.63, 95%CI = -0.83, -0.43) and higher PANSS negative subscale scores (k = 5, ES = 0.66, 95%CI = 0.05, 1.27). In FEP, longer DUP is related to greater baseline negative symptoms, less remission, and more suicide attempts, as well as greater postbaseline negative symptom severity and functional disability. To what degree longer DUP contributes to poorer outcomes or whether DUP only correlates with these outcomes requires further study. A greater consensus on the definition of long DUP is needed to make comparisons between studies more feasible.

Body Composition and Incident High-Intensity Back Pain and/or High Disability: A 10-Year Prospective Population-Based Male Cohort.

Back pain poses a significant global burden, within which individuals with more severe symptoms consume higher healthcare expenses than those with lesser back pain. Whether measures of body composition predict high-intensity back pain and/or high-disability in population-based cohorts is unknown. This study aimed to examine the association between body composition at baseline and their change in the prior 5 years (between 2001-2005 and 2006-2010) and incident high-intensity back pain and/or high-disability in long-term follow-up, 10 years later (2016-2021) in a population-based cohort of men. This study examined men with no or low-intensity back pain and disability (Graded Chronic Pain Scale) at back pain study baseline (2006-2010) within the Geelong Osteoporosis Study. Those developing high-intensity pain and/or high disability at follow-up (2016-2021) were identified. Weight, body mass index (BMI), abdominal circumferences, fat mass and lean mass (dual energy X-ray absorptiometry) were assessed prebaseline (2001-2005) and at baseline. The association of body composition at baseline and change in body composition from prebaseline to baseline with incident high-intensity pain and/or high disability at follow-up were examined using multivariable logistic regression. Of 695 participants with no or low-intensity pain and disability at baseline, 441 (62.3%) completed follow-up with a mean age of 54.3 ± 14.1 years: 37 (8.3%) developed high-intensity pain and/or high-disability, 33 (7.5%) developed high-intensity pain and 14 (3.2%) high disability. No measures of body composition at baseline were associated with incident high-intensity pain and/or high disability at follow-up in the whole population. In subgroup analysis, among men aged over 60 years, but not younger, higher lean mass was associated with decreased likelihood of high-intensity pain and/or high-disability (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.76, 0.97, interaction p < 0.001). In the whole population, examination of the relationship between change in measures of body composition between prebaseline and baseline, only a one unit increase in BMI, equivalent to 3.1-kg weight gain, was associated with increased incident high disability (OR 1.63, 95% CI 1.06, 2.51). In a population-based sample, without severe back pain and disability, in older men aged ≥60 years, higher lean mass was protective of incident high-intensity pain and/or high disability. An increase in BMI, over 5 years, equivalent to 3.1-kg weight gain, was associated with incident back pain related high disability 10 years later. These results demonstrate another detrimental consequence of weight gain and highlight the importance of maintaining muscle mass in older men.

Cognitive function with changing hormonal milieu across menopausal transition stages and related symptoms in midlife and beyond

ABSTRACT The menopausal transition is regarded as the critical window where midlife women experience various health challenges having debilitating impact on their wellbeing. The present cross-sectional study intends to assess cognitive outcome with changing hormonal milieu during menopausal transition and related symptoms in midlife and beyond. For this purpose, cognitive performance of women and menopausal symptoms were studied on the sample of 320 women ranging in age from 45 to 60 years. Data collection was carried out by purposive sampling method from rural areas of Haryana from March 2021 to January 2023. Findings of the study demonstrated a successive downward trend in the mean scores of orientation to time and place, registration, attention, recall, as well as language and visual spatial skills cognitive domain from premenopause to late postmenopause stage. Multivariate logistic regression analysis (adjusted for age and educational status) identified severe menopausal symptoms, i.e. heart beating quickly or strongly, difficulty in sleeping, feeling tired, feeling unhappy or depressed, and sexual dysfunction as the potential determinants of poor functioning of different cognitive domains among women transitioning menopause and beyond. Hence, it was observed that cognitive decline during menopause transition and beyond is sensitive to severe menopausal symptoms.

A multi-region single nucleus transcriptomic atlas of Parkinson’s disease

Parkinson’s Disease (PD) is a debilitating neurodegenerative disorder, characterized by motor and cognitive impairments, that affects >1% of the population over the age of 60. The pathogenesis of PD is complex and remains largely unknown. Due to the cellular heterogeneity of the human brain and changes in cell type composition with disease progression, this complexity cannot be fully captured with bulk tissue studies. To address this, we generated single-nucleus RNA sequencing and whole-genome sequencing data from 100 postmortem cases and controls, carefully selected to represent the entire spectrum of PD neuropathological severity and diverse clinical symptoms. The single nucleus data were generated from five brain regions, capturing the subcortical and cortical spread of PD pathology. Rigorous preprocessing and quality control were applied to ensure data reliability. Committed to collaborative research and open science, this dataset is available on the AMP PD Knowledge Platform, offering researchers a valuable tool to explore the molecular bases of PD and accelerate advances in understanding and treating the disease.

Assessment of Health-Related Quality of Life and the Role of Social Support in Reducing the Severity of Symptoms in Women with Polycystic Ovary Syndrome

Assessment of Health-Related Quality of Life and the Role of Social Support in Reducing the Severity of Symptoms in Women with Polycystic Ovary Syndrome

Effect of intravenous ketamine on suicidality in adults with treatment-resistant depression: A real world effectiveness study

Suicidal ideation is a significant symptom associated with mood disorders. Ketamine is an emerging treatment with rapid and robust antidepressant and antisuicidal effects observed in clinical trial populations. Herein we assessed the real-world effectiveness of ketamine in ameliorating suicidality. A retroactive chart analysis of 96 adult TRD patients that received treatment in a private community clinic in Toronto, Ontario was conducted. Suicidality and depressive symptom outcomes were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS) (self-report version) and the Quick Inventory for Depressive Symptomatology Self-Report 16-Item (QIDS-SR16) respectively. The effect of ketamine on suicidal ideation was modelled using generalized estimating equations adjusting for demographic predictors and depressive symptom severity. A mediation analysis was conducted to evaluate the contribution of the antidepressant effects of ketamine on its antisuicidal properties. Mean C-SSRS score significantly decreased following a single ketamine infusion and was indicative of a reduction in suicidality from active to passive suicidal ideation on a group level. Results of the mediation analysis indicated that the antisuicidal effects of ketamine are partially independent of its antidepressant effects. Our study supports the use of ketamine in treating suicidal ideation in a real-world setting with benefits comparable to clinical trials.

Urban Environmental Threat Moderates the Relationship Between Depression and Insulin Resistance Among Latinxs With Type 2 Diabetes.

As the largest minoritised ethnic group in the United States, Latinxs face a greater risk for type 2 diabetes and depression. The aim of the present study was to explore whether the relationship between depressive symptoms and insulin resistance among Latinxs with type 2 diabetes was moderated by toxic stressors arising from urban environmental threat (i.e., uncomfortable or unsafe aspects of city life). A community sample of Latinx adults with type 2 diabetes (n=121) was recruited from Hartford, Connecticut. Participants self-reported depressive symptoms and exposure to urban environmental threat using items from the Patient Health Questionnaire and Urban Hassles Index, respectively. Insulin and glucose levels assessed via fasting blood draw were used to calculate insulin resistance using the HOMA-IR formula. After controlling for demographic, financial and health-related factors, results from a regression analysis revealed a significant interaction between depressive symptoms and urban environmental threat; more severe symptoms of depression predicted greater insulin resistance, but only amongst those with frequent exposure to urban environmental threats. Findings from the current study suggest that improving urban living conditions may offer an alternate avenue for attenuating the deleterious impacts of depression on type 2 diabetes progression in Latinxs.

Symptom burden and clusters during chemotherapy in patients with lung cancer

ObjectiveThis study aims to investigate the distribution characteristics of symptoms in patients with lung cancer during chemotherapy, identify the symptom clusters (SCs) and explore the underlying mechanisms. The findings will provide evidence to assist clinical staff in effectively managing symptoms and SCs.MethodsParticipants were recruited from the Oncology Department of Guang’anmen Hospital, China Academy of Chinese Medical Sciences, between July 2022 and December 2022. The incidence and severity of symptoms were assessed and SCs were identified. Spearman’s correlation analysis was used to examine the correlation between lung cancer-specific SC and routine blood indices.ResultsA total of 169 patients participated in the study. The most prevalent and severe symptom was loss of appetite. Based on the occurrence rate and severity of symptoms, SC extraction was performed for mild, moderate, and severe symptoms, resulting in the identification of five SCs: psycho-emotional SC, chemotherapy-related SC, lung cancer-specific SC, urinary-related SC, and gastrointestinal SC. When only the moderate and severe symptoms were considered, two SCs were identified: chemotherapy-related SC and lung cancer-specific SC. Additionally, the lung cancer-specific SC showed a negative correlation with eosinophils.ConclusionPatients with lung cancer undergoing chemotherapy experience complex and diverse symptoms. A total of five SCs were extracted based on mild, moderate and severe symptoms and two SCs were extracted based on moderate and severe symptoms. The results of the study showed that lung cancer-specific SC was negatively correlated with eosinophils. Future research should focus on developing and refining research tools, methodologies, understanding the pathogenesis, and exploring intervention measures for SCs.

Pharmacist-led Si-care (schizophrenia care) model to improve medication adherence and symptom management in schizophrenia

IntroductionSchizophrenia is a chronic mental disorder that requires long-term treatment, particularly antipsychotic medications. However, medication adherence among patients with schizophrenia is often suboptimal, leading to symptom relapse and poor outcomes. The Si-Care (Schizophrenia Care) program was developed as a pharmacist-led home intervention to improve medication adherence and support symptom control in patients with schizophrenia. This study aimed to evaluate the effectiveness of the Si-Care intervention in improving medication adherence and maintaining stability of symptoms among schizophrenia patients. MethodsA quasi-experimental study was conducted in three community health centers or Puskesmas in Banjarmasin, Indonesia. A total of 57 participants were recruited according to the sampling criteria. The Si-Care intervention consisted of seven home visits by trained pharmacists over four months, providing education, counseling, and medication monitoring. Adherence to medication was evaluated using the pill count method and severity of symptoms was measured using the Positive and Negative Syndrome Scale (PANSS) pre- and post-intervention. Data were analyzed using the Friedman test for adherence and the Wilcoxon test for PANSS scores. ResultsMean medication adherence improved significantly from 77.38 % ± 25.85 at baseline (T0) to 97.57 % ± 11.09 at the final visit (T4) (p = 0.000). However, the decrease in PANSS scores from 38.03 ± 9.14 to 37.81 ± 9.15 was not statistically significant (p = 0.089). Despite the lack of significant change in PANSS scores, symptoms remained stable throughout the intervention, suggesting effective symptom management. ConclusionsThe Si-Care intervention significantly improved medication adherence among people with schizophrenia, contributing to the maintenance of stable symptoms. Pharmacist-led home interventions provide valuable support to address adherence challenges and should be considered a critical component in schizophrenia care. Future studies should consider a more rigorous design, a larger sample size, and longer follow-up to better evaluate the sustainability, scalability, and applicability of the intervention in diverse healthcare settings.

The contribution of cerebral small vessel disease in idiopathic normal pressure hydrocephalus: Insights from a prospective cohort study.

Idiopathic normal pressure hydrocephalus (iNPH) and cerebral small vessel disease (CVSD) are age-related diseases, but their prevalence and clinical relationship are unclear. This prospective cohort study enrolled 95 patients with probable iNPH in China and evaluated their CSVD burden using magnetic resonance imaging. Linear regression models were used to analyze the association between CSVD scores and clinical outcomes. The results showed 78% of the patients had at least one CSVD imaging marker, and higher total CSVD scores were significantly associated with declines in attention, executive function, psychomotor speed, and gait performance after multivariate adjustments. However, the preoperative CSVD score did not affect the post-shunt improvement in modified Rankin scale or iNPH grading scale scores. Our findings suggest that CSVD is prevalent in patients with iNPH and is associated with more severe symptoms, but it may not affect shunt outcomes. Future studies are needed to elucidate the underlying mechanisms. We found that 78% of the patients with idiopathic normal pressure hydrocephalus (iNPH) had at least one type of cerebral small vessel disease (CSVD) imaging marker. The CSVD burden aggravates cognitive and gait impairments in patients with iNPH but may not affect shunt outcomes. The effects of different imaging markers of CSVD on cognition and gait are different and worthy of further investigation.

Diagnosis and treatment of transient neonatal thrombocytopenia (Draft clinical recommendations for discussion by specialists)

Transient neonatal thrombocytopenia occurs with a frequency of 0.7–0.9% and is divided by etiological factor into primary (alloimmune and transimmune) and secondary (symptomatic) thrombocytopenia, according to the time of occurrence of thrombocytopenia is divided into early and late. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome of varying severity, which occurs in 20–30% of newborns with thrombocytopenia, in other newborns thrombocytopenia is asymptomatic. The most severe clinical symptom is intracranial hemorrhages, which occur in 10–30% of cases. The most common types of bleeding of the platelet-vascular type are petechiae, ecchymoses, nosebleeds, melena, hematuria, cephalohematoma and other types of bleeding. In dynamics, symptoms of posthemorrhagic anemia may appear with massive bleeding (pallor, tachycardia, tachypnea, decreased blood pressure). The main criterion for the diagnosis of transient neonatal thrombocytopenia is a decrease in the number of platelets below the reference values for a given gestational and chronological age of a newborn child. To diagnose the type of thrombocytopenia, a thorough collection of maternal anamnesis is necessary, examination of parents if they suspect the immune nature of the disease, diagnosis of the disease as a result of which thrombocytopenia has developed, if it is secondary. Correction of thrombocytopenia, if indicated, is carried out by intravenous administration of platelet concentrate. If the immune nature of thrombocytopenia with severe thrombocytopenia is suspected and/or the presence of moderate and higher hemorrhagic syndrome, the administration of normal human immunoglobulin is recommended. If immunoglobulin therapy for immune thrombocytopenia is ineffective, glucocorticoids are prescribed.

Myocarditis and pericarditis in young patients following Campylobacter jejuni enterocolitis infection: a systematic review of case studies

BackgroundCampylobacter is known to be the leading cause of foodborne illness. Campylobacter jejuni, specifically, most commonly causes self-limiting enterocolitis, but infection can lead to extraintestinal manifestations, including rare yet severe cardiac complications, such as myocarditis and/or pericarditis. This review aims to determine whether a relationship exists between the timing of a positive stool culture and the overall clinical course in patients with Campylobacter jejuni-associated myocarditis and/or pericarditis.MethodsA systematic search was conducted using PubMed, MEDLINE, CINAHL Ultimate, Academic Search Premier, and Nursing and Allied Health Premium databases. A gray literature search was also performed. Covidence.org was used to screen, select, and extract data by two independent reviewers. Following a full-text evaluation, the quality of each study was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.ResultsThe search resulted in 434 records, of which 7 case reports met the inclusion criteria, each study including one patient. The average number of days from hospital presentation to obtaining a stool sample was 1.7. The average number of days from stool culture obtainment to clinical course improvement was 3.3, with four case studies reporting a range of 2–4 days.ConclusionThis systematic review raises awareness regarding the manifestations of Campylobacter jejuni, specifically the severe cardiac symptoms that may present in young individuals. Given the significant sequelae that can develop, providers must elicit a thorough history consisting of questions related to recent travel, food consumption, and gastrointestinal symptoms, especially among young individuals presenting with cardiac complaints.

A study of comparing between auditory manifestations in post-COVID 2019 and 2023

BackgroundIt’s known that COVID-19 affects the audio-vestibular system, while its variant is not studied yet. Accordingly, this work was designed to study the effect of COVID-19 and its variant on audio-vestibular system and to compare between symptoms and effects of these two.MethodsA case- control study was conducted, with each case and control group consisting of 75 people who were age and gender matched. Their age ranged from 18 to 45 years. They were splited into three groups as follows: Study group 1 (post-COVID-19), it consisted of 25 post recovery adults, Study group 2 (post- COVID-23) consisted of 25 post recovery adults. Finally, a control group (group 3) consisted of 25 healthy people. PTA and tympanometry were used to evaluate hearing while VNG was used to evaluate vestibular system in all subjects included.ResultsRegarding the SNHL there was a statistically significant difference between post-COVID-19 and controls while no statistically significant difference was reported between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding conductive hearing loss there was statistically significant difference between post-COVID-23 and controls with no statistically significant differences between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding the vestibular examination, Statistical analysis revealed significant difference in caloric test results between post-COVID-19 and controls with no statistically significant difference between the post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls.ConclusionsSNHL was more than CHL in post-COVID 2019. On the other hand, in post COVID-2023 cases CHL was more than SNHL. Also, the severity of symptom decreased from 2019 to 2023. We recommend that COVID patients should proceed with an audio-vestibular evaluation. So that early affection could be detected and managed properly accordingly.

The Correlation Between Electrodiagnostic Severity and Patient-Reported Disability Among Carpal Tunnel Syndrome Patients.

The use, easy applicability, and costs of accurate diagnostic tools and their utility for early diagnosis, efficient treatment, and follow-up are important. In this study, we aimed to evaluate how electrophysiologic data were reflected in the clinical data of the patients with carpal tunnel syndrome (CTS). This study included 102 patients with definitive CTS based on electroneuromyography. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the 36-item Short Form (SF-36) questionnaire of the general quality of life, the Visual Analog Scale (VAS), and the painDETECT (PD-Q) neuropathic pain questionnaire were administered by a clinical practitioner. We found a moderate correlation between electrophysiologic measurements and VAS and a weak correlation between PD-Q scores. When we tested the mean scores of the SF-36 quality of life scale subscales for differences across the CTS groups, we found significant differences in the mean scores of the physical functioning, bodily pain, and social functioning subdomains by disease severity (P < 0.05 for each). While the BCTQ Symptom Severity Scale (BCTQ-SSS) was predictive of the early stages of CTS, we found that both BCTQ-SSS and BCTQ-Functional Status Scale scores increased in correlation with advanced stage CTS. In addition to the electrophysiological data, self-report measures may help to pursue a multidirectional approach in patient management by acting as a reference for the diagnosis, treatment, and monitoring of CTS. The correlation between objective data and time-saving, practical, subjective measurements can serve as markers to facilitate a diagnosis.

TMS-evoked potentials provide novel neurophysiological features of Tourette syndrome

IntroductionGilles de la Tourette syndrome (TS) is a neuropsychiatric disorder associated with abnormal activation of the cortico-striatal-thalamo-cortical circuits and dopaminergic system. We sought to examine changes in neurotransmission relating to cortical excitation/inhibition of TS by measuring TMS-evoked potentials (TEPs) of selected networks. MethodsThirty-three adult TS patients and 18 healthy controls underwent evaluation of symptom severity using the YGTSS (tics), PUTS (premonitory urge), Y-BOCS (OCD), CAARS (ADHD), BDI (depression), and BAI (anxiety). TMS-EEG was performed to measure TEPs obtained from the primary motor cortex (M1), dorsolateral prefrontal cortex (DLPFC), and primary visual cortex (V1). ResultsTEP analysis revealed a delayed P180 latency in M1 for TS patients compared to controls (p = 0.006). Lower early amplitude of TEP in response to stimulation of DLPFC (50–70 ms), and delayed DLPFC P180 latency were associated with higher tic severity (p = 0.001 and p = 0.003, respectively). M1 early amplitude (50–70 ms) also effectively differentiated TS with mild-moderate from severe tics (p = 0.003). Significant correlation was found between TEP V1 early amplitude (15–45 ms) and severity of TS anxiety. ConclusionDistinct TEP patterns registered in response to DLPFC, M1, and V1 stimulation may shed light on the underlying pathophysiology of TS and are associated with tic severity and comorbidities.

Reevaluating Diabetes and COVID-19 outcomes using national-level data

PurposeUsing a US nationally representative survey of adults, we aimed to evaluate the association between prevalent diabetes and the uptake of COVID-19 testing, rate of positive testing and symptom severity. MethodsData were sourced from the 2020-2021 National Health Interview Survey. COVID-19 outcomes were defined as: (1) test uptake (2) test positivity (3) diagnosis of COVID-19 and (4) severe disease symptoms with a positive COVID-19 test result. We compared the prevalence of COVID-19 outcomes by diabetes status and examined their associations using multivariate adjusted logistic and ordered logistic regression models. ResultsThe prevalence of test uptake and test positivity were 50.7% and 9.4% in the US population, respectively. 10.3% were diagnosed with COVID-19 infection by health professionals. There were no statistically significant differences in the outcomes by diabetes status. However, individuals with diabetes were more likely to have severe symptoms. In adjusted regression model, we found no significant associations of diagnosed diabetes with all outcomes. ConclusionsOur findings contrast with prior evidence derived from hospitalized patients. Researchers and policy makers are encouraged to review the properties of data sources and their impact on public health recommendations, particularly in response to future pandemics.

The Influence of Kinesiophobia on Time to Clinical Recovery in Collegiate Athletes with Concussion.

Several factors such as acute symptom severity, premorbid anxiety, and depression have been associated with concussion recovery. Elevated kinesiophobia has been associated with recovery from musculoskeletal conditions, as well as increased reaction time and vestibular-ocular motor dysfunction following concussion. However, kinesiophobia has yet to be evaluated as a modifier of concussion recovery time. This study was designed to evaluate the role of acute kinesiophobia levels on days until clinical recovery in collegiate athletes with concussion. We hypothesized that collegiate athletes with elevated Tampa Scale of Kinesiophobia (TSK) scores would take a greater number of days to achieve clinical recovery compared with athletes with lower values. Division I collegiate athletes diagnosed with a concussion (N = 113, 19.9 ± 1.5years, 42% female) participated in this descriptive laboratory study. Participants were assigned to high [≥ 37 (H-TSK, n = 54)] or low [< 37 (L-TSK, n = 59)] TSK groups on the basis of the first TSK values recorded within 72h of their concussion. Participants were also administered the Revised Head Injury Scale (HIS-r) to assess symptom severity within 72h of injury. The Immediate Postconcussion and Cognitive Test (ImPACT) battery was administered at baseline and used to gather demographic variables such as biological sex, age, history of anxiety/depression, and concussion history, and as part of the athletes' symptom-free assessment. Days until clinical recovery between H-TSK and L-TSK groups were compared using a Mann-Whitney U test. Spearman's rank correlation coefficients were calculated to determine the relationship between TSK and days until clinical recovery in addition to other modifiers of recovery. Multiple linear regression was used to evaluate days until clinical recovery as a function of the TSK total score, controlling for the HIS-r and ImPACT variables. Days until clinical recovery was significantly longer in the H-TSK group (median difference = 2.5days, p < 0.001) compared with the L-TSK group. A significant, moderate positive correlation between the TSK score and days to clinical recovery (ρ = 0.45, p < 0.001) was observed, which was also the strongest correlation among all variables. Our regression model demonstrated that for every point increase on the TSK, days until clinical recovery increased by 0.23 while controlling for total symptom severity, age, concussion history, psychiatric history, and biological sex (β = 0.23, p = 0.018). All other variables entered into the regression were not statistically significant. Our data suggest that athletes with TSK scores above 37 within 72h of a concussion had a greater number of days until clinical recovery when compared with athletes with TSK values below 37. The TSK score had the highest correlation with days until clinical recovery when compared with other known modifiers of recovery, including total symptom severity. The TSK score was also the strongest predictor of days until clinical recovery. Collectively, these findings suggest that the TSK score should be considered by healthcare professionals to help inform effective management strategies for collegiate athletes with concussion.

Thematic analysis of X (Twitter) users’ experiences of Hyperemesis Gravidarum (HG)

ABSTRACT Hyperemesis Gravidarum (HG) is a debilitating condition characterized by severe nausea and vomiting during pregnancy, yet its severity is often misunderstood or underestimated by both the public and healthcare providers. This lack of understanding can lead to misdiagnosis, inadequate treatment, and undue suffering for individuals experiencing HG. This study explores the online discourse surrounding HG to identify key themes related to patient experiences and perceptions. Using the Twint0 application, we collected 5,856 relevant posts from the X social networking site over a 12-month period. A thematic analysis revealed four major themes: (1) misconceptions about severity of symptoms, (2) emotional and psychological toll of HG, (3) experiences with healthcare and treatment, and (4) impact on pregnancy and maternal health. The findings highlight the urgent need for greater awareness and understanding of HG, particularly within healthcare settings, to improve diagnosis and treatment. Additionally, the study emphasizes the importance of patient-centered care and mental health support to address the emotional challenges faced by women with HG.

An in vivo three-dimensional, kinematics study of the cervical vertebrae under physiological loads in patients with cervical spondylosis

Background ContextStudies of in vivo kinematic differences between healthy individuals and those with cervical spondylosis (CS) have been reported, but only movements under non-physiological loads have been investigated. Differences in the in vivo, cervical kinematics between healthy individuals and those with CS are unknown. PurposeTo investigate the in vivo, cervical kinematics of patients with CS under physiological loads. Study DesignThis was a retrospective, case-controlled study that used three-dimensional (3D) to 3D registration techniques combined with conical beam computed tomography (CBCT) to investigate the cervical kinematics of patients with CS. Patient SampleTwenty individuals diagnosed with CS were selected for study participation and matched with 20 participants who did not have CS and were in good health. Outcome MeasuresPfirrmann grading,intervertebral range of motion(ROM), kinematics and cross-sectional area of posterior neck muscles(CAPNM). MethodsAll study participants underwent seven CBCT scans of their cervical vertebrae. The 3D segmental motion features of the vertebra in vivo were calculated using 3D-to-3D volume registration to overlay images of the vertebra at each functional position. The 3D range of motion (ROM) of each cervical segment was expressed with six degrees of freedom using Euler angles and translated onto a coordinate system. A kinematic subgroup analysis was conducted based on the severity of symptoms within the CS group, and differences in muscle volume between the CS and control groups were also evaluated. Project supported by the National Natural Science Foundation of China (Grant No. 81960408,82260445), Training plan for academic and technical leaders of major disciplines in Jiangxi Province(Grant No.20204BCJL22047), Clinical Cultivation Project of The First Affiliated Hospital of Nanchang University (Grant No.YFYLCYJPY 20220203).The authors declare no conflict of interest in preparing this article. ResultsThe CS group exhibited noticeable reductions in the primary rotational ROMs of left-right rotation at C4-C5, C5-C6, C6-C7, C4-C7, and C1-C7 compared to the controls. During left-right bending, there were no significant differences in the primary ROMs, coupled translations, or rotations between the two groups. However, compared to controls, the CS group had significantly lower primary ROMs for C4 C7, C1-C7 and C5-C6 during flexion-extension. During left-right rotation, the primary rotations and coupled lateral bending at C6-C7 were significantly increased in the mild CS group compared to the moderate CS group. In the mild CS group, the primary ROM of the C4-C5 and C5-C6 during flexion-extension was significantly greater than that of the moderate CS group. ConclusionsFor the first time, the in vivo 3D kinematics of the cervical spine during head movement under physiological load in CS individuals have been adequately described and compared with healthy cervical vertebrae, which can be used as a reference point for future studies. The application of CBCT helps to obtain accurate and precise movement information of CS patients and effectively enhance the evaluation results obtained from imaging information.