Total Symptom Severity Research Articles

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.

Results of a multicentre double-blind placebo-controlled randomized trial of the liquid form of Anaferon for children in the treatment of acute upper respiratory tract infections

Acute respiratory infections (ARI) are major causes of morbidity in children. Symptomatic treatment is insufficiently effective and requires additional drugs with etiotropic action. This multi-center double blind placebo-controlled randomized clinical study with superiority model design considers a liquid formulation of Anaferon for children.Methods. The study included 142 children from 1 month to 3 years 11 month 29 days old with ARI of the upper respiratory tract. They were randomized into Anaferon for children and Placebo groups (71 in each group) via interactive voice randomization system. The treatment period was 5 days, observation period – 14 days. The average duration of the symptoms and the severity of the respiratory disease were used as primary efficacy endpoints.Results. All 142 patients were randomized and included into ITT (Intention to treat) analysis. 140 patients (70 patients in each group) were included into PP-analysis. The patients in the Anaferon for children group had better results with average duration of ARI as compared to the Placebo group (87.7±31.5h vs. 103.3±19.4h; p =0.007). The authors marked efficacy of Anaferon for children in such parameters as disease severity (ITT-analysis: p=0.0004), total severity of disease symptoms (ITT-analysis: ANOVA: “Group” factor p=0.0004; “Day” factor p&lt;0.0001), and percentage of recovered patients (Log-rank test, p=0.035). There were no discrepancies between the groups in concomitant therapy (ITT-analysis: ANOVA “Group-Day” factor p=0.88), bacterial complications frequency (p=1.0), adverse effects (Fisher criteria: p=0.5321). The authors registered 14 cases of adverse events (10 cases in Anaferon group and 4 cases in Placebo group) in 11 patients. None of the adverse events had a certain or probable relation to the studied drug.Conclusion. Anaferon for children proved their efficiency and safety in young children with ARI.

Fibromyalgia syndrome in chronic hemodialysis patients is associated with depression, hypoalbuminemia and inflammation

Objectives: Fibromyalgia syndrome (FMS) is an entity that presents with wide-spread chronic pain in musculoskeletal system, disturbed sleep, reduced mental functioning and depressed mood. We aimed to determine the incidence of FMS in our hemodialysis patients and to evaluate the association between FMS, depression and inflammation in patients ongoing hemodialysis. Methods: Among 169 patients, 140 patients were enrolled into our study. Twenty-nine patients were excluded according to exclusion criteria. Demographic characteristics including age, sex, body mass index, duration of dialysis, the etiology of end stage renal disease, the dialysis adequacy (Kt/V) were also recorded. All patients were evaluated through 2010 ACR preliminary diagnostic criteria including widespread pain index (WPI) and total symptom severity. All subjects completed Beck depression inventory (BDI) to determine psychological status. Results: Among 140 hemodialysis patients, 76 (54.2%) patients presented chronic widespread pain and 20 patients (14.2%) met the 2010 ACR criteria for FMS. Patients were divided into FMS (n = 20; 14.2%) and non-FMS (n = 120; 85.8%) groups. FMS group had significantly higher serum C-reactive protein levels and lower serum albumin levels when compared to non-FMS group. BDI (31.4 ± 1.4 vs 14.8 ± 0.6, p &amp;lt; 0.005), WPI (11.2 ± 0.7 vs 2.8± 0.2, p = 0.002) and symptom severity (7.3 ± 0.3 vs 3.7 ± 0.1, p &amp;lt; 0.005) scores were significantly higher in FMS group. Conclusions: The FMS itself and the related symptoms were correlated with depression in maintenance hemodialysis patients. Besides, inflammation and perhaps malnutrition-inflammation sydrome may trigger FMS in this population.

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 Influence of Hormonal Contraceptives on Baseline ImPACT Performance

Abstract Purpose Our study examined the influence of hormonal contraceptives (HC) on pre-injury (baseline) ImPACT performance in female collegiate athletes. Methods Participants in our cross-sectional study consisted of 304 NCAA Division I female athletes who self-reported taking (HC+ [n=154]) or not taking (HC- [n=154]) HC. HC+ participants were matched to HC- participants for height, weight, sport, and position. HC+ participants had an average age of 19.0±1.33 years, height of 170.5–8.70 cm, and mass of 64.2–10.58 kg. HC- participants had an average age of 19.0±1.24 years, height of 170.3–9.19 cm, and mass of 64.2–9.75 kg. Participants completed ImPACT as part of their preseason baseline assessment. Only participants with valid ImPACT assessments were included in our analyses. Chi-squared (χ2) tests were performed to compare groups in terms of medical history variables. Independent t-tests were used to compare groups in terms of demographic variables, self-reported hours of sleep, and ImPACT (Verbal and Visual Memory, Visual Motor Speed [VMS], Reaction Time [RT], and Total Symptom Severity [TSS]) outcome scores. Analyses were performed with α=0.05. Results No differences were observed between groups for demographic variables, hours of sleep, or medical history variables (p&lt;0.05). For VMS, the HC- group (42.9+5.63) scored significantly worse (t[304]=2.17, p=0.03; d=0.25; 95% CI [0.1, 2.7]) than the HC+ group (44.3+5.67). For RT, the HC- group (0.55+0.06) performed significantly slower (t[304]=-2.02, p=0.05; d=0.23; 95% CI [-0.03, -0.0003]) than the HC+ group (0.54+0.05). Conclusion Our results suggest HCs may influence ImPACT performance in female collegiate athletes. Clinicians must consider the role of HCs when interpreting ImPACT outcome scores.

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.

B-56 Personal and Family Psychiatric Histories and Self-Report of Post-Concussive Symptoms in Concussed Children and Adolescents with Prolonged Recovery

Abstract Objective This study seeks to examine whether personal psychiatric history (PPH) and/or family psychiatric history (FPH) are related to prolonged concussion recovery and increased post-concussive symptoms (PCs) in concussed children and adolescents. We hypothesized that individuals with PPH/FPH would endorse a greater number of and more severe PCs relative to those with concussion only or concussion with either PPH or FPH. Methods Data from 255 concussed 8 to 18-year-olds (median = 15.50 years, range = 10.25 years) were retrospectively examined from a clinical database excluding patients with confounding medical comorbidities. PCs (i.e., total symptom count and severity [frequency, intensity, and duration of symptoms]) were compared among four groups (concussion only [n = 80], concussion + PPH [n = 14], concussion + FPH [n = 125], and concussion + PPH/FPH [n = 36]) using a multivariate Kruskal-Wallis test and post-hoc Mann-Whitney U tests. Results The omnibus analysis indicated group differences for injury interval (p = 0.05) and PCs severity (p = 0.002). Post-hoc analyses indicated patients with concussion + PPH/FPH reported greater PCs severity than those with concussion only (U = 726.00, p = 0.0001, r = 0.36) and those with concussion + FPH (U = 1203.00, p = 0.003, r = 0.23). Injury interval was greater for patients with concussion + FPH than those with concussion alone (U = 3474.50, p = 0.007, r = 0.19). Other group differences were non-significant. Conclusions All groups reported a similar number of PCs. FPH contributes to severity of symptoms when combined with PPH. PPH alone did not significantly affect PCs severity. Findings suggest that providers should screen for both PPH and FPH at the time of concussion diagnosis. Early identification of risk factors may lead to targeted intervention, therefore reducing persistent PCs.

In Vivo Availability of Cannabinoid 1 Receptor Levels in Patients With First-Episode Psychosis

ImportanceExperimental and epidemiological studies implicate the cannabinoid 1 receptor (CB1R) in the pathophysiology of psychosis. However, whether CB1R levels are altered in the early stages of psychosis and whether they are linked to cognitive function or symptom severity remain unknown.ObjectiveTo investigate CB1R availability in first-episode psychosis (FEP) without the confounds of illness chronicity or the use of illicit substances or antipsychotics.Design, Setting, and ParticipantsThis cross-sectional, case-control study of 2 independent samples included participants receiving psychiatric early intervention services at 2 independent centers in Turku, Finland (study 1) and London, United Kingdom (study 2). Study 1 consisted of 18 volunteers, including 7 patients with affective or nonaffective psychoses taking antipsychotic medication and 11 matched controls; study 2, 40 volunteers, including 20 antipsychotic-naive or antipsychotic-free patients with schizophrenia or schizoaffective disorder and 20 matched controls. Data were collected from January 5, 2015, through September 26, 2018, and analyzed from June 20, 2016, through February 12, 2019.Main Outcomes and MeasuresThe availability of CB1R was indexed using the distribution volume (VT, in milliliters per cubic centimeter) of 2 CB1R-selective positron emission tomography radiotracers: fluoride 18–labeled FMPEP-d2 (study 1) and carbon 11–labeled MePPEP (study 2). Cognitive function was measured using the Wechsler Digit Symbol Coding Test. Symptom severity was measured using the Brief Psychiatric Rating Scale for study 1 and the Positive and Negative Syndrome Scale for study 2.ResultsA total of 58 male individuals were included in the analyses (mean [SD] age of controls, 27.16 [5.93] years; mean [SD] age of patients, 26.96 [4.55] years). In study 1, 7 male patients with FEP (mean [SD] age, 26.80 [5.40] years) were compared with 11 matched controls (mean [SD] age, 27.18 [5.86] years); in study 2, 20 male patients with FEP (mean [SD] age, 27.00 [5.06] years) were compared with 20 matched controls (mean [SD] age, 27.15 [6.12] years). In study 1, a significant main effect of group on [18F]FMPEP-d2 VT was found in the anterior cingulate cortex (ACC) (t16 = −4.48; P < .001; Hedges g = 1.2), hippocampus (t16 = −2.98; P = .006; Hedges g = 1.4), striatum (t16 = −4.08; P = .001; Hedges g = 1.9), and thalamus (t16 = −4.67; P < .001; Hedges g = 1.4). In study 2, a significant main effect of group on [11C]MePPEP VT was found in the ACC (Hedges g = 0.8), hippocampus (Hedges g = 0.5), striatum (Hedges g = 0.4), and thalamus (Hedges g = 0.7). In patients, [11C]MePPEP VT in the ACC was positively associated with cognitive functioning (R = 0.60; P = .01), and [11C]MePPEP VT in the hippocampus was inversely associated with Positive and Negative Syndrome Scale total symptom severity (R = −0.50; P = .02).Conclusions and RelevanceThe availability of CB1R was lower in antipsychotic-treated and untreated cohorts relative to matched controls. Exploratory analyses indicated that greater reductions in CB1R levels were associated with greater symptom severity and poorer cognitive functioning in male patients. These findings suggest that CB1R may be a potential target for the treatment of psychotic disorders.

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.

Decreased Nociceptin Receptors Are Related to Resilience and Recovery in College Women Who Have Experienced Sexual Violence: Therapeutic Implications for Posttraumatic Stress Disorder

BackgroundPosttraumatic stress disorder (PTSD) is a stress disorder that develops in only some individuals following a traumatic event. Data suggest that a substantial fraction of women recover after sexual violence. Thus, the investigation of stress and antistress neuropeptides in this sample has the potential to inform the neurochemistry of resilience following trauma. Nociceptin is an antistress neuropeptide in the brain that promotes resilience in animal models of PTSD. Methods[11C]NOP-1A positron emission tomography was used to measure the in vivo binding to nociceptin receptors in 18 college women who had experienced sexual violence irrespective of whether they met DSM-5 diagnostic criteria for PTSD. [11C]NOP-1A data from 18 healthy control subjects were also included to provide a contrast with the sexual violence group. [11C]NOP-1A total distribution volume (VT) in the regions of interest were measured with kinetic analysis using the arterial input function. The relationships between regional VT and Clinician-Administered PTSD Scale for DSM-5 total symptom and subscale severity were examined using correlational analyses. ResultsNo differences in [11C]NOP-1A VT were noted between the sexual violence and control groups. VT in the midbrain and cerebellum were positively correlated with PTSD total symptom severity in the past month before positron emission tomography. Intrusion/re-experiencing and avoidance subscale symptoms drove this relationship. Stratification of subjects by a DSM-5 PTSD diagnosis and contrasting their VT with that in control subjects showed no group differences. ConclusionsDecreased midbrain and cerebellum nociceptin receptors are associated with less severe PTSD symptoms. Medications that target nociceptin should be explored to prevent and treat PTSD.

Concussion History and Career Status Influence Performance on Baseline Assessments in Elite Football Players.

To determine if concussion history and career status is associated with neurocognitive performance in elite football players. The study design was a cross-sectional single assessment. Fifty-seven elite football players (age 29.39 ± 7.49 years) categorized as draft prospects, active professional players, and retired professional players were assessed on the Sport Concussion Assessment Tool - third edition (SCAT-3), in an outpatient therapy setting. Common symptoms were the following: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0-1) group reported fewer symptoms (U = 608.50, p < .001), less symptom severity (U = 598.00, p = -.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = .024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = .066) on the Mann-Whitney U test. The Kruskal-Wallis test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < .001), total symptom severity (p < .001), SAC total scores (p = .030), and m-BESS (p < .001). Concussion history and career status appear associated with total symptoms, symptom severity, performance on the SAC, and the m-BESS in elite football players. With this in mind, future research is recommended to determine longitudinal impact for elite football players.

Biological and psychological components of depression in patients receiving IFN-alpha therapy for hepatitis C.

Depressive symptoms are frequent side effects of interferon α therapy (IFN-α). Both biological and psychological processes may occur concomitantly during hepatitis C treatment. This study was carried out to determine the impact of biological (immune response) and psychological factors on formation of depressive symptoms and major depressive disorder (MDD) during hepatitis C treatment. A total of 99 patients receiving pegylated IFN-α and ribavirin for chronic C type hepatitis participated in the prospective cohort study. Symptoms of depression were assessed with the MontgomeryÅsberg Depression Rating Scale (MADRS) during treatment and 24 weeks after treatment. Neuroticism was measured with the Eysenck Personality Questionnaire - Revised (EPQ-R/N). Diagnosis of MDD was made using the Present State Examination (PSE-10) and DSM-IV-TR criteria. Factor analysis was used to detect factors adding up to total severity of depressive symptoms. Predictors of MDD were investigated using logistic regression analysis. Factor analysis returned 3 factors: 1st - MADRS scores at weeks 0-12, 2nd - MADRS and N scores before treatment, 3rd - MADRS at the 24th week of treatment and 24 weeks after treatment. The total severity of depressive symptoms consisted of 3 components: personality-related before treatment, IFN-α-related during treatment and dependent on the effect of treatment. Regression analysis showed that a history of psychiatric disorders (OR = 4.8) and MADRS scores before treatment (OR = 1.25) were predictors of MDD, as opposed to level of neuroticism. The severity of depressive symptoms and MDD during the hepatitis C treatment was related to general depressive vulnerability, not to psychological factors related to neuroticism.

Baseline Concussion Clinical Measures Are Related to Sensory Organization and Balance.

This study aimed to examine relationships among baseline demographics, symptom severity, computerized neurocognitive outcomes, and balance performance in collegiate athletes. Collegiate varsity athletes (N = 207, age = 19.3 ± 1.0 yr) participating in an ongoing clinical research program who completed concussion baseline assessments including a demographic questionnaire, a graded symptom checklist, a neurocognitive assessment, and the Sensory Organization Test (SOT) were included in this study. The SOT composite equilibrium score (COMP) and three sensory ratio scores-vestibular (VEST), visual (VIS), and somatosensory (SOM)-were used to describe athletes' overall sensory organization and ability to use input from each sensory system to maintain balance. Separate stepwise multiple linear regression models were performed for each SOT outcome. Total symptom severity level and CNS Vital Signs domain scores served as predictor variables. Stepwise regression models for COMP (R = 0.18, F4,201 = 11.29, P < 0.001), VEST (R = 0.14, F4,201 = 8.16, P < 0.001), and VIS (R = 0.10, F4,201 = 5.52, P < 0.001) were all significant. Faster reaction times and higher executive function scores were associated with higher COMP and VEST scores in separate models. Those with faster reaction times also had significantly higher VIS scores. Reaction time and executive function demonstrated significant relationships with SOT balance performance. These cognitive processes may influence athletes' ability to organize and process higher-order information and generate appropriate responses to changes in their environment, with respect to balance and injury risk. Future investigations should consider these relationships after injury, and clinicians should be mindful of this relationship when considering concussion management strategies.

Sexual function and depressive symptoms in young women with overt hyperthyroidism

ObjectiveDespite high prevalence in a female population, surprisingly little is known about sexual functioning of women with thyroid hyperfunction. This study was aimed at assessing female sexual function and depressive symptoms in women with overt hyperthyroidism of autoimmune and non-autoimmune origin. Study designThe study included three age-matched groups of young women inhabiting the Upper Silesia (a selenium-deficient and iodine-sufficient area): individuals with overt hyperthyroidism induced by Graves’ disease (group A, n = 31), women with overt hyperthyroidism caused by toxic multinodular goiter or toxic adenoma (group B, n = 30) and women with normal thyroid function (group C, n = 34). Apart from measuring serum hormone levels, serum antibody titers and determining calculated parameters of thyroid homeostasis, all women completed questionnaires evaluating femalesexual function (FSFI) and depressive symptoms (BDI-II). ResultsThe mean total FSFI score and all domain scores were lower while the overall BDI-II score was higher in both groups of women with overt hyperthyroidism than in the control group, and correlated with thyrotropin and free thyroid hormone levels, as well as with the SPINA-GT index. The FSFI score as well as domain scores for desire, arousal and sexual satisfaction were lower, while the BDI-II score was higher in group A than in group B. In group A, the total FSFI score, desire, arousal, sexual satisfaction and severity of depressive symptoms correlated with TRAb and TPOAb titers. ConclusionThe obtained results suggest that excessive thyroid hormone production and thyroid autoimmunity have an additive effect on sexual functioning and mood.

The effect of high impact crossfit exercises on stress urinary incontinence in physically active women.

The impact of CrossFit (high energy and intensity exercise) on SUI has not been well described. This study evaluates the incidence of SUI in physically active women, and examines specific exercises that can increase SUI. A cross-sectional study was conducted in women from four CrossFit centers and one aerobic center for comparison. Participants were surveyed regarding baseline demographics, activity levels, severity, and frequency of leakage during CrossFit exercises as well as preventative strategies against SUI. Participants were stratified based on age, body mass index, types of exercises, parity, delivery, and compared using Mann Whitney-U and Chi square. This study had 105 CrossFit (mean = 36.9 years) and 44 aerobic (mean = 29.0 years) participants. Fifty women reported SUI during exercises, while none of the aerobic women reported SUI during exercise. The top three CrossFit exercises associated to SUI were double-unders (47.7%), jumping rope (41.3%), and box jumps (28.4%). CrossFit women with a history of parity had significantly more episodes of SUI with box jumps, jumping rope, double-unders, thrusters, squats without weights, squats with weights, and trampoline jumping (P < 0.001). The top preventative strategies were emptying the bladder before workouts, wearing dark pants, and performing Kegel exercises during workout. Vaginal delivery (OR 4.94) and total incontinence symptom severity index (OR 1.45) were both significant predictors of SUI during exercise (P < 0.05). There is a significantly higher risk of SUI during CrossFit exercises associated with previous pregnancy and vaginal delivery but also in nulliparous women. In general, women participating in CrossFit have been applying preventative measures for protection of SUI during exercises.

Predictors of treatment noninitiation, dropout, and response for cognitive behavioral therapy for trauma nightmares.

This report aims to extend previous findings on predictors of treatment dropout and response within nightmare treatment. Factors predicting treatment noninitiation, dropout, and response were examined in 70 trauma-exposed individuals treated in a randomized controlled trial of 2 conditions (exposure [EX] and nonexposure) of a therapy for trauma nightmares. Together, treatment noninitiation and dropout was predicted by younger age for the EX condition only and by fewer nights with nightmares at baseline for both conditions. Treatment noninitiation was predicted by fewer nights with nightmares. Treatment dropout was not predicted by any variables. For the EX condition, more baseline nightmares predicted more posttreatment nightmares, whereas more reported nights with nightmares at baseline predicted fewer nightmares at posttreatment. Baseline sleep quality and total posttraumatic stress disorder (PTSD) severity predicted posttreatment sleep quality and PTSD severity, respectively. In the nonexposure condition, more traumatic events predicted fewer nightmares at posttreatment, whereas more nightmares predicted more nightmares at posttreatment. Baseline daytime sleepiness predicted worse posttreatment sleep quality, and total PTSD symptom severity predicted posttreatment PTSD severity. Baseline symptom severity on constructs targeted in treatment are the best indicators of response. Treatment initiation appears to be more significant than dropout. Identifying reasons for treatment noninitiation is needed to maximize engagement. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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.

Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality.

Schizophrenia is a severe psychiatric disorder with a lifetime prevalence of about 1%. People with schizophrenia have a 4-fold higher prevalence of metabolic syndrome than the general population, mainly because of antipsychotic treatment but perhaps also because of decreased physical activity. Metabolic syndrome is a risk factor for cardiovascular diseases, and the risk of these diseases is 2- to 3-fold higher in schizophrenia patients than in the general population. The suicide risk is also higher in schizophrenia, partly as a result of depression, positive, and cognitive symptoms of the disease. The higher suicide rate and higher rate of cardiac mortality, a consequence of the increased prevalance of cardiovascular diseases, contribute to the reduced life expectancy, which is up to 20 years lower than in the general population. Regular physical activity, especially in combination with psychosocial and dietary interventions, can improve parameters of the metabolic syndrome and cardiorespiratory fitness. Furthermore, aerobic exercise has been shown to improve cognitive deficits; total symptom severity, including positive and negative symptoms; depression; quality of life; and global functioning. High-intensity interval endurance training is a feasible and effective way to improve cardiorespiratory fitness and metabolic parameters and has been established as such in somatic disorders. It may have more beneficial effects on the metabolic state than more moderate and continuous endurance training methods, but to date it has not been investigated in schizophrenia patients in controlled, randomized trials. This review discusses physical training methods to improve cardiorespiratory fitness and reduce metabolic syndrome risk factors and symptoms in schizophrenia patients. The results of studies and future high-quality clinical trials are expected to lead to the development of an evidence-based physical training program for patients that includes practical recommendations, such as the optimal length and type of aerobic exercise programs and the ideal combination of exercise, psychoeducation, and individual weight management sessions.

Concussion history and career status influence sports concussion assessment tool (SCAT-3) performance in elite football players

ObjectiveTo determine if concussion history and career status influences baseline Sports Concussion Assessment Tool (SCAT-3) performance in elite football players.Design/methodsFifty-seven elite football players (age 29.39 ± 7.49 years) categorized by career status (draft prospects, active professional players and retired professional players) underwent SCAT-3 assessments. The SCAT-3 was administered in accordance to published recommendations.14 To examine our primary purpose, participants were placed into either a low concussion history (0–1 concussions) or multiple concussion history (2 + concussions) group. A Mann-Whitney U test was used to examine the differences of concussion history on SCAT-3 total symptoms, total symptom severity, SAC total scores, and m-BESS balance scores. To examine our secondary purpose, a Kruskal-Wallis test and a post-hoc analysis was used to analyze differences between career status categories.ResultsAt baseline, common baseline symptoms were: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0–1) group reported fewer symptoms (U = 608.50, p = 0.001), less symptom severity (U = 598.00, p = 0.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = 0.024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = 0.066) on the Mann-Whitney U test. The Kruskal-Wallis Test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p &lt; 0.001), total symptom severity (p &lt; 0.001), SAC total scores (p = 0.030), and m-BESS (p &lt; 0.001).ConclusionsConcussion history and career status appear to influence performance on the SCAT-3 in elite football players. With this in mind, future research is recommended to determine normative scores on the SCAT-3 for elite football players.