Total Symptom Severity Score Research Articles

Multifarious experiences of women drivers post-car accidents: An urban community experience

BackgroundFiguring out the effect of car accidents on women drivers in Egypt, helps their return to a healthier level of function. ObjectiveThis study aims to assess frequency of posttraumatic stress disorder (PTSD) symptoms among women drivers who experienced car accidents in Cairo, and further explore their experiences regarding the worst car accident. MethodsA mixed study design; composed of quantitative and qualitative parts. The quantitative part was a descriptive cross-sectional design while the qualitative part was a descriptive phenomenology design assessing lived experiences during in-depth interviews. ResultsCorrelating subscales of Posttraumatic Diagnostic Scale (PDS) with socio-demographic data revealed that total symptom severity score (SSS) and arousal score had positive, significant relationships with participants' age, their driving years and number of previous accidents. ConclusionScreening of PTSD manifestations by paraprofessionals in non-clinical media like social networks helps early disclosure of PTSD symptoms and timely referral to psychiatric specialists.

Probiotic Supplementation and Respiratory Infection and Immune Function in Athletes: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To evaluate the effectiveness of probiotic supplementation on upper respiratory tract infection (URTI) and inflammatory markers in elite athletes. We searched the PubMed, EBSCOhost, Scopus, and Web of Science databases using the following terms: probiotic OR probiotics AND exercise OR sport OR athletes AND URTI OR respiratory infection OR URTIs OR inflammation OR inflammatory OR cytokines. We screened the titles and abstracts of 2498 articles using our inclusion criteria. A total of 14 articles were selected for further analysis. For each study, 2 independent reviewers extracted the study design, participant characteristics, inclusion and exclusion criteria, intervention characteristics, outcome measures, and main results. We did not observe an effect of probiotic supplementation on the number of days of illness or the mean number or duration of URTI episodes but did note an effect of probiotic supplementation on the total symptom severity score (-0.65; 95% CI = -1.05, -0.25; P = .02). Lower levels of interleukin 6 (-2.52 pg/mL; 95% CI = -4.39, -0.66 pg/mL; P = .002) and tumor necrosis factor α (-2.31 pg/mL; 95% CI = -4.12, -0.51 pg/mL; P = .01) were also reported after supplementation. This meta-analysis provides evidence that probiotic supplementation, especially among professional athletes, is an effective way to decrease the total URTI symptom severity score. In addition, probiotic supplementation may decrease interleukin 6 and tumor necrosis factor α levels. More studies involving larger groups are needed to better assess this effect. The optimal timing, duration, composition, and dose of such supplementation need to be determined.

The association of concussion history and symptom presentation in combat sport athletes

ObjectiveThe purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. DesignCross-sectional survey. SettingData were collected using an online survey instrument. ParticipantsThree hundred and nine adult combat sport athletes. Main outcome measuresSelf-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. ResultsA history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of ‘high’ total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting ‘high’ total symptoms and symptoms severity scores. ConclusionAthletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.

Differences In Baseline Concussion Symptom Reporting Across Age And Gender

PURPOSE: Previous studies have identified significant differences across age and gender in post-concussion symptoms reporting, with female and high school aged athletes reporting both a higher number of symptoms and a greater symptom severity. This study evaluates differences in baseline symptom reporting across age group and gender. METHODS AND STUDY DESIGN: Between 2007-2019, concussive symptoms were reported by middle school (MS), high school (HS) and collegiate athletes (CA) utilizing the post-concussion symptom scale at baseline. Excluded athletes included those with invalid testing, age > 24y or < 10y, learning disabilities, ADHD, autism, or a prior history of concussion. ANOVA was performed assessing the total number of symptoms and the total symptom severity score as reported by age group, and gender. Results: (1000)25,694 athletes (60% male and 40% female) were included: 4.6% MS (n=1,179), 89.7% HS (n=23,047) and 5.7% CA (n=1,468). Among the different age groups, there were no significant differences in number of symptoms (p=0.21) or symptom severity score (p=0.48). However, there were significant differences noted between male and female athletes. Males reported fewer symptoms than females (1.75 ± 3.0 vs 2.50 ± 3.6, p<1x10-70). Males also reported a lower baseline symptom severity (3.34 ± 6.7 vs 4.96 ± 8.7, p<1x10-62). This difference between genders held true across age levels with significant differences in the number of baseline symptoms reported (MS p<0.001, HS p<1x10-60, CA p<0.001) and symptom severity score (MS p<0.001, HS p<1x10-51, CA p<0.01). CONCLUSION: This study identifies symptom differences between genders at baseline. These baseline differences may contribute to the post-concussive discrepancies seen previously. In contrast, baseline differences are not present between age groups possibly suggesting a pathophysiologic underpinning to the post-concussive discrepancies of higher total symptoms and higher severity noted in high school athletes. Significance of Findings: Significant differences in concussive symptom reporting by age level, despite comparable baselines shown here, may reflect pathophysiologic, rather than reporting discrepancies, necessitating specific evaluation and management strategies across age levels.

Effect of Montelukast on the Symptom Severity Score of Allergic Rhinitis.

IntroductionRhinitis is a common respiratory disorder that can be broadly defined as an inflammation of nasal mucosa. Allergic rhinitis is the most common form of chronic rhinitis characterized by one or more symptoms including sneezing, nasal itching, nasal congestion, postnasal drip, and rhinorrhea. Montelukast is an antagonist to the leukotriene receptor. It is non-sedating, dosed once daily, and has a safety profile similar in adults and children, with approval down to six months of age. The purpose of the study was to see the improvement in the severity of symptoms of the patients with allergic rhinitis treated with montelukast.MethodsThe symptom severity score for allergic rhinitis was calculated by asking the patient to evaluate the severity of individual symptoms (sneezing, nasal congestion, rhinorrhea, and postnasal drip) against the 4-point scoring scale over the last 24 hours. After explaining the scoring system to the patient, a proforma was filled before starting the treatment. A dose of 10 mg of montelukast once daily was prescribed. On the follow-up visit after four weeks of therapy, compliance was ensured and then the symptom severity score was recorded again on the proforma. The total nasal symptom severity score (TNSSS) was calculated as a sum of all four nasal symptoms. Pre- and post-treatment mean of TNSSS was compared using a t-test. P-value of less than 0.05 was considered significant.ResultsA total of 140 patients were included in the study. The mean age was 30 years. The minimum age was 15 years and the maximum age was 45 years. There were 93 males and 47 females. The difference between pre- and post-mean values of TNSSS was 5.82. Both pre- and post-mean of TNSSS were compared using the t-test, and P-value was significant, i.e., <0.005.ConclusionsThe common symptoms of allergic rhinitis evaluated in the study showed improvement in response to the treatment with montelukast. The improvement in symptom severity score was maximum in sneezing and least in rhinorrhea. In light of recent developments on neuropsychiatric adverse effects and FDA warnings, caution needs to be exercised to reserve the use of montelukast for the selected patients.

Prospective Evaluation of the Frequency and Severity of Symptoms in Lyme Disease Patients With Erythema Migrans Compared With Matched Controls at Baseline, 6 Months, and 12 Months.

Erythema migrans is the most common clinical manifestation of Lyme disease. Despite antibiotic therapy, typically at least 10% of adult patients with erythema migrans experience persistence of at least 1 subjective symptom for ≥6 months (posttreatment Lyme disease symptoms [PTLDS]). This study was designed to determine whether the frequency and severity (based on a visual analogue scale) of 12 particular symptoms in patients with erythema migrans (n = 52) differed from matched control subjects (n = 104) followed prospectively for 12 months. At baseline, patients with Lyme disease were more likely than controls to have at least 1 symptom (P = .006). Among symptomatic subjects, Lyme disease patients had a higher mean number of symptoms (P < .001) and a higher mean total symptom severity score (P < .001). At both 6 and 12 months, however, there were no significant differences for these variables and no significant differences in the frequency or severity of any of the 12 individual symptoms assessed. However, 10 patients were clinically assessed as having possible PTLDS. Patients with erythema migrans were more likely than matched control subjects to be symptomatic at baseline with a greater symptom severity score, but this was not found at ≥6 months. Use of symptom survey data alone, however, was less likely to identify patients with possible PTLDS compared with individual clinical assessments. Because it is very challenging to be certain that the presence of long-term symptoms in a particular patient is correctly attributable to having had Lyme disease, an objective biomarker would be highly desirable.

Baseline Performance of High School Rugby Players on the Sport Concussion Assessment Tool 5.

Version 5 of the Sport Concussion Assessment Tool (SCAT5) was released in 2017 with an additional 10-word list option in the memory section and additional instructions for completing the symptom scale. To provide reference scores for high school rugby union players on the SCAT5, including immediate memory using the 10-word list, and examine how age, sex, and concussion history affected performance. Cross-sectional study. Calgary, Alberta high schools. High school rugby union players (ages 15-18 years) participating in a 2018 season cohort study (n = 380, males = 210, females = 170). Sport Concussion Assessment Tool 5 scores, including total number of symptoms (of 20), symptom severity (of 132), 10-word immediate memory (of 30), delayed memory (of 10), modified Standardized Assessment of Concussion (of 50), and balance examination (of 30). The median number of symptoms reported at baseline ranged from 5 to 8 across sex and age stratifications. Median symptom severity was lowest in males with no concussion history (7; range, 0-28) and highest in females with a concussion history (13, range = 0-45). Median total scores on immediate memory were 2-3 (range = 0-4) for males and 21 (range = 9-29) for females. Median total scores were 3 (range = 0-4) on digits backward and 7 (range = 0-20) on delayed memory (all groups). Based on simultaneous quantile (q) regression at 0.50 and 0.75, adjusted for age and concussion history, being female was associated with a higher total symptoms score (q0.75 βfemale = 2.85; 99% confidence interval [CI] = 0.33, 5.37), higher total symptom severity score (q0.75 βfemale = 8.00; 99% CI = 2.83, 13.17), and lower number of errors on the balance examination (q0.75 βfemale = -3.00; 99% CI = -4.85, -1.15). Age and concussion history were not associated with any summary measures. The 10-word list option in the memory section reduced the likelihood of a ceiling effect. A player's sex may be an important consideration when interpreting the SCAT5 after concussion.

Computer vision syndrome among individuals using visual display terminals for more than two hours

Purpose Nowadays exposure to visual display terminals (VDT) is an integral part of our daily life. Adolescents are also exposed to extended use of VDTs. This study aimed to assess the proportion of individuals experiencing various ocular symptoms according to their VDT usage and age.Patients and methods This cross-sectional comparative study was conducted from April 2017 to March 2018. Validated computer vision syndrome (CVS) questionnaire was used for the assessment of CVS. The questionnaire includes 16 symptoms that are scored using two rating scales, one for frequency and the other for intensity. Study participants were divided into two groups: group I included individuals using VDT more than or equal to 6 h per day and group II included those using VDT for less than 6 h per day.Results A total of 120 individuals were included in this study. The total symptom severity score of more than or equal to 6 (i.e. with CVS) was recorded in 83 (69.2%) patients. The median symptom severity score was 8 (SD: 10.2, range: 0–46). In CVS patients, headache (79 patients=95.2%) was the most prevalent symptom followed by blurred vision (70 patients=84.3%), dryness (57 patients=68.7%), heavy eyelid (57 patients=68.7%), eye redness (55 patients=66.3%), and eye pain (53 patients=63.9%). Among group I, 50 (68.4%) patients had CVS while in group II, 33 (70.2%) patients had CVS (P=1.0; c2 test). In adults, 57 (67.1%) patients had CVS compared with 26 (74.3%) patients among adolescents (P=0.001, Fisher’s exact test).Conclusion The proportion of CVS among individuals who were using VDT for more than 2 h was significantly higher in adolescents as compared with the adult age group.

Age, symptoms, and functional outcome after mild traumatic brain injury.

Previous older adult studies have examined outcome from moderate-to-severe traumatic brain injury (TBI), but fewer have focused on the effects of milder brain injuries. This study examined age-related differences in symptom reporting and whether symptoms are differentially related to functional outcome based on age. Patients presenting with a head injury at the Tampere University Hospital emergency department (N=325, aged 18-100) were evaluated at 1week postinjury on the Modified Rankin Scale and Rivermead Post Concussion Symptoms Questionnaire (RPQ). A quarter of participants had missing RPQ data, with missingness associated with greater age and strongly associated with pre-existing functional impairment, dementia, and/or neurological conditions. Among participants with complete data, participants <65years old endorsed headaches, noise/light sensitivity, irritability, and frustration/impatience at a greater frequency than participants ≥65years old. However, no differences were found in the number of symptoms endorsed or the total symptom severity score. The correlations between the severity of symptoms and change in function were similar between the two age groups. Older adults tended to report fewer symptoms, but symptoms had a roughly equivalent relationship with declines in functioning across age groups. A large percentage of older adults in this study had pre-injury dementia or neurological disease that contributed to missing data on the 1-week outcome measures. The results provide insight into the impact of mild spectrum TBI on older adults compared to younger patients.

Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms

This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. Paired right-sided SGB or sham procedures at weeks 0 and 2. Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was -12.6 points (95% CI, -15.5 to -9.7 points) for the group receiving SGB treatments, compared with -6.1 points (95% CI, -9.8 to -2.3 points) for those receiving sham treatment (P = .01). In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. ClinicalTrials.gov identifier: NCT03077919.

Influence of Test Environment, Age, Sex, and Sport on Baseline Computerized Neurocognitive Test Performance

Background: Baseline computerized testing is a common component of concussion assessments, and the testing environment has been suggested to influence test performance and validity. Purpose: To compare concussion baseline computerized neurocognitive test performance and validity among adolescent athletes based on testing environment (group, individual), age group (10-12, 13-15, 16-18 years), sex (male, female), and sport type (collision/combat, contact, noncontact). Study Design: Cohort study; Level of evidence, 3. Methods: Through a concussion community outreach program, participants completed baseline computerized neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). A total of 2845 athletes aged 10 to 18 years completed the baseline assessment. A total of 2241 (79%) athletes completed baseline testing in a group environment, and 604 (21%) completed testing in an individual environment. A random subsample of 500 athletes from each group was selected for statistical comparison. Results: No significant differences were supported in baseline computerized neurocognitive test performance between the group and individual administration environments. Test validity was statistically similar across testing environment, age group, and sex. However, patients of older age (16-18 years), female sex, and collision/combat and contact sports performed better on ImPACT. There were differences in total symptom severity scores (t = 2.19, df = 998, P = .03), with participants in the group testing environment reporting lower total symptom severity scores than those in the individual testing environment. The rates of invalid tests were low across all age groups, averaging from 4.0% in the 10- to 12-year age group to 4.8% in the 13- to 15-year age group. Conclusion: The findings indicated that concussion baseline neurocognitive test performance is similar when administered in group and individual testing environments. However, differences based on age group, sex, and sport type should be considered when interpreting baseline computerized neurocognitive test scores. The finding of higher symptom scores in older adolescents in the individual testing environment suggests that they may be less forthcoming about symptoms in a group setting.

Estimated Age of First Exposure to Contact Sports Is Not Associated with Greater Symptoms or Worse Cognitive Functioning in Male U.S. Service Academy Athletes.

This study examined the association between estimated age of first exposure (eAFE) to contact sport participation and neurocognitive performance and symptom ratings in U.S. service academy National Collegiate Athletic Association (NCAA) athletes. Male cadets (N = 891), who participate in lacrosse (n = 211), wrestling (n = 170), ice hockey (n = 81), soccer (n = 119), rugby (n = 10), or non-contact sports (n = 298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each neurocognitive domain score and total symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact); eAFE (eAFE <12 years vs. eAFE ≥12 years); group-by-eAFE; and covariates for learning accommodation status, concussion history, and age. The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald χ2 = 0.073, p = 0.788; Visual Memory, Wald χ2 = 2.71, p = 0.100; Visual Motor Speed, Wald χ2 = 0.078, p = 0.780; Reaction Time, Wald χ2 = 0.003, p = 0.955; Symptom Severity, Wald χ2 = 2.87, p = 0.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (χ2 = 6.19, p = 0.013, B = -2.97). Older age was associated with faster reaction time (χ2 = 4.40, p = 0.036, B = -0.006) and lesser symptom severity (χ2 = 5.55, p = 0.019, B = -0.068). No other parameters were significant. We observed no association between eAFE, contact sport participation, neurocognitive functioning, or subjectively experienced symptoms in this cohort. Earlier eAFE to contact sport participation is not related to worse neurocognitive performance or greater subjectively experienced symptoms in male U.S. service academy NCAA athletes.

Initial Average Symptom Severity is a Better Predictor of Recovery following Concussion than Total Symptom Burden

Abstract Purpose Symptom reports such as the Post-concussion Symptom Scale (PCSS) are common assessments following concussion. Patients with high symptom burden following a concussion take longer to recover. However, two patients could have a symptom burden of 30, which is high, but one patient has endorsed only 6 items for an average severity of 5; whereas, another patient has endorsed 15 items for an average severity of 2. The purpose of this study was to compare the association of different symptom outcomes (i.e., average symptom severity, total symptom severity [i.e., symptom burden] and total number of symptoms) on recovery time. Methods Participants included 109 (46-M/64-F) concussed patients aged 13–21 years (15.0±1.7) from a specialty clinic. Participants completed the PCSS and total symptom and average symptom severity scores were then calculated. Recovery time (i.e., date of injury to full medical clearance) was recorded. Pearson product-moment correlations and multiple regression (MR) were used to analyze the data. Results The results from the Pearson product-moment correlations indicated that all of the symptom outcomes were correlated. Only the average symptom severity score was correlated (r=.23, p&lt;.05) with recovery time. Results from the MR for recovery time indicated that average symptom severity was associated with a longer recovery time (Beta=.40, t=2.2, p=.03). Conclusion Findings indicate that average symptom severity was the best predictors of recovery time, which is in contrast to the literature, and highlights the importance for clinicians to consider average symptom severity in prognosis following concussion.

The Role of Premorbid Psychiatric History and Current Mood Ratings on Self-Reported Concussion Symptom Severity

Abstract Purpose Psychiatric history is known to be relevant to concussion outcomes, although less is known about the role of such factors or current mood ratings in adolescents. The aim of this study was to assess the role of premorbid psychiatric history (PPH) and current mood ratings (CMR) on overall sports-related concussion (SRC) symptomology and cognitive outcomes in adolescent and young adult athletes. Methods Participants age 12–25 years (M=14.8) diagnosed with SRC (n=560) were evaluated within 14 days of injury as part of the North Texas Concussion Registry (ConTex) using the Patient Health Questionnaire-8 Items (PHQ-8), General Anxiety Disorder-7 Item Scale (GAD-7), and ImPACT. Subjects were dichotomized into those with (PPH+) and without (PPH-) pre-existing reported psychiatric diagnoses, and CMR groups were determined by normal vs. elevated scores on the GAD-7 and PHQ-8. T-tests were used to compare groups. Results Significant differences in total symptom severity scores were found between both PPH (p=.01) and CMR (p&lt;.001) groupings. PPH+ (n=27) reported significantly higher symptom scores (M=31.6) than PPH- subjects (n=316, M=20.9). Additionally, those reporting elevated CMR endorsed 2.3x higher symptom severity scores (n=48, M=42.1 vs. n=276, M=18.2). Among ImPACT cognitive scores, only Visual Memory differed between CMR groups (p=.047). Conclusion Findings suggest that PPH and elevated CMR are associated with greater self-reported symptom severity in adolescent SRC, but have little relationship to cognitive outcomes as assessed by ImPACT. Further research is needed to understand the interaction between PPH, CMR, and SRC recovery across the age spectrum.

Post-Concussion Symptom Factors in Male and Female High School and Collegiate Athletes

Previous research suggests concussed female athletes report higher severity of total symptoms; however, sex differences for symptom factors across recovery are understudied. PURPOSE: To examine sex differences in post-concussion symptom factors across concussion recovery (i.e., ≤72 hours, return-to-play, >one-month). METHODS: Symptoms were rated from 0 (none) to 6 (severe) on the Post-Concussion Symptom Scale (PCSS), which consists of 22 total symptoms and a total symptom severity score ranging from 0-132. The PCSS was broken into two symptom factors: cognitive-migraine-fatigue (headache, dizziness, fatigue, drowsiness, sensitivity to light/noise, feeling slowed down, fogginess, difficulty concentrating/remembering) and affective (sadness, nervousness, feeling more emotional). A 2 sex (male, female)*2 group (concussed, healthy)*3 time (≤72 hours, return-to-play, >one-month) repeated measures ANOVA was used to analyze sex differences in symptom factors throughout recovery between concussed and healthy athletes. RESULTS: There were 167 (M=17.46 years, SD=2.2; male=97, female=70; concussed=78, healthy=89) total athletes. There were no significant sex differences between testing sessions at ≤72 hours (M=2.03 days, SD=0.8, p=.42), return-to-play (M=16.09 days, SD=11.7, p=.95), and >one-month (M=59.72 days, SD=21.4, p=.65). There was no significant within-subject interaction for sex*group*time for the cognitive-migraine-fatigue or affective symptom factors. There was a significant between-subjects sex*group interaction for the cognitive-migraine-fatigue symptom factor (F(1,163)=5.52, p=.02, η2=.03). Simple main effects analysis revealed concussed females (M=7.39, SE=0.57) reported significantly higher severity for the cognitive-migraine-fatigue symptom factor than concussed males (M=4.83, SE=0.48; p≤.001), yet no sex differences were observed between healthy athletes (p=.82). There was no significant between-subjects sex*group interaction for the affective post-concussion symptom factor. CONCLUSIONS: Concussed females reported greater symptom severity for the cognitive-migraine-fatigue symptom factor compared to concussed males, which may direct targeted concussion management approaches between female and male athletes.

Posttraumatic stress and health-related quality of life in parents of children with cardiac rhythm devices.

Studies have shown a high prevalence of post-traumatic stress disorders (PTSD) among parents of children with life-threatening diseases. However, it is yet unknown whether parents of children with cardiac rhythm device develop posttraumatic stress symptoms or even PTSD. This cross-sectional investigation is part of a comprehensive single-center study of long-term medical and psychosocial outcomes in pediatric patients with pacemaker (PM) and implantable cardioverter defibrillator (ICD). 69 patients (78%) were included in the study, with the participation of 69 mothers and 57 fathers. Parents completed the Posttraumatic Diagnostic Scale and Medical Outcomes Study Short Form-36 item questionnaire. Child's medical data was collected retrospectively from patients' hospital records. At assessment, the patients (39% females) were on average 11.2years old. The predominant device type was PM in 56 cases (81%). The mean time since device implantation was 6.3years (SD = 4.3). Full heart-disease related PTSD was diagnosed in one mother and no father, while partial heart-disease-related PTSD was diagnosed in 3 mothers (4%) and 2 fathers (4%). Parental HRQoL-especially regarding the mental health dimension-was affected in both parents. In both parents, total PTSD symptom severity scores were a significant predictor for mental health summary scores after controlling for child age at implantation, presence of other non-cardiac disease in the child, parental age, and presence of own chronic disease. Special attention should be given to parental PTSD symptoms in the clinical follow-up of PM and ICD patients as some parents might probably benefit from psychological support.

Influence of Self-reported Fatigue and Sex on Baseline Concussion Assessment Scores.

Background:Baseline concussion assessments are advocated to provide an objective preinjury point of comparison for determining the extent of postconcussion neurological deficits and to assist with return-to-activity decision making. Many factors, including testing environment, proctor availability, and testing group size, can influence test accuracy and validity; however, it is unknown how self-reported fatigue affects test scores.Purpose:To investigate the influence of self-reported fatigue and patient sex on baseline concussion assessment scores.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Participants included 494 healthy Division I college student-athletes (221 women, 273 men; mean ± SD age, 20.0 ± 1.3 years). During preseason baseline testing, participants were asked to rate their fatigue on a scale from 0 to 100 based on how they normally feel and function each day (0, completely exhausted; 100, completely awake and alert). Each participant then completed a multimodal baseline concussion assessment, including a graded symptom checklist (number of symptoms endorsed and total symptom severity score), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and CNS Vital Signs computerized neurocognitive testing. Multiple linear regressions tested whether self-reported fatigue and sex predicted baseline concussion examination scores.Results:Athletes with higher self-reported fatigue levels (ß = –0.014, P < .01) and female athletes (ß = –0.216, P < .01) reported more total symptoms. Being male (ß = 0.856, P < .01) increased the likelihood of endorsing zero symptoms versus any symptoms by a factor of 2.40. Women also had significantly higher SAC scores (ß = 0.569, P < .001), BESS scores (ß = –2.747, P < .001), and CNS Vital Signs summary scores (ß = 4.506, P < .001). SAC, BESS, and CNS Vital Signs scores were not predicted by fatigue level (P > .05).Conclusion:Female athletes and fatigued athletes endorsed more symptoms and higher symptom severity at baseline. Using total symptom endorsement and total symptom severity scores as part of the postinjury management is a common practice. The current data suggest that levels of reported exhaustion can influence concussion assessment scores meant to represent a healthy baseline and likely would interfere with postinjury assessment scores.

The implementation and evaluation of HIV symptom management guidelines: A preliminary study in China

ObjectiveThe overarching objective of this study was to examine the effectiveness of HIV symptom management guidelines in China in reducing the incidence and severity of symptoms and improving patients' quality of life. MethodsWe conducted a controlled, pre- and post-implementation design in the HIV/AIDS inpatient unit in Shanghai. Patients recruited from November 2014 to February 2015 were in the intervention group and those from October 2013 to February 2014 were in the control group. There were 74 patients in each group. Participants in the intervention group received interventions based on the HIV symptom management guidelines. Overall symptom severity, depression, and quality of life were measured in two groups at baseline, week 4, and week 8. ResultsTotally 126 patients completed the research, 65 in the intervention group and 61 in the control group. The total symptom severity scores showed a statistically significant difference between groups across time (P < 0.05). It showed that frequencies of fatigue (36.9% vs. 44.3%), fever (6.2% vs. 11.5%), loss in weight (9.2% vs. 16.4%), mouth ulcers (12.3% vs. 16.4%), headaches (9.2% vs. 19.7%) and depression (F = 1.09, P > 0.05) in the intervention group were lower than those in the control group in week 8 without statistical significance. The multilevel growth mixture model indicated a greater increase in the total score of quality of life for the group treated according to the symptom management guidelines (P = 0.04). ConclusionThe evidence-based HIV symptom management guidelines can improve a patient's quality of life and relieve negative symptoms. The guidelines can be applied in a similar context to other HIV/AIDS units or clinics.

2418 Post-traumatic stress symptoms in caregivers of pediatric hydrocephalus population

OBJECTIVES/SPECIFIC AIMS: The goal of this study is to characterize traumatic events and post-traumatic stress symptom severity experienced by caregivers of children with hydrocephalus. Results will eventually be evaluated and compared with demographic and medical characteristics. This study is part of a larger research project that aims to (1) determine the prevalence and risk factors for post-traumatic stress symptoms in pediatric hydrocephalus patients and their caregivers; (2) develop a targeted intervention to mitigate its effects and pilot test the intervention. METHODS/STUDY POPULATION: Caregivers of children with hydrocephalus that have received surgical treatment (CSF shunt or ETV/CPC) were enrolled during routine follow up visit in a pediatric neurosurgery clinic. Caregivers completed the PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report measure that assesses the presence and severity of post-traumatic stress disorder (PTSD) symptoms. RESULTS/ANTICIPATED RESULTS: Participant responses (n=56) revealed that 57.14% of caregivers indicated that their most traumatic event was directly related to their child’s medical condition. In total, 23.21% of caregivers did not specify their most traumatic event and 1.79% of caregivers indicated that they had never experienced a traumatic event. Median Total Symptom Severity Score was 11 (mean: 15.32±14.92), and scores ranged from 0 to 67; 32.14% of caregivers scored 19 or greater, and 16.07% of caregivers scored 33 or greater, a value suggestive of a provisional diagnosis of PTSD. Severity scores by DSM-V clusters were as follows: cluster B—intrusion symptoms (mean: 4.91±4.77, median: 4, range: 0–20), cluster C—avoidance symptoms (mean: 1.27±1.87, median: 0.5, range: 0–8), cluster D—negative alterations in cognition and mood (mean: 4.86±6.07, median: 2, range: 0–22), and cluster E—alterations in arousal and reactivity (mean: 4.29±4.07, median: 3, range: 0–17). DISCUSSION/SIGNIFICANCE OF IMPACT: Preliminary results from this study indicate that post-traumatic stress symptoms are prevalent among caregivers of children with hydrocephalus. These results suggest that psychosocial issues such as PTSS may be a significant problem in need of treatment, that is not traditionally addressed as part of routine care for families of children with hydrocephalus. Characterizing post-traumatic stress symptoms in this population sets the foundation for the development of screening and treatment protocols for post-traumatic stress symptoms in caregivers of children with hydrocephalus. This study is the first step towards fundamentally improving routine clinical care and quality of life for patients with hydrocephalus and their caregivers by understanding and addressing the effects of traumatic stress.

The role of human Metapneumovirus genetic diversity and nasopharyngeal viral load on symptom severity in adults

BackgroundHuman metapneumovirus (HMPV) is established as one of the causative agents of respiratory tract infections. To date, there are limited reports that describe the effect of HMPV genotypes and/or viral load on disease pathogenesis in adults. This study aims to determine the role of HMPV genetic diversity and nasopharyngeal viral load on symptom severity in outpatient adults with acute respiratory tract infections.MethodsSeverity of common cold symptoms of patients from a teaching hospital was assessed by a four-category scale and summed to obtain the total symptom severity score (TSSS). Association between the fusion and glycoprotein genes diversity, viral load (quantified using an improved RT-qPCR assay), and symptom severity were analyzed using bivariate and linear regression analyses.ResultsAmong 81/3706 HMPV-positive patients, there were no significant differences in terms of demographics, number of days elapsed between symptom onset and clinic visit, respiratory symptoms manifestation and severity between different HMPV genotypes/sub-lineages. Surprisingly, elderly patients (≥65 years old) had lower severity of symptoms (indicated by TSSS) than young and middle age adults (p = 0.008). Nasopharyngeal viral load did not correlate with nor predict symptom severity of HMPV infection. Interestingly, at 3–5 days after symptom onset, genotype A-infected patients had higher viral load compared to genotype B (4.4 vs. 3.3 log10 RNA copies/μl) (p = 0.003).ConclusionsOverall, HMPV genetic diversity and viral load did not impact symptom severity in adults with acute respiratory tract infections. Differences in viral load dynamics over time between genotypes may have important implications on viral transmission.