Total Symptom Severity Score Research Articles

Viral Load and Sequence Analysis Reveal the Symptom Severity, Diversity, and Transmission Clusters of Rhinovirus Infections.

Rhinovirus (RV) is one of the main viral etiologic agents of acute respiratory illnesses. Despite the heightened disease burden caused by RV, the viral factors that increase the severity of RV infection, the transmission pattern, and seasonality of RV infections remain unclear. An observational study was conducted among 3935 patients presenting with acute upper respiratory illnesses in the ambulatory settings between 2012 and 2014. The VP4/VP2 gene was genotyped from all 976 RV-positive specimens, where the predominance of RV-A (49%) was observed, followed by RV-C (38%) and RV-B (13%). A significant regression in median nasopharyngeal viral load (VL) (P < .001) was observed, from 883 viral copies/µL at 1-2 days after symptom onset to 312 viral copies/µL at 3-4 days and 158 viral copies/µL at 5-7 days, before declining to 35 viral copies/µL at ≥8 days. In comparison with RV-A (median VL, 217 copies/µL) and RV-B (median VL, 275 copies/µL), RV-C-infected subjects produced higher VL (505 copies/µL; P < .001). Importantly, higher RV VL (median, 348 copies/µL) was associated with more severe respiratory symptoms (Total Symptom Severity Score ≥17, P = .017). A total of 83 phylogenetic-based transmission clusters were identified in the population. It was observed that the relative humidity was the strongest environmental predictor of RV seasonality in the tropical climate. Our findings underline the role of VL in increasing disease severity attributed to RV-C infection, and unravel the factors that fuel the population transmission dynamics of RV.

Rapid sideline performance meets outpatient clinic: Results from a multidisciplinary concussion center registry

ObjectiveThis study investigated the utility of sideline concussion tests, including components of the Sports Concussion Assessment Tool, 3rd Edition (SCAT3) and the King-Devick (K-D), a vision-based test of rapid number naming, in an outpatient, multidisciplinary concussion center treating patients with both sports-related and non-sports related concussions. The ability of these tests to predict clinical outcomes based on the scores at the initial visit was evaluated. MethodsScores for components of the SCAT3 and the K-D were fit into regression models accounting for age, gender, and sport/non-sport etiology in order to predict clinical outcome measures including total number of visits to the concussion center, whether the patient reached a SCAT3 symptom severity score≤7, and the total types of referrals each patient received over their course. Patient characteristics, differences between those with sport and non-sport etiologies, and correlations between the tests were also analyzed. ResultsAmong 426 patients with concussion, SCAT3 total symptom score and symptom severity score at the initial visit predicted each of the clinical outcome variables. K-D score at the initial visit predicted the total number of visits and the total number of referrals. Those with sports-related concussions were younger, had less severely-affected test scores, had fewer visits and types of referrals, and were more likely to have clinical resolution of their concussion and to reach a symptom severity score≤7. ConclusionsThis large-scale study of concussion patients supports the use of sideline concussion tests as part of outpatient concussion assessment, especially the total symptom and symptom severity score portions of the SCAT3 and the K-D. Women in this cohort had higher total symptom and symptom severity scores compared to men. Our data also suggest that those with non-sports-related concussions have longer lasting symptoms than those with sports-related concussions, and that these two groups should perhaps be regarded separately when assessing outcomes and needs in a multidisciplinary setting.

Do NAA/CHO and NAA/CR ratios as measure by 1h MR spectroscopy differ between symptomatic and non-symptomatic concussed athletes in the early post injury period?

ObjectiveChanges in cerebral N-acetylaspartate and choline (NAA/Cho) or creatine (NAA/Cr) following a mild traumatic brain injury (mTBI) in sport have been measured by 1H (Proton) magnetic resonance spectroscopy (1H-MRS). We intend to investigate the effect that presenting symptomatology has on these parameters.DesignObservational cohort study.SettingUK Premiership and Championship Rugby.ParticipantsAthletes aged 18-40 years.Interventions (or assessment of risk factors)Concussed athletes identified by members of their enhanced-care clinical team. Imaging undertaken on a Philips Achieva 3.0 T MR scanner (32 channel SENSE coil). A PRESS sequence (et 37 ms, rt 2000 ms) generated spectra in a 20 mm MRS cubic voxel in right-sided superior frontal white matter. Symptoms were assessed using the IMPACT and SCAT-3 concussion assessment tools. Recruits were divided into either ‘symptomatic’ or ‘non-symptomatic’ at presentation based on a minimum severity score from either of these assessments.Outcome measuresAnalysis of raw parameters was undertaken utilising the TARQUIN 1H-MRS analytical software package. A Mann-Whitney-U test was performed to compare results between the symptomatic and non-symptomatic groups.Main results33 concussed professional athletes were recruited. Of these a total of 7 Symptomatic (6 male, mean age 24yrs, scoring a total symptom severity score of &lt;10 on either assessment measure) and 11 non-symptomatic (all male, mean age 25 yrs) athletes tested within the target window (2–4 days). Ratios between groups did not vary significantly (NAA/Cho mean 4.43 vs 4.53 and NAA/Cr 1.24 vs 1.26, p=0.84 and p=0.99 respectively).ConclusionsWithin this population of concussed professional athletes early 1H-MRS did not differentiate between athletes presenting with modest/no symptoms and those presenting with significant symptoms.Competing interestsNone.

Self-stigma and quality of life in outpatients with depressive disorder – a cross-sectional study

BackgroundSelf-stigma is a maladaptive psychosocial phenomenon that may disturb many areas of patient's life and have the negative impact on their quality of life. The present study explored the association between self-stigma, quality of life, demographic data, and the severity of symptoms in patients with depressive disorder.MethodPatients, who met ICD-10 research criteria for depressive disorder, were enrolled in the cross-sectional study. All probands completed these measurements: the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), the Internalised Stigma of Mental Illness Scale (ISMI), demographic questionnaire, and the severity of the disorder measured by objective and subjective Clinical Global Impression severity scales (CGI).ResultsEighty-one depressive patients (with persistent affective disorder – dysthymia, major depressive disorder or recurrent depressive disorder) and 43 healthy controls contributed to the study. Comparing with the healthy control group, there was a lower quality of life in patients with depression. The level of self-stigma correlated positively with total symptom severity score and negatively with the quality of life. Multiple regression analysis discovered that the overall rating of objective symptoms severity and self-stigma were significantly associated with the quality of life.ConclusionsPresent study suggests the lower quality of life in outpatients with depressive disorder in comparison with healthy controls, and the negative impact of self-stigma level on quality of life in patients suffering from depressive disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Self-Reported Outcomes for Patients Undergoing Revision Carpal Tunnel Surgery With or Without Hypothenar Fat Pad Transposition.

Carpal tunnel surgery is the most common surgical procedure performed on the hand. Although complications are rare, recurrent or persistent carpal tunnel syndrome can be a significant problem after primary decompression. Various procedures have been described for the treatment of these patients including repeat decompression and hypothenar fat pad transposition. The purpose of this study is to compare the outcomes of patients undergoing revision carpal tunnel decompression with and without hypothenar fat pad transposition. We performed a retrospective review of all patients undergoing revision carpal tunnel surgery at our institution between 2002 and 2014. Identified patients were contacted by telephone. A Boston Carpal Tunnel Questionnaire (BCTQ) was administered to all participants. Seventy-six patients underwent revision carpal tunnel surgery over the study period. Twenty-nine of 45 potential participants provided a survey response (64.9%) representing a total of 33 carpal tunnel revision surgeries. Seventeen hands underwent repeat decompression alone, and 16 hands underwent repeat decompression with hypothenar fat pad transposition. A trend toward improved overall BCTQ score was noted for patients undergoing decompression alone; however, no significant difference was determined for total survey score by procedure type. Similarly, total symptom severity and functional scores were not statistically significant between groups; however, a trend toward significance for improved symptom severity score was observed in patients undergoing decompression alone. Our results reveal no difference in self-reported symptom severity and functional scores between patients undergoing revision carpal tunnel surgery with repeat decompression alone or decompression with fat pad transposition.

Do post-concussion-like symptom responses change following exercise or sports participation in a non-concussed cohort?

The purposes of this study were (a) to determine the reliable change in post-concussion-like symptoms reported following self-selected exercise or sports activities and (b) to explore the potential influence of gender and exercise parameters on post-concussion-like symptoms reported by a non-concussed cohort following exercise/training. A pre-to-post observational design was used. A convenience sample of students aged 18-30years who visited a university recreation center to engage in their chosen exercise activity and a purposeful sample of men's and women's rugby union players engaged in their regular training sessions were included in the study. All participants reported their symptoms using the symptom scale of the Sport Concussion Assessment Tool 2. The reliable change index was used to determine the change in symptom scores reported from pre-to post-exercise/training. Multiple linear regression analysis was used to model the exercise variables to explain the impact on the reporting of symptoms. A total of 260 participants (146 males and 114 females) completed their self-selected exercise activity or rugby union training. Approximately two-thirds of all participants did not demonstrate a change (increase or decrease) in total symptom score (201/260, 77.9%) and/or symptom severity score (212/260, 81.9%) from pre-to post-exercise/training. The symptom response following exercise or sports training did not change in the majority of participants. Clinicians need to be aware of these findings to make informed decisions on return-to-play following a concussive brain injury.

Psychological and Lifestyle Factors That Influence the Serial Reporting of Postconcussion-like Symptoms in a Non-concussed Population

BackgroundSymptoms related to concussion are generally nonspecific in nature, as they are also reported by non-concussed individuals. What is currently not known is whether the symptoms vary over time, and whether they are also influenced by a multitude of factors. ObjectiveThe aim of this study was to investigate the potential influence of psychological, lifestyle, and situational factors on the change in postconcussion-like symptoms reported over 7 consecutive days in a cohort of normal individuals. DesignThis was a longitudinal observational study. SettingThe setting was a real-world context. ParticipantsA convenience sample of 180 non-concussed university students were enrolled. Of these, 110 participants provided data for the entire period of the study. MethodsAn experience-sampling methodology was used to document the symptoms reported over time. Stepwise multivariate linear mixed-effects modeling was performed to identify the predictors contributing to the serially reported symptoms. Independent VariablesIndependent variables considered were gender, time of the day, location, primary activity, and type of interactant (person) of the participant, physical activity status, trouble sleeping, alcohol consumption, caffeine consumption, stress, anxiety, depression, mental and physical fatigue, and life stressors. Main Outcome MeasuresThe key outcome measures were the change in total symptom score (TSSchange) and symptom severity score (SSSchange) reported over 7 consecutive days. ResultsThe predictors of location at the time of reporting, physical fatigue (estimate: −0.98, P < .001) and mental fatigue (estimate: −0.53, P < .001) contributed to the TSSchange. Post hoc analysis of the variable of location at the time of reporting revealed that participants reported increased TSSchange when they were at a café/restaurant compared to a flat/college or university. ConclusionsA number of factors within the context of daily life influenced the postconcussion-like symptoms reported over time. These findings indicate that clinicians need to be cautious when interpreting the serially assessed symptom scores to track the recovery profile of a concussed athlete to make decisions on return-to-play. Additional investigation is warranted to examine the change in symptom scores reported over time by concussed individuals, considering that this study was conducted in a nonconcussed cohort. Level of EvidenceNot applicable.

Self-stigma and quality of life in patients with depressive disorder: a cross-sectional study.

BackgroundSelf-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients’ lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder.Patients and methodsPatients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder – dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study.ResultsCompared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL.ConclusionThis study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders.

Assessing Symptoms in Adolescents Following Sport-Related Concussion: A Comparison of Four Different Approaches

This study compared post-concussion symptom endorsements on the Post-Concussion Symptom Scale (PCSS) between a clinical open-ended interview, clinician-guided PCSS, parent-report PCSS, and computer-based PCSS in youth athletes with sport-related concussion (SRC). Participants included 54 patients aged 13–17 years (M = 15.19, SD = 1.29, 51.8% male) with a diagnosed SRC seen at a concussion clinic. Participants were administered a computer-based version (COMP) of the PCSS followed by clinical open-ended symptom interview (OPEN) and clinician-guided PCSS (GUIDED). Participants’ parents concurrently and independently endorsed their children's symptoms by completing the PCSS in the waiting room (PARENT). Total number of symptoms reported and total symptom severity score were analyzed and compared across the four PCSS administration methods. Results revealed significantly lower total number of symptoms for OPEN compared to GUIDED (p = .002), PARENT (p < .001), and COMP (p = .006); and significantly lower total severity score for OPEN compared to GUIDED (p = .04) and PARENT (p < .001). These data support using the PCSS as a structured method of assessing post-concussion symptoms and question the utility of unstructured interview methods for assessing symptoms in youth athletes with SRC.

Systematic review and meta-analysis: Gastric electrical stimulation for gastroparesis.

Controlled trials of gastric electrical stimulation (GES) for gastroparesis reported no significant improvement in symptoms, while open label studies suggested substantial clinical benefits. To determine if GES is effective in reducing symptoms in patients with gastroparesis. We searched PubMed and Embase for articles published in English (1990-2014) using "gastroparesis" as a search term restricted to "clinical trial". We included studies describing repeated patient-based symptom ratings before and during standardized treatments of at least one week duration. Five studies randomly allocated patients to periods with or without GES. Total symptom severity (TSS) scores did not differ between these periods (0.17 [95% confidence interval: -0.06 to 0.4]; P=0.15). However, sixteen open label studies of GES showed a significant TSS decrease (2.68 [2.04-3.32]; Q=39.0; P<0.001). Other treatment modalities similarly improved TSS by 1.97 [1.5-2.44] for medical therapy (MED), by 1.52 [0.9-2.15] for placebo arms (PLA), and by 2.32 [1.56-3.06] for botulinum toxin (BTx). There were significant differences in baseline TSS ratings among these studies (GES: 6.28 [6.28-7.42]; MED: 4.76 [4.09-5.42]; PLA: 4.59 [3.77-5.42]; BTx: 6.02 [5.3-6.74]; Q=35.1; P<0.001). Meta-regression analysis showed these baseline differences to significantly impact TSS ratings during treatment (Q=71.8; P<0.001). Independent of the treatment modality, baseline symptom severity impacts treatment results in gastroparesis. Considering the skewed population with refractory symptoms, regression to the mean likely contributes to the substantial discrepancies between the reported results of controlled and open label GES studies, raising questions about the use of GES outside of defined clinical trials.

Increased anticipatory contingent negative variation in posttraumatic stress disorder

Altered anticipation processes are implicated across various clinical samples, but few studies focused on the posttraumatic stress disorder (PTSD). We measured contingent negative variation (CNV) in a choice reaction paradigm among 58 survivors of the Wenchuan earthquake, including 28 individuals who were diagnosed with PTSD and 30 without PTSD. Compared to the non-PTSD group, the PTSD group had significantly larger CNV amplitude. On the behavioral level, although the reaction times were comparable between groups, the PTSD group committed more errors than the non-PTSD group. Furthermore, the total PTSD symptom severity score as well as the re-experiencing symptom score were positively related to CNV amplitude. These results suggested that individuals with PTSD might be more alerted to and anticipate more to upcoming events in their environment, yet still have degraded performance in response to the stimulus.

Self-stigma and quality of life in Psychopharmacs treated outpatients with schizophrenia and related disorders - A cross-sectional study

IntroductionSelf-stigma is a maladaptive psychosocial phenomenon that can disturb self-image and quality of life in psychiatric outpatients and may lead to dysphoria, social isolation and reduced adherence to treatment.ObjectivesSelf-stigma and QoL could be reflected as important factors for patients, who suffer from schizophrenia spectrum disorders, their caregivers and mental health specialists. Focus on reducing the self-stigma in supportive and educational therapy could be an important factor in promoting a higher QoL.AimsCurrent research moved attention to the relationship between demographic data, the severity of symptoms, self-stigma and quality of life in schizophrenic outpatients compared to the QoL in healthy controls.MethodsPatients who met ICD-10 criteria for schizophrenia spectrum disorder were recruited in the study. The Quality of Life Satisfaction and Enjoyment questionnaire (Q-LES-Q), Internalized Stigma of Mental Illness (ISMI) and severity of the disorder measured by objective and subjective Clinical Global Impression severity scales (CGI) were assessed.ResultsOne hundred and nine psychotic patients and 91 healthy controls participated in the study. Compared to the control group, there was a lower QoL and a higher score of self-stigma in psychotic patients. We found the correlation between the self-stigma, duration of disorder and QoL. The level of self-stigma correlated positively with total symptom severity score and negatively with the QoL. Stepwise regression analysis revealed that the objective severity and self-stigma score were significantly associated with the quality of life (Figure 2 and 3, Fig. 1).ConclusionsOur study suggests a negative impact of self-stigma level on the quality of life in patients suffering from schizophrenia spectrum disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Are self-stigma, quality of life, and clinical data interrelated in schizophrenia spectrum patients? A cross-sectional outpatient study.

BackgroundCurrent research attention has been moving toward the needs of patients and their consequences for the quality of life (QoL). Self-stigma is a maladaptive psychosocial phenomenon disturbing the QoL in a substantial number of psychiatric patients. In our study, we examined the relationship between demographic data, the severity of symptoms, self-stigma, and QoL in patients with schizophrenia spectrum disorder.MethodsProbands who met International Classification of Diseases-10 criteria for schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, or delusional disorder) were recruited in the study. We studied the correlations between the QoL measured by the QoL Satisfaction and Enjoyment Questionnaire, self-stigma assessed by the Internalized Stigma of Mental Illness, and severity of the disorder measured by the objective and subjective Clinical Global Impression severity scales in this cross-sectional study.ResultsA total of 109 psychotic patients and 91 healthy controls participated in the study. Compared with the control group, there was a lower QoL and a higher score of self-stigmatization in psychotic patients. We found the correlation between an overall rating of self-stigmatization, duration of disorder, and QoL. The level of self-stigmatization correlated positively with total symptom severity score and negatively with the QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and the score of self-stigma were significantly associated with the QoL.ConclusionOur study suggests a negative impact of self-stigma level on the QoL in patients suffering from schizophrenia spectrum disorders.

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.

Sex differences in the trauma-related symptoms: A pilot study

Introduction: During the year 2014, a part of the population from Serbia was exposed to floods. After natural disasters and other types of extreme trauma, some people will be more affected by trauma than others. How women and men differ, in the symptoms that can manifest after the exposure to extreme trauma, is still an open question. Aim: To evaluate if there are differences in the severity of trauma-related symptom clusters between the sexes (re-experiencing, avoidance, negative cognitions and mood, and arousal; according to DSM V) and in experiencing negative emotional states (depression, anxiety, stress). Material and methods: Forty healthy volunteers from Obrenovac (25 women and 15 men) were administered with three instruments: The Life Events Checklist - LEC-5, PTSD checklist for DSM V - PCL-5 and Depression Anxiety Stress Scale - DASS. Results: The majority of subjects reported floods as the major lifetime trauma (72.5%). Despite the relatively low level of the post-traumatic symptom intensity (5.02 ±4.99), women exhibited significantly higher total post-traumatic symptom severity scores in comparison to men (p<0.01) and higher severity of trauma re-experiencing symptoms (p<0.01). Sex differences were neither observed in other trauma-related symptoms clusters, nor in the severity of current depression, anxiety and stress symptoms. Conclusion: In the non-clinical sample, with only a sub-threshold level of post-traumatic symptoms, the most prominent difference between sexes was found in relation to re-experiencing and this finding is consistent with the results obtained from clinical samples. Future studies are needed, in order to examine whether trauma-focused treatments can be gender-tailored and to which extent they might prevent the full-blown post-traumatic stress disorder.

Validation of the parent version of the World Health Organization Adult ADHD Self-Report Scale for adolescents

Objective: To investigate the validity of a parent version of the World Health Organization Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale for adolescents (ASRS-AP) and the 6-question screening version (ASRS-AP-S). Methods: Adolescent psychiatric outpatients (N = 112, mean age 15 years, 40% boys) and their parents were interviewed with the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS), and the parents reported on the ASRS-AP/ASRS-AP-S. Results: Internal consistency (Cronbach’s alpha) was 0.93 for ASRS-AP and 0.85 for ASRS-AP-S, 0.91 and 0.87 for the inattention subscale, and 0.91 and 0.72 for the hyperactivity subscale, respectively. The concurrent validity (Spearman’s correlation coefficient) between the total K-SADS ADHD symptom severity score and the sum of the score on the ASRS-AP/ASRS-AP-S was 0.75 and 0.66, respectively. Diagnostic accuracy measures for the ASRS-AP and ASRS-AP-S were 78% and 80% sensitivity, 75% and 74% specificity, 73% and 71% positive predictive value (PPV), and 81% and 82% negative predictive value (NPV), respectively. Conclusions: The ASRS-AP and ASRS-AP-S showed high internal consistency and concurrent validity in relation to total K-SADS ADHD symptom severity score. Both scales showed favourable diagnostic accuracy measures.

Vaccine-associated reduction in symptom severity among patients with influenza A/H3N2 disease

BackgroundThe moderate level of protection conferred by influenza vaccines is well-known, but the vaccine's ability to attenuate symptom severity among vaccinated individuals (i.e., vaccine failures) has not been established. MethodsWe enrolled otherwise healthy adults who presented with influenza-like illness (ILI) at five US military hospitals between 2009 and 2014. Influenza was diagnosed and subtyped by PCR. Individual and composite severity scores were compared between those who had vs. had not received the seasonal influenza vaccine >14 days prior to enrollment. ResultsA total of 155 cases of influenza (A/H1N1, n=69; A/H3N2, n=66; A/untyped, n=3; B, n=17) were identified, of whom 111 (72%; A/H1N1, n=44; A/H3N2, n=52; A/untyped, n=3; B, n=12) had been vaccinated. Women were significantly less likely to be vaccinated than men (49% vs. 89%; p<0.01). In multivariate analysis, vaccinated individuals were significantly less likely to report a fever >101°F (OR 0.24; 95% CI [0.10, 0.62]) and more likely to report myalgias (OR 3.31; 95% CI [1.22, 8.97]) than vaccinated individuals. Among patients with A/H3N2 infection, upper respiratory and total symptom severity scores were significantly lower for vaccinated patients during the first 2 days of illness, and differences in total symptom severity persisted over 7 days (p<0.05 for all comparisons). Differences across additional symptom categories (lower respiratory and systemic) were also observed throughout 7 days of illness in bivariate analyses. Differences in symptom severity were not observed between vaccinated and unvaccinated participants with A/H1N1 infection. ConclusionsAmong patients with A/H3N2 infection, receipt of seasonal influenza vaccine was associated with reduced symptom severity. Patient-centered discussion about the benefits of influenza vaccination should be expanded to include the possibility that the vaccine could attenuate symptoms.

Generic and disease-specific quality of life and its predictors among Chinese inpatients with schizophrenia

This study aims to describe generic and disease-specific quality of life (QOL) and its predictors among Chinese inpatients with schizophrenia. A total of 209 subjects participated in this study: 121 men and 88 women. Their ages ranged from 18 to 64, with a mean age of 33.85 (S.D.=10.84). The total scores of generic and disease-specific QOL were statistically significant, correlated with patients׳ total symptom severity scores and social support scores (all P values less than 0.01). Multiple regression analysis revealed that monthly household income and subjective social support were statistically significant predictors of generic and disease-specific QOL. Duration of hospitalization, support use degree, negative and general psychopathology symptoms were additional significant predictors of disease-specific QOL. This study suggests the importance of improving subjective social support in order to promote generic and disease-specific QOL. Controlling negative and general psychopathology symptoms and improving support use degree could additionally enhance the disease-specific QOL in patients with schizophrenia.

Gastric Electrical Stimulation for Refractory Gastroparesis: Predictors of Response and Redefining a Successful Outcome

Predictors of a favorable response and measures of success with gastric electrical stimulation (GES) for gastroparesis remain elusive. Published results remain inconsistent with respect to patient perceived benefit, despite statistical improvements in objective measures of symptom severity. We performed a retrospective analysis of 56 patients with gastroparesis who underwent insertion of a gastric electrical stimulator during the study period. Data included demographics, symptoms, total symptom severity score (TSS, range 0-24, initial and most recent), and gastric emptying times. TSS were grouped into four severity categories (0-10, 11-14, 15-18, 19-24). TSS improvement was defined as movement to a lower severity category. Perception of improvement was compared with that of TSS score improvement using χ(2) test. Etiology as a predictor of improvement was measured using logistic regression. Initial mean TSS was 21, and post-treatment TSS was 13.5. Improvement was significant for individual symptoms and in reduction of TSS for both diabetic/idiopathic etiologies (P ≤ 0.001). No correlation was noted between likelihood of success/failure and gastric emptying times (P = 0.32). Thirty-eight improved (moved to lower TSS category), whereas 18 failed (remained in same category) (P ≤ 0.001), which correlated with perception of improvement. Of 18 failures, 14 (77.7%) were idiopathic. On logistic regression, diabetics were more likely than idiopathic patients to move to a lower TSS category (odds ratio 14, P = 0.003) and even more likely to improve based on patient perception (odds ratio 45, P = 0.005). GES produces far more consistent improvement in diabetics. Further study of GES in idiopathic gastroparesis is needed. Application of the proposed TSS severity categories allowed differentiation of small, statistically significant (but clinically insignificant) reductions in TSS from larger, clinically significant reductions, thereby permitting more reliable application of TSS to the evaluation of GES efficacy.

Validation of the World Health Organization Adult ADHD Self-Report Scale for adolescents

Background: The World Health Organization Adult ADHD Self Report Scale (ASRS) is a widely used diagnostic tool for assessment of attention-deficit hyperactivity disorder (ADHD) symptoms in clinical psychiatry in Sweden. The ASRS consists of 18 questions, the first six of which can be used as a short screening version (ASRS-S). There is a version for adolescents—ASRS-Adolescent (ASRS-A)—and the corresponding screening version (ASRS-A-S), which has not been validated to date. Aim: The aim was to validate the ASRS-A and the ASRS-A-S for use in adolescent clinical populations. Methods: Adolescent psychiatric outpatients (n = 134, mean age 15 years, 40% boys) reported on the ASRS-A, and were interviewed with the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS), a semi-structured interview, together with a parent. Results: Internal consistency was 0.79 for the ASRS-A-S and 0.92 for the ASRS-A (Cronbach's alpha). Internal consistency values were 0.79 and 0.87 for the inattention subscale, and 0.68 and 0.89 for the hyperactivity subscale, respectively. Concurrent validity values, measured with Spearman's correlation coefficient, between the total K-SADS ADHD symptom severity score and the sum of ASRS-A-S and ASRS-A total scores were 0.51 and 0.60, respectively. Psychometric properties of the ASRS-A-S and the ASRS-A were: sensitivity 74% and 79%; negative predictive value 81% and 84%; specificity 59% and 60%; and positive predictive value 49% and 51%, respectively. Both versions showed better properties for girls than for boys. Conclusion: Both the ASRS-A-S and the ASRS-A showed promising psychometric properties for use in adolescent clinical populations.