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This study aimed to elucidate the mechanisms by which symptom burden affects demoralization in Chinese lung cancer patients, with a focus on the roles of family functionality, resilience, and coping strategies. The study also explored differences in these pathways between two distinct demoralization categories. A cross-sectional survey was conducted among 567 lung cancer patients who completed questionnaires assessing symptom burden, family functioning, resilience, coping strategies, and demoralization. Data were analyzed using partial least squares structural equation modeling (PLS-SEM), with multigroup structural equation modeling (MG-SEM) employed to compare pathways between the psychological distress-subjective incompetence group (PDSIG) and the low demoralization-emotional disturbance group (LDEDG). PLS-SEM analysis demonstrated a good model fit. Symptom burden (β = 0.26), confrontation coping (β = 0.11), and acceptance-resignation coping (β = 0.41) had positive direct effects on demoralization, whereas resilience (β = -0.19) and family function (β = -0.27) had negative direct effects. Additionally, family function, resilience, and acceptance-resignation coping mediated the relationship between symptom burden and demoralization. MG-SEM revealed that, in the PDSIG, symptom burden (β = 0.47) and family function (β = -0.46) had similarly strong impacts on demoralization, with stronger family function associated with lower demoralization. In contrast, resilience (β = -1.02) was the most significant factor in the LDEDG. These findings highlight the importance of screening for demoralization, particularly among lung cancer patients with a high symptom burden, maladaptive resignation coping, family dysfunction, and low resilience. Effective strategies should focus on symptom management, family support, resilience building, and fostering positive coping mechanisms. Tailored interventions based on demoralization subtypes are essential to improve psychological well-being in this population.

BACKGROUND: Detailed information on patient characteristics and symptom burden associated with multimorbidity in oncology patients is extremely limited. Purposes were to determine the prevalence of low (≤ 2) and high (≥ 3) multimorbidity in a sample of oncology outpatients (n = 1343) undergoing chemotherapy and evaluate for differences between the two multimorbidity groups in demographic and clinical characteristics; the occurrence, severity, and distress of 38 symptoms; and the stability and consistency of symptom clusters. METHODS: Using the Self-Administered Comorbidity Questionnaire, patients were classified into low and high multimorbidity groups. Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms prior to the patients second or third cycle of chemotherapy. For each multimorbidity group, symptom clusters based on occurrence rates were identified using exploratory factor analysis. RESULTS: Compared to the low group (61.4%), patients in the high group (38.6%) were older, had fewer years of education, were less likely to be married or partnered, less likely to be employed, and had a lower annual income. In addition, they had a higher body mass index, poorer functional status, were a longer time since their cancer diagnosis, and were more likely to have received previous cancer treatments and have metastatic disease. Patients in the low and high groups reported 12.7 (±6.7) and 15.9 (±7.5) concurrent symptoms, respectively. Eight and seven symptom clusters were identified for the low and high groups, respectively. Psychological, gastrointestinal, weight gain, hormonal, and respiratory clusters were stable across multimorbidity groups. Weight gain and respiratory clusters were consistent. Three unstable clusters were identified in the low group and two in the high group. CONCLUSIONS: Findings suggest that higher multimorbidity is associated with various social determinants of health and a higher symptom burden. Differences between multimorbidity groups may be related to aging, treatments, and/or comorbid conditions.

BackgroundDepression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.ObjectivesPurposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.MethodsPatients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.ResultsThree distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).ConclusionsAlmost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.Implications for practiceClinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.

BACKGROUND: Interindividual variability in oncology patients symptom experiences poses significant challenges in prioritizing symptoms for targeted intervention(s). In this study, computational approaches were used to unbiasedly characterize the heterogeneity of the symptom experience of oncology patients to elucidate symptom patterns and drivers of symptom burden. METHODS: Severity ratings for 32 symptoms on the Memorial Symptom Assessment Scale from 3088 oncology patients were analyzed. Gaussian Graphical Model symptom networks were constructed for the entire cohort and patient subgroups identified through unsupervised clustering of symptom co-severity patterns. Network characteristics were analyzed and compared using permutation-based statistical tests. Differences in demographic and clinical characteristics between subgroups were assessed using multinomial logistic regression. RESULTS: Network analysis of the entire cohort revealed three symptom clusters: constitutional, gastrointestinal-epithelial, and psychological. Lack of energy was identified as central to the network which suggests that it plays a pivotal role in patients overall symptom experience. Unsupervised clustering of patients based on shared symptom co-severity patterns identified six patient subgroups with distinct symptom patterns and demographic and clinical characteristics. The centrality of individual symptoms across the subgroup networks differed which suggests that different symptoms need to be prioritized for treatment within each subgroup. Age, treatment status, and performance status were the strongest determinants of subgroup membership. CONCLUSIONS: Computational approaches that combine unbiased stratification of patients and in-depth modeling of symptom relationships can capture the heterogeneity in patients symptom experiences. When validated, the core symptoms for each of the subgroups and the associated clinical determinants may inform precision-based symptom management.

A growing body of evidence explored symptom burden of somatic symptom disorder (SSD) and its complex etiology involving psychosocial aspects. Child abuse has been linked to numerous psychopathologies including somatic symptoms as well as impaired personality functioning and disruptions in epistemic trust. This work aims to investigate personality functioning and epistemic trust in the association between child abuse and somatic symptom burden. We conducted structural equation modelling (SEM) using representative data of the German population (N = 2436). Personality functioning (OPD-SQS) was applied as a mediator between retrospectively recalled child abuse (ICAST-R) and somatic symptom burden (SSS-8, SSD-12, 6 month time criterion), while epistemic trust was added as a predictor of personality functioning. 6.8 % (n = 166) of participants self-reported SSD. Prevalence of child abuse (53.6 % vs. 31.7 %; χ 2 = 33.44, p <.001) was significantly higher among those with SSD. Child abuse was significantly associated with somatic symptom burden (criterion A: β = 0.23, 95 %-CI: 0.19–0.27, p <.001; criterion B (β = 0.24, 95 %-CI: 0.20–0.28, p <.001) and explained 6 % and 5 % of its variance respectively. Adding personality functioning as a mediator increased the explained variance to 28 % for both somatic symptom burden criterion A and B. Including epistemic trust further increased the explained variance of personality functioning (from 15 to 36 %). All assessments and results are based on self-report and cross-sectional data. Impairments in personality functioning and disruptions in epistemic trust might play an important role in experiencing symptoms of SSD. Both domains thus present new avenues for treatment improvement and further research in patients with SSD. • Based on representative and self-report data, 6.8 % of the German population fulfill the criteria for SSD • SSD showed strongly impaired personality functioning and disruptions of epistemic trust • Experiences of child abuse were associated with a 2.5 times increased likelihood of SSD • Personality functioning mediates this association with somatic symptom burden criterion A and B (explained variance 28 %) • Impaired epistemic trust and personality functioning might be considered in patients with SSD [ABSTRACT FROM AUTHOR]

• Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and morbidity worldwide. • People with COPD experience chronic dyspnea, cough, fatigue, and impaired exercise tolerance, often refractory to medical therapies. • Similarly, anxiety, depression, and social isolation affect both people with COPD and their caregivers, resulting in significant quality of life impairment. • Palliative care (PC) improves quality of life, reduces symptom burden, increases prognostic awareness, and is proven to be cost-effective for people with COPD. • While early PC integration is essential for people with COPD, it is often delayed due to misconceptions which equate PC exclusively with end-of-life care. Chronic obstructive pulmonary disease (COPD) is a life-limiting condition and the third leading cause of death worldwide. People with COPD experience physical and psychological symptoms and functional limitations that impair their quality of life. Their caregivers face adverse clinical outcomes due to personal, social, and financial demands. As such, recent emphasis has been placed on early referral to palliative care services to enhance prognostic awareness, clarify goals of care, and manage symptoms. In this narrative synthesis of key aspects of COPD care, we propose practical, evidence-based strategies to integrate palliative care principles with conventional disease-directed treatments throughout the illness trajectory. We emphasize the importance of equipping clinicians caring for people with COPD with a thorough understanding of both the inherent disease complexities and the cornerstones of its multimodal management, including palliative care, to address the unique psychosocial and physical needs of this patient population. The hallmarks of COPD for clinicians caring for people with COPD. Visualization of the narrative review including background, its conclusions, and the featured hallmarks of chronic obstructive pulmonary disease (COPD), alongside practical tips for clinicians caring for these patients. COPD: chronic obstructive pulmonary disease; PC: palliative care; ACP: advanced care planning. [Display omitted] [ABSTRACT FROM AUTHOR]

COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both. What are the abilities of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD? Analysis of people aged ≥ 40 years with FEV 1 to FVC ratio of < 0.70 after bronchodilator administration and ≥ 10 pack-years of smoking from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg scale 0-10) intensity rating more than the upper limit of normal at the symptom-limited peak of CPET using normative reference equations. We included 318 people with COPD (40% female) with a mean (SD) age of 66.5 (9.3) years and FEV 1 of 79.5% predicted (19.0% predicted); 26% showed abnormally low exercise capacity (peak oxygen uptake less than the lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC score of 0 and CAT score of < 10, respectively. An mMRC score of ≥ 2 and CAT score of ≥ 10 was most specific (95%) to detect abnormal exertional breathlessness, but showed low sensitivity of only 12%. Accuracy for all scale cutoffs or combinations was < 65%. Compared with people with true-negatives findings, people with abnormal exertional breathlessness but low mMRC score, low CAT scores (false-negatives findings), or both showed worse self-reported and physiologic outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to be taking any respiratory medication (37% vs 30%; mean difference, 6.1%; 95% CI, –7.2 to 19.4; P=.36). In COPD, mMRC and CAT showed low concordance with CPET and failed to identify many people with abnormally high exertional breathlessness. ClinicalTrials.gov ; No.: NCT00920348; URL: www.clinicaltrials.gov [ABSTRACT FROM AUTHOR]

Objective: Early response is considered to be an important predictor for therapy outcomes; yet little is known about its relevance in psychosomatic rehabilitation. This paper aims to describe the association of early response in psychosomatic rehabilitation, as well as the associations of early response with pre-rehabilitative factors such as illness and treatment beliefs. Methods: A longitudinal study with three measurement points was applied. Early response was defined using the percent improvement method after two weeks of treatment. Its association with therapy outcome and with illness and treatment beliefs was analyzed using multiple regression analyses. Results: A total of 264 participants took part. Early response was a significant predictor of psychosomatic rehabilitation outcome, explaining an incremental variance of 1–30% after controlling for initial symptom burden. Illness and treatment beliefs predicted 6–20% variance in early response. Important illness beliefs referred to perceived symptoms, consequences and comprehensibility of the illness. Important treatment beliefs referred to expectations about rehabilitation structure, processes and concerns. Conclusion: Early response is associated with the therapy outcome of psychosomatic rehabilitation, with illness and treatment beliefs found to be associated with early response. Further research on the predictors of early response in psychosomatic rehabilitation is needed. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is characterized by a range of symptoms that often cluster together, impacting the quality of life (QoL) of affected individuals. Objective: To delineate the composition of symptom clusters in patients with SLE and analyze their correlation with QoL, thus providing a basis for symptom management. Methods: Using convenience sampling, 201 patients were recruited. Data were collected using a general information questionnaire, SLE Symptom Checklist and Lupus Quality of Life scale. Symptom clusters were identified using exploratory factor analysis, and their correlations with QoL were analyzed using Spearman correlation analysis. Results: The most common symptom among patients was fatigue (64.7%). Five symptom clusters were identified: fatigue-related symptoms, weight gain-related symptoms, itch-pain-related symptoms, skin change symptoms, and body image symptoms. Fatigue-related, weight gain-related, and body image symptom clusters showed significant negative correlations with overall QoL scores and scores in various dimensions (P <.05). The itch-pain symptom cluster was negatively correlated with the total score of QoL and several dimensions such as pain status, burden status, mental health status, physical health status, and fatigue status (P <.05). The skin change symptom cluster was negatively correlated with the total score of QoL and several dimensions, such as mental health, physical health, and fatigue status (P <.05). Conclusion: Patients with SLE exhibit significant symptom clusters correlating with overall QoL. Such data highlight the need for nurses to evaluate symptom clusters and intervene in related factors, enhancing QoL. [ABSTRACT FROM AUTHOR]

Purpose: To develop models using different machine learning algorithms to predict high-risk symptom burden clusters in breast cancer patients undergoing chemotherapy, and to determine an optimal model. Methods: Data from 647 breast cancer patients were analyzed to develop a model predicting high-risk symptom burden clusters. Five machine learning algorithms, including an artificial neural network (ANN), a decision tree (DT), a support vector machine (SVM), a random forest (RF), and extreme gradient boosting (XGBoost), were tested, as was traditional logistic regression. Performance was evaluated by deriving the predictive accuracy, precision, discriminatory capacity, calibration, and clinical utility, and an optimal model was identified. Results: A model based on the RF algorithm exhibited better accuracy, precision, and discriminatory capacity than the other models. The area under the receiver operator curve was 0.91, the sensitivity was 65.8%, the specificity was 93.5%, the positive predictive value was 98.02%, and the false positive rate was only 0.91%. Conclusion: The model created using the RF algorithm was excellent in terms of predictive accuracy and precision, and can be used for early identification of the risk of self-reported symptom burden clusters in breast cancer patients undergoing chemotherapy. [ABSTRACT FROM AUTHOR]

Background: This protocol was developed to describe the design of a randomised controlled trial that will examine the clinical efficacy of a 6-week, novel, home-based stretching programme compared with usual care on the effect of symptoms experienced by patients with fibromyalgia. The hypothesis is that the total score of the Fibromyalgia Impact Questionnaire (FIQ-R) and other fibromyalgia symptoms will improve 6 weeks following the stretching intervention compared with usual care. Methods: Fifty-eight adults under 65 years of age diagnosed with fibromyalgia will be recruited for this study. Participants will be randomised into an intervention group and a control group (waitlist). Randomisation will be stratified by sex. The intervention group will perform 6 weeks of daily stretching exercises for 6 min—a day. The control group will maintain usual care. A mHealth app will support stretching adherence. The primary outcome will be the total score of the Revised Fibromyalgia Impact Questionnaire (FIQ-R). The secondary outcomes include regional and widespread pain sensitivity, range of motion, quality of life (SF-36), mental and physical functioning and adherence. Evaluations will be performed at baseline, following 6 weeks of daily stretches (primary endpoint) and 6 months after the termination of the intervention period (secondary endpoint). Discussion: By investigating the clinical efficacy of a 6-week, novel, home-based stretching programme, we hope to provide applicable and generalisable knowledge about the efficacy of stretching exercises that can potentially help ease the burden of symptoms experienced by patients with fibromyalgia. Trial registration: NTC, NCT06487741. Registered on 24 June 2024. [ABSTRACT FROM AUTHOR]

The transition to menopause is associated with disappearance of menstrual cycle symptoms and emergence of vasomotor symptoms. Although menopausal women report a variety of additional symptoms, it remains unclear which emerge prior to menopause, which occur in predictable clusters, how clusters change across the menopausal transition, or if distinct phenotypes are present within each life stage. We present an analysis of symptoms in premenopausal to menopausal women using the MenoLife app, which includes 4789 individuals (23% premenopausal, 29% perimenopausal, 48% menopausal) and 147,501 symptom logs (19% premenopausal, 39% perimenopausal, 42% menopausal). Clusters generated from logs of 45 different symptoms were assessed for similarities across methods: hierarchical clustering analysis (HCA), K-Means clustering of principal components of symptom reports, and binomial network analysis. Participants were further evaluated based on menstrual cycle regularity or natural versus medically induced menopause. Menstrual cycle-associated symptoms (e.g., cramps, breast swelling), digestive, mood, and integumentary symptoms were characteristic of premenopause. Vasomotor symptoms, pain, mood, and cognitive symptoms were characteristic of menopause. Perimenopausal women exhibited both menstrual cycle-associated and vasomotor symptoms. Subpopulations across life stages presented with additional correlated mood and cognitive, integumentary, digestive, nervous, or sexual complaints. Symptoms also differed among women depending on the reported regularity of their menstrual cycles or the way in which they entered menopause. Notably, we identified a set of symptoms that were very common across life stages: fatigue, headache, anxiety, and brain fog. Finally, we identified a lack of predictive power of hot flashes for any symptom except night sweats. Together, premenopausal women exhibit menstrual cycle-associated symptoms and menopausal women reported vasomotor symptoms, while perimenopausal women report both. All report high rates of fatigue, headache, anxiety, and brain fog. Limiting focus of menopausal treatment to vasomotor symptoms, or to premenstrual syndrome in premenopausal women, neglects a large proportion of overall symptom burden. Future interventions targeting mood and cognition, digestion, and the integumentary system are needed across stages of female reproductive life. [ABSTRACT FROM AUTHOR]

Objective: The scarcity of literature necessitates further research to differentiate between acute and chronic painful temporomandibular disorders (TMDs). This study compared pain characteristics, oral behaviors, jaw function, and psychosocial distress between TMD patients with acute and chronic pain, examined correlations among variables, and identified factors associated with chronic pain-related TMDs (PT). Methods: Anonymized data were gathered from consecutive patients seeking TMD treatment at a university-based oral medicine clinic. Axis I diagnoses were made using the Diagnostic Criteria for TMDs, and patients with PT were categorized into acute (AP) and chronic pain (CP) groups. Axis II assessments were performed, evaluating pain characteristics, oral behaviors, jaw functional limitation, somatic symptoms, depression, and anxiety. Statistical analysis utilized chi-square/non-parametric tests and logistic regression (α = 0.05). Results: Among the 488 PT patients, 34.6% experienced AP and 65.4% had CP. Significant differences were observed in pain intensity, interference, disability, jaw overuse behavior, functional limitation, somatic symptom burden, depression, and anxiety. (CP> AP). Moderate-to-strong correlations were found in both the AP (rs = 0.43–0.83) and CP (rs = 0.46–0.87) groups, although the specific relationships between pain, behavioral, and psychosocial factors differed somewhat. The multivariate regression model revealed that only pain intensity (OR = 1.01) and oral behaviors (OR = 1.06) significantly increased the odds of chronic PT. Conclusion: Chronic pain was more prevalent in PT patients and associated with greater severity in pain, behavioral, and psychosocial variables. Pain intensity and oral behaviors were linked to an increased likelihood of chronic pain. [ABSTRACT FROM AUTHOR]

Background: The heterogeneity of chronic obstructive pulmonary disease (COPD) is increasingly recognized. To characterize the heterogeneity of COPD, we aimed to identify subtypes related to quantitative CT by using principal component analysis (PCA) and cluster analysis. Methods: The data of 1879 participants in the SPIROMICS study were obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. A combination of PCA and k-means clustering was used to analyze the data from these participants in the SPIROMICS study. We randomly split the samples into training and validation sets. Clusters were evaluated for their relationship with acute exacerbation risk throughout the entire follow-up period. The results of the training set were confirmed in the validation set. To avoid sampling errors, we conducted 10 random sampling cycles. Normalized mutual information (NMI) was applied in every cycle to evaluate the stability of clustering. Results: We identified five clusters related to quantitative CT characterized as follows: (1) male-dominated low disease impact cluster, (2) obesity with relatively high symptom burden cluster, (3) airway wall lesion cluster, (4) lung upper region zone-predominant emphysema cluster, (5) severe emphysema cluster. There are significant differences in acute exacerbation risk among these five clusters. Conclusions: Cluster analysis identified 5 clusters related to quantitative CT of all participants in the SPIROMICS cohort with significant differences in baseline characteristics and acute exacerbation risk. The stability of clustering results was validated through NMI in 10 sampling cycles. In addition, dimensionality reduction results showed high reproducibility in different studies. [ABSTRACT FROM AUTHOR]

Background: The Integrated Palliative Care Outcome Scale for People with Dementia (IPOS-Dem) was developed as a promising person-centred proxy measure of symptoms and concerns. We used the Swiss-German easy-read version, a measure designed to be completed individually by family members and frontline staff caring for people with dementia. In this secondary data analysis of multicentre trial data, we investigate the IPOS-Dem's structural validity and internal consistency of the version. Methods: A total of 257 people with dementia were assessed by frontline staff, while family members assessed 118 people residing in one of 23 participating Swiss-German long-term care facilities. Each IPOS-Dem version, corresponding to the two rater populations (family members and frontline staff), underwent exploratory factor analysis separately, using data from one assessment per person with dementia. A minimum residual solution with varimax rotation was calculated to determine the factor structure. Item reduction decisions were based on factor loadings and indices for internal consistency. Results: The construct validity of the Swiss-German easy-read IPOS-Dem for frontline staff is demonstrated by two factors: Dementia Interaction and Physical Impact (Cronbach's α = 0.83) and Dementia Emotional and Behavioural Impact (Cronbach's α = 0.81). Four factors, with Cronbach's α ranging from 0.77 to 0.86, were computed for the family member version: Dementia Interaction Impact, Easy-to-Assess Dementia Physical Impact, Hard-to-Assess Dementia Physical Impact and Dementia Emotional and Behavioural Impact. Conclusions: Like other reduced patient-related outcome measures, palliative care measures and their parent instrument IPOS we identified subscales in the easy-read IPOS-Dem that describe a psychosocial impact and a physical impact. Differences in the internal structure of the family and staff versions of the IPOS-Dem likely stem from variations in observation intervals, roles and perspectives, with family members often focusing on loss and past experiences whereas staff may equate quality of life with quality of care leading to differing ratings. However, the identified internal consistency indices between 0.77 and 0.86 indicate acceptable internal consistency for the subscales and the IPOS-Dem should be taken forward for further psychometric evaluation. Trial registration: The overarching trial has been approved by the Swiss Regional Ethics Committee of the Canton of Zürich as the leading ethics committee for the involved regions, with clearance certification number BASEC2019-01847 (12/11/2019). The main study and secondary analysis are registered with the German Clinical Trials Register (DRKS00022339, 05/10/2020). Full registration is available online at http://www.drks.de/DRKS00022339. [ABSTRACT FROM AUTHOR]

The possible impact of premorbid Attention-Deficit/Hyperactivity Disorder (ADHD) in the recovery process following sport-related concussion (SRC) in adolescents is not clear. The purpose of this study was to investigate the impact of ADHD together with other selected variables on symptom presentation and neurocognitive performance in a well-matched sample of adolescents with SRC. We hypothesized that more symptoms and poorer neurocognitive performance would be observed in those with ADHD. Symptoms from the Sideline Concussion Assessment Tool-5 and cognitive test results from the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) were examined at initial visit, and symptoms were re-assessed at 3-months in a sample of 112 participants with (n = 56) and without (n = 56) ADHD (ages 12–18 years; M = 14.68, SD = 1.77) who were matched by age, sex, ethnicity/race, and days post-injury. Exclusion criteria included severe medical illness or moderate/severe brain injury and lack of English fluency. No significant group differences were found in total symptoms (p = .145), symptom severity (p = .179), or neurocognitive functioning at initial visit (all p > .79) or at 3 months. However, athletes with ADHD reported more nausea (p = 0.22) and feeling slowed down at initial testing (p = .021). Additionally, premorbid anxiety influenced symptom report (p = .010). ADHD did not appear to pose a specific risk for greater symptom burden or neurocognitive deficits in the first 3 months post-concussion. [ABSTRACT FROM AUTHOR]

AbstractSystemic amyloidosis refers to a group of protein misfolding disorders resulting in organ deposition with amyloid, leading to organ dysfunction, ultimately resulting in organ failure and death if not successfully treated. Treatment is type-specific and aimed at the underlying source of the misfolded protein. In the past decades, treatments have become increasingly available across the various amyloidosis types with improved response rates and longer survival. Supportive care measures are an integral part of care for patients with systemic amyloidosis to improve symptom burden and quality of life, reduce healthcare costs, and potentially prolong survival while type-directed therapy takes effect. In these guidelines, we provide supportive care recommendations across eight areas of interest in systemic amyloidosis: cardiology, nephrology, peripheral neuropathy, central nervous system involvement, autonomic neuropathy, gastroenterology, coagulopathy and bleeding, nutrition and hematology. These guidelines were developed on behalf of the International Society of Amyloidosis (ISA) by experts in the above fields and provide the best available evidence and expertise for supportive care in these rare disorders. [ABSTRACT FROM AUTHOR]

Background: Insecure adult attachment has previously been linked to more severe psychopathology and to alterations within neuronal connectivity on a structural as well as functional level. Little is known about the resting state functional connectivity (rs-FC) of the attachment system in patients suffering from poly-drug use disorder (PUD). Methods: The present study investigated rs-FC at two measuring points (t1: ROI-to-ROI; t2: seed-to-voxel) in a sample of PUD patients (n = 33; Age: M = 30y; SD = 8y; Female = 15%). Adult attachment was measured with the German version of the Experiences in Close Relationships Scale (ECR-RD8). Furthermore, insecure attachment was correlated with depressive symptoms (ADS), trait anxiety (STAI) and general psychopathology (BSI-53). Results: More insecure attachment was associated with increased trait anxiety, depressive and general psychiatric symptom burden in patients. Furthermore, we observed time-stable links between insecure adult attachment and increased rs-FC between the left lateral parietal default mode network (DMN LP) and bilateral parts of the salience network, as well as decreased rs-FC between DMN LP and medial parts of the DMN. Discussion: Implications of the present study are highlighting the association between attachment security and brain areas related to affect regulation. [ABSTRACT FROM AUTHOR]

Background: The relationship between spirituality and mental health has garnered attention, fostering overall well-being. Spirituality, posited as a protective factor, may enhance resilience and provide meaning, thus benefiting mental health. This study aims to identify spirituality-associated factors influencing clinical outcomes in psychosomatic inpatients and validate the Transpersonal Spirituality Inventory (TSI). Methods: The study involved 4952 psychosomatic inpatients completing the Transpersonales Vertrauen (TPV) and 7739 patients completing the TSI, with assessments conducted at admission and discharge. Additional instruments included the ISR for symptom rating and the LK-18 for life skills. Factor analysis and Spearman's rank correlation were used to evaluate the validity of TSI and the relationship between spirituality and clinical outcomes. Results: Factor analysis confirmed the TSI's two-factor structure: "centered connectedness" (F1) and "transcendent orientation" (F2), with satisfactory internal consistency (Cronbach's α = 0.824 for F1 and 0.644 for F2). Higher spirituality levels, particularly in transpersonal trust and centered connectedness, correlated with lower depression and psychosomatic symptoms (ISR). Although these correlations were generally weak, significant associations were found between spirituality and life competences, particularly in meaning, belief, and values (r =.595 for TPV and.598 for TSI F1). Conclusion: Despite correlations between psychosomatic health and spirituality as measured with TPV and TSI were rather small several spirituality items could be identified which seem to have a prominent connection to the diagnosis and development of psychosomatic health. Specific spiritual attitudes, such as access to inner stillness and connection to a greater whole, were linked to positive treatment responses and reduced symptom burden. These findings suggest potential benefits in incorporating spirituality into psychosomatic treatments, though its complex and multifaceted nature warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Mindfulness-based interventions can improve psychological well-being and reduce symptoms of mental burden, including among adolescents. Relationships between basic mindfulness (trait mindfulness) and the immediate effects of a single mindfulness intervention have not been thoroughly researched, especially in adolescents. In this study, we aimed to elucidate these aspects by using a multimodal approach—measuring the effect of a single mindfulness intervention on both subjective and physiological parameters. Methods: A total of 78 healthy adolescents (12–19 years of age, 50% female) were assigned to either a mindfulness or an active control group. Before and after the interventions, subjective parameters (mood, stress, and state mindfulness) were assessed using bipolar visual analogue scales. Physiological parameters (heart rate and heart rate variability) were measured before and during the interventions. Participants also completed the Self-Compassion Scale (SCS-D) with the subscale "mindfulness" as an assessment of trait mindfulness, and the State-Trait Anxiety-Depression Inventory (STADI). Results: Our results showed no significant interactions between time and intervention, either subjectively or physiologically. For heart rate, we found a main effect of time. For all subjective parameters, we observed a main effect of trait mindfulness. Age was a relevant factor for heart rate and state mindfulness, suggesting age effects. We also observed strong correlations between trait mindfulness, trait anxiety, and depression scores. Conclusion: A single mindfulness intervention had no immediate observable effects in our healthy adolescent sample, and possible reasons for this finding are discussed. Nevertheless, the present data show the potential for increased resilience through mindfulness in adolescence. [ABSTRACT FROM AUTHOR]

Background: Social alienation is prevalent among lung cancer (LC) patients undergoing chemotherapy. Although previous research has established an association between social alienation and symptom burden, the mechanisms underlying this relationship remain not fully understood. Methods: This cross-sectional study used convenience sampling to select 378 LC patients undergoing chemotherapy from September 2022 to December 2023 at a tertiary care hospital in Guangzhou, China. Data collection was conducted using a proprietary Sociodemographic Information Questionnaire, MD Anderson Symptom Inventory (MDASI), Social Alienation Questionnaire, Perceptions of Social Support (PSS) Questionnaire, and Positive Psychological Capital (PPC) Questionnaire. To analyze chain-mediated effects, the PROCESS v3.3 Model 6 SPSS macro software was employed. Results: The analysis revealed that the burden of symptoms significantly exacerbates social alienation, as evidenced in the mediation effects model (Bootstrap 95% CI: 0.031, 0.092). Furthermore, the burden of symptoms indirectly diminishes PSS (Bootstrap 95% CI: 0.019, 0.057) and PPC (Bootstrap 95% CI: 0.002, 0.020). It is crucial to note that both PSS and PPC significantly mediate the relationship between symptom burden and social alienation, as evidenced (Bootstrap 95% CI: 0.001, 0.011). Conclusions: The impact of symptom burden on social alienation is moderated through PSS and PPC, manifesting both directly and indirectly. Moreover, the influence of PPC tends to mitigate the mediating role of PSS. Clinical interventions aimed at bolstering PSS and augmenting PPC may potentially alleviate social alienation and enhance the quality of life for patients undergoing chemotherapy for LC. [ABSTRACT FROM AUTHOR]

Symptom burden is known to be high in patients with hematologic malignancies and can adversely impact patients' quality of life. The aims of this retrospective observational cohort study were to explore symptoms in patients with hematologic malignancies, including during the last year of life, to explore symptom profiles in patients with hematologic malignancies, and to explore associations among symptoms/symptom profiles and demographic, clinical, and treatment-related variables. Symptom prevalence and severity and symptom profiles were explored in patients with hematologic malignancies who completed patient-reported outcome measures (n = 6136) between October 2019 and April 2020. Emergency department visits and hospital admissions during the study period were reviewed. Chart audits were undertaken for patients who died within a year of completing patient-reported outcome measures (n = 432) to explore symptoms and healthcare utilization in the last year of life. Patients with hematologic malignancies in this study reported multiple symptoms co-occurring, with more than 50% of patients reporting four or more symptoms. Classes of co-occurring symptoms (symptom profiles) were associated with demographic and clinical factors as well as with healthcare utilization, particularly emergency department visits. The most reported symptoms were tiredness, impaired well-being, and drowsiness. The findings emphasize the need for more supports for patients with hematologic malignancies, particularly for symptom management. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is the most common malignancy affecting women globally, significantly impacting their quality of life (QoL). This study aimed to assess the prevalence and severity of symptoms in newly diagnosed BC patients undergoing chemotherapy in Oman using the Edmonton Symptom Assessment System (ESAS-A); Materials and Methods: A cross-sectional study was conducted between December 2022 and February 2024 at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), University Medical City, Oman. The study included 105 Omani women, aged 18 to 60, diagnosed with stage I to III BC and undergoing chemotherapy. Symptom evaluation was performed using ESAS-A. Descriptive statistics were employed to summarize socio-demographic characteristics and clinical outcomes, while the Mann–Whitney U test and multiple linear regression analysis were used to examine associations between independent variables and symptom scores; Results: Out of 127 invited participants, 105 (82.6%) agreed to participate. The average age was 43.6 years (SD = 7.2). Fatigue (37.1%), poor well-being (30.5%), and drowsiness (27.6%) were the most commonly reported symptoms. Anxiety and depression affected 21.9% and 17.1% of participants, respectively. Linear regression analysis showed that having children was linked to higher fatigue and shortness of breath, while inversely associated with pain. A family history of chronic disease was significantly correlated with higher depression scores; Conclusions: This study is the first in Oman to utilize ESAS-A for assessing symptom burden in newly diagnosed BC patients undergoing chemotherapy. The findings highlight the importance of personalized symptom management and enhanced supportive care to improve patient well-being. [ABSTRACT FROM AUTHOR]

Background Nirmatrelvir/ritonavir (NMV/r) is an oral antiviral treatment for mild to moderate coronavirus disease 2019 (COVID-19). Methods This phase 2/3, double-blind, randomized (1:1) study assessed oral NMV/r 300 mg/100 mg versus placebo every 12 hours for 5 days in high-risk, unvaccinated, nonhospitalized, symptomatic adults with COVID-19 from 343 sites across 21 countries. In testing the primary endpoint of COVID-19‒related hospitalization and all-cause deaths and key secondary endpoints, including symptom duration and COVID-19‒related medical visits, type I error was controlled with prespecified sequential testing and the Hochberg procedure. Results Among 2113 randomized patients enrolled from July 2021 through December 2021, 1966 (NMV/r, n = 977; placebo, n = 989) were included in the prespecified analysis population (symptom onset ≤5 days, did not receive monoclonal antibodies). NMV/r significantly reduced times to sustained alleviation (median, 13 vs 15 days; hazard ratio = 1.27, P <.0001) and resolution (16 vs 19 days; hazard ratio = 1.20, P =.0022) through day 28 and significantly reduced the number of COVID-19‒related medical visits and the proportion of patients with such visits. Hospitalized patients treated with NMV/r had shorter stays, none required intensive care unit admission or mechanical ventilation, and all were discharged to home/self-care. Fewer NMV/r-treated patients required additional treatment for COVID-19. No NMV/r-treated patients died through week 24 compared with 15 placebo-treated patients. Conclusions In addition to reducing COVID-19‒related hospitalization or death from any cause through day 28, NMV/r was found to also reduce duration of COVID-19 symptoms and utilization of healthcare resources versus placebo in patients at high risk of progressing to severe disease. Clinical Trial Information ClinicalTrials.gov , NCT04960202, https://clinicaltrials.gov/study/NCT04960202 [ABSTRACT FROM AUTHOR]

Past studies associating personality with psychosis have been limited by small nonclinical samples and a focus on general symptom burden. This study uses a large clinical sample to examine personality's relationship with psychosis-specific features and compare personality dimensions across clinically and neurobiologically defined categories of psychoses. A total of 1352 participants with schizophrenia, schizoaffective disorder, and bipolar with psychosis, as well as 623 healthy controls (HC), drawn from the Bipolar-Schizophrenia Network for Intermediate Phenotypes (BSNIP-2) study, were included. Three biomarker-derived biotypes were used to separately categorize the probands. Mean personality factors (openness, conscientiousness, extraversion, agreeableness, and neuroticism) were compared between HC and proband subgroups using a generalized linear model. A robust linear regression was utilized to determine personality differences across biotypes and diagnostic subgroups. Associations between personality factors and cognition were determined through Pearson's correlation. A canonical correlation was run between the personality factors and general functioning, positive symptoms, and negative symptoms to delineate the relationship between personality and clinical outcomes of psychosis. There were significant personality differences between the proband and HC groups across all five personality factors. Overall, the probands had higher neuroticism and lower extraversion, agreeableness, conscientiousness, and openness. Openness showed the greatest difference across the diagnostic subgroups and biotypes, and greatest correlation with cognition. Openness, agreeableness, and extraversion had the strongest associations with symptom severity. Individuals with psychotic disorders have different personality traits compared to HC. In particular, openness may be relevant in distinguishing psychosis-specific phenotypes and experiences, and associated with biological underpinnings of psychosis, including cognition. Further studies should identify potential causal factors and mediators of this relationship. [ABSTRACT FROM AUTHOR]

Myeloproliferative neoplasms (MPNs) are a group of rare chronic progressive blood cancers that vary widely in clinical presentation, yet all patients have a risk of disease progression and thrombotic complications. Diseases include primary myelofibrosis, polycythemia vera, and essential thrombocythemia. With current treatment approaches, most patients live a prolonged life, but many experience a complex of symptoms that negatively influence their functional status and quality of life. Although significant advances have been made in preventing arterial and venous complications while mitigating inflammatory processes, comprehensive palliative care can help address unmet complex physical and psychosocial needs on a long-term basis. This article, created by a multidisciplinary group of providers, offers an overview of MPNs so palliative care clinicians can better support patients with these hematologic cancers. [ABSTRACT FROM AUTHOR]

In September 2021, California Governor Gavin Newsom signed Senate Bill 311 (Ryan's Law), mandating that healthcare facilities permit terminally ill patients to use their own medical cannabis under the Compassionate Access to Medical Cannabis Act. This law challenged an inpatient oncology unit to develop a policy and clinical workflow to allow eligible patients to self-administer oral and topical cannabis. A case study illustrates how oncology nurses implemented Ryan's Law for patient symptom management during hospitalization. Nursing satisfaction surveys revealed that oncology nurses felt comfortable adopting Ryan's Law into their practice postimplementation. [ABSTRACT FROM AUTHOR]

Palliative care offers undeniable advantages to elderly patients with multiple chronic illnesses in managed long-term care. However, only approximately 14% of those who require palliative care actually receive it. To investigate factors influencing decision-making regarding palliative care acceptance, and healthcare providers' communication strategies, which patients or family caregivers perceive during managed long-term care. Qualitative thematic content analysis study. Two data sources from home and community-based health care organization in a metropolitical city in the Northeastern United States were used: (a) retrospectively collected 79 phone call audio recordings between patients and/or family caregivers with healthcare providers when initiate palliative care option, and (b) prospectively collected 10 exploratory qualitative interviews with patients and/or family caregivers for this study purpose. From a total of 89 conversations, 7 themes emerged during palliative care decision-making: (a) capability for self-management; (b) symptom severity; (c) perceptions of chronic disease; (d) satisfaction with current health services; (e) code status; (f) caregiver burden and (g) other reasons, including financial considerations and service affiliations. In addition, from 10 qualitative interviews, 4 key themes in healthcare providers' communication that optimize palliative care conversations were indicated: (i) trust and relationship dynamics; (ii) positive reinforcement and personal connection; (iii) conversation setting and initiator; and (iv) collaborative approach to care coordination. Enhancing decision-making around palliative care and improving acceptance of palliative care services may be improved through the integration of personalized care plans, empathetic communication, use of symptom-inclusive assessments for timely care, and proactively addressing caregiver burden. [ABSTRACT FROM AUTHOR]

Background This study explored differences in patient-reported outcomes (PROs) for patients with central nervous system (CNS) tumors during COVID, compared to pre-pandemic assessments, in light of impacted access to in-person care. Methods Patient-reported outcomes (PROMIS-Anxiety and Depression Short-Forms, EQ-5D-3L, MDASI-BT/Spine, NeuroQoL-Perceived Cognitive Functioning) were collected from 149 participants on the Neuro-Oncology Branch Natural History Study seen during the first year of COVID between March 2020 and February 2021, which were compared to assessments collected pre-COVID. Paired sample t -tests and proportion tests (z -tests) were used to compare PROs with effect sizes reported using Hedges g and Cohen's h. Logistic regression models with backwards selection were used to identify risk factors for high levels of depression and anxiety pre- and during COVID. Results Participants were primarily male (54%) and Caucasian (84%) with a median age of 46 (range 20–79) and 66% had high-grade tumors. More patients reported moderate-severe depressive symptoms during the COVID year, compared to pre-COVID assessments (13% vs 8%, Cohen's h  = 0.17, P  = .021), with modest increases in symptom burden and cognitive dysfunction reported as well. Logistic regressions revealed that during COVID, concurrent moderate-severe distress and low tumor grade predicted depression and anxiety, with psychotropic medication use also predicting depression while active treatment predicted anxiety. Conclusion During COVID, patients experienced higher levels of depression, which has the potential to negatively influence treatment success and survival. Future work is needed to incorporate innovative tools and interventions that can be utilized remotely to identify and target mood disturbance in these vulnerable patients. [ABSTRACT FROM AUTHOR]

There has been some effort to map the prevalence, frequency, and severity of symptoms of long COVID at local and national levels. However, what is frequently absent from such accounts is details of the impact the disease and its symptoms have had on those living with the condition. In this article, we present details of the impact on work, caring, and mental health gathered using a cross-sectional survey. Data were collected using an online survey that was available from April 21, 2022, to August 5, 2022. Included participants had either self-diagnosed or confirmed long COVID, were living in Scotland, and were aged ≥18 years. Hospitalization during initial COVID-19 infection was an exclusion criterion. Participants were asked to report on the impact of their illness on everyday activities such as working, studying, or caring. They also completed an assessment of their current mood. People with long COVID were often severely impacted in their ability to work and study. Severe impact on work and study were predicted by more severe and more frequent fatigue, more severe pain, and more severe cognitive impairment. Respondents' ability to care for child dependents was also associated with more severe and more frequent fatigue, and more severe cognitive impairments. More severe pain associated with greater impact on adult care. Negative mood correlated most strongly with frequency and severity of neurological symptoms, including lack of attention, loss of smell, impaired sense of smell, loss of taste, impaired sense of taste, and loss of appetite. Long COVID has a significant impact on ability to work, study, and care for dependents. The severity of this impact is associated with specific symptom burden, including fatigue, pain, and cognitive impairment. [ABSTRACT FROM AUTHOR]

Ethiopia's Tigray in 2020. This war has had a detrimental impact on the mental health and overall wellbeing of Tigrayans living in other countries and abroad. The present study investigated the state of mental health and wellbeing among Tigrayan diaspora living in Australia, many of whom are migrants, but most are refugees. We employed a cross-sectional survey gathered through Qualtrics-designed hybrid data collection techniques. We assessed vicarious trauma using the secondary traumatic stress scale (STSS), depression, anxiety, and stress using the Depression Anxiety and Stress Scale-21 (DASS-21), PTSD using PTSD Checklist- Civilian Version (PCL C), and resilience using the Connor–Davidson Resilience Scale (CD-RISC-10). We calculated the psychometric properties of these tools among the population. We employed binary logistic regression analysis to identify factors associated with the outcomes of interest. 241 people participated in the survey. Intrusion symptoms of vicarious trauma were prevalent among 85.6 % (172/201) of participants, avoidance symptoms of vicarious trauma among 87.6 % (176/201) of participants, and arousal vicarious trauma among 83.6 % (168/201) of participants. Extremely severe depression was prevalent among 38.2 % (81/212) of participants, extremely severe anxiety among 47.6 % (101/212) of participants, and extremely severe stress among (26.9 % (57/212) of participants. PTSD symptoms were prevalent among 75 % (151/204) of participants. Resilience was reduced among 67.5 % (135/200) of participants. The study implies that conflict occurring in one's home country can have a profound impact on the mental wellbeing of individuals residing abroad. • There is evidence on trauma among survivors of war but little on the impact of war on people who experience it via social mediabut not first-hand. • This is the first study that provides evidence on the issue among Tigrayan diaspora who vicariously sufferred from a war in their home country. • The study found a high burden of symptoms of mental health outcomes, but relative resilience among Tigrayan diaspora in Australia. • The study contributes to the literature gap of conflict-related vicarious trauma among the diaspora community during a war in their home country. [ABSTRACT FROM AUTHOR]

Background/Objectives: Adult-onset Still's disease (AOSD) is an autoinflammatory disorder that can be challenging to diagnose and manage. The aim of this study was to analyze retrospective data to provide insights into the clinical presentation, disease activity, and treatment patterns and outcomes of AOSD during routine clinical care prior to the release of new AOSD guidelines. Methods: This retrospective database analysis evaluated adult patients (≥18 years) with a diagnosis of AOSD who engaged in a clinical visit between 1 January 2010 and 31 December 2020. The evaluated outcomes included demographic characteristics, symptoms, disease activity, and treatment. Results: Our study included 120 patients (67 [55.8%] of whom were female) diagnosed with AOSD according to the Yamaguchi criteria at ten German rheumatology centers. The median (quartile [Q] 1, Q3) age was 51 (36, 62) years, and the median (Q1, Q3) time from diagnosis was 9 (4, 11) years. Approximately half (66 [55.0%]) had a polycyclic disease course. The most frequent symptoms at initial diagnosis were arthralgia (105 [87.5%]) and fever (86 [71.7%]), and these symptoms continued for a substantial proportion of patients at the current visit (35 [29.2%] and 22 [18.3%], respectively). High neutrophil and ferritin levels were also common. The mean Still Activity Score, a measure of disease activity, improved from 4.66 at initial diagnosis to 1.97 at the most recent visit. The treatments most frequently used at some point in the disease course were glucocorticoids (118 [98.3%]), interleukin (IL)-1 inhibitors (89 [74.2%]), and methotrexate (85 [70.8%]). The most common current treatments were IL-1 inhibitors (55 [45.8%]), followed by methotrexate (29 [24.2%}) and glucocorticoids (28 [23.3%]). Conclusions: Our cohort of patients with AOSD seen at German rheumatology clinics showed strong improvements in symptoms and disease activity from initial diagnosis, but a high symptom burden remained for some patients. Future studies may be able to build on our data to document the impact of new guidelines on treatment patterns. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to investigate the effectiveness of an 8-wk cardiopulmonary rehabilitation program on cardiorespiratory fitness (VO2peak) and key cardiopulmonary exercise test measures, quality of life, and symptom burden in individuals with long COVID. Design: Forty individuals with long COVID (mean age 53 ± 11 yrs), were randomized into two groups: (1) rehabilitation group: center-based individualized clinical rehabilitation program (8 wks, 3 sessions per week of aerobic and resistance exercises, and daily inspiratory muscle training) and (2) control group: individuals maintained their daily habits during an 8-wk period. Results: There was a significant difference between groups in mean VO2peak improvement (P = 0.003). VO2peak improved significantly in the rehab group (+2.7 mL.kg.min; 95% CI = +1.6 to +3.8; P < 0.001) compared to the control group (+0.3 mL.kg.min; 95% CI = −0.8 to +1.3 P = 0.596), along with VE/VCO2 slope (P = 0.032) (−2.4; 95% CI = −4.8 to +0.01; P = 0.049 and +1.3; 95% CI = −1.0 to +3.6; P = 0.272, respectively) and VO2 at first ventilatory threshold (P = 0.045). Furthermore, all symptom impact scales improved significantly in the rehabilitation group compared to the control group (P < 0.05). Conclusions: An individualized and supervised cardiopulmonary rehabilitation program was effective in improving cardiorespiratory fitness, ventilatory efficiency, and symptom burden in individuals with long COVID. Careful monitoring of symptoms is important to appropriately tailor and adjust rehabilitation sessions. [ABSTRACT FROM AUTHOR]

Previous reports from relatively small clinical cohorts have suggested that the clinical presentation of obstructive sleep apnea (OSA) differs between men and women. We aimed to explore sex differences in clinical and polysomnographic features of OSA in a large nationwide registry. Participants from the ongoing Turkish Sleep Apnea Database (TURKAPNE) Study from 34 centers were included in the current analysis. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/hour and was classified as mild, moderate, and severe according to AHI cut-offs 5, 15, and 30 events/hour, respectively. In all, 7130 patients (2259 women) were included. OSA was observed in 6323 (88.7 %), of whom 70.2 % were male and 29.8 % were female. In the OSA group, women were older (56.7 ± 11.9 vs. 49.5 ± 11.3 years; p < 0.001) and more obese (body mass index 34.3 ± 7.2 vs. 31.4 ± 5.6 kg/m2; p < 0.001) and had lower AHI (29.8 ± 24.1 vs. 36.8 ± 26.2 events/h; p < 0.001) than men. Loud snoring and witnessed apnea were more common in men than in women whereas women were more frequently presented with insomnia, headache, and mood changes. Women had significantly less total sleep time, less sleep efficiency, and longer sleep latency compared with men (p < 0.001 for each). Additionally, comorbid diseases such as diabetes mellitus, hypertension, asthma, psychiatric disorders, hypothyroidism as well as drug use were more common in women than in men independent of age and obesity (p < 0.05 for each). Our results suggest significant sex differences in clinical and polysomnographic features in this nationwide Turkish adult population. Women with OSA have more symptom burden and comorbidities despite having a less severe AHI. [Display omitted] • Clinical presentation of obstructive sleep apnea differs between men and women, in which effects of age and obesity are unknown. • Our results suggest significant sex differences in clinical and polysomnographic features in this large nationwide cohort. • Women with obstructive sleep apnea have less severe apnea-hypopnea index but more symptom burden independent of age and obesity. • These aspects should be carefully considered to avoid delay in diagnostic evaluation of obstructive sleep apnea in women. [ABSTRACT FROM AUTHOR]

The article discusses the development of a symptom burden measurement tool for patients with complex malignant and benign skull base tumors (SBT) from the patient's perspective. Through qualitative interviews with 29 patients, a preliminary MDASI-SB module was created, comprising 34 items including core, disease-specific, and interference items. Patients with SBT experience a wide range of symptoms, with a core group of symptoms common across different disease sites, forming the basis of the preliminary MDASI-SB for further validation. [Extracted from the article]

The article discusses the development of the Craniopharyngioma Quality of Life (C-Qol) Index, a patient-centered, disease-specific instrument to measure quality of life in patients with craniopharyngiomas. The study involved interviews with patients who underwent treatment for craniopharyngiomas, resulting in a 29-item survey that was validated by patients and expert providers. The C-Qol Index aims to provide valuable insights into the care of patients with these complex tumors once externally validated. [Extracted from the article]

This article presents a retrospective study on 457 patients with adenoid cystic carcinoma (ACC) in the sinonasal tract, nasopharynx, and upper oral and oropharyngeal cavity. The study aims to define optimal treatment strategies for ACC and identify a new definition of recovery due to its unique behavior. Findings indicate that gross total resection without adjuvant radiotherapy leads to higher disease-specific survival, while patients with noncurative treatment intent have a worse prognosis. The study also highlights the significant burden of symptoms and toxicity from retreatments, as well as the potential for local and distant metastases years after primary treatment. [Extracted from the article]

The article discusses the development of the Non-Functioning Pituitary Adenoma Inventory (NFPAI), a patient-centered tool to assess quality of life in individuals with nonfunctioning pituitary adenomas. The NFPAI was created through a process of consolidating relevant items from existing questionnaires and was found to be effective in capturing the impact of symptoms and treatment on quality of life. Patients and providers had differing perspectives on the relevance of certain items, highlighting the importance of a patient-centered approach in assessing quality of life in this population. [Extracted from the article]

Background: Chronic pain is common and associated with disruptions in quality of life (QoL) and psychosocial functioning. These issues are particularly pronounced in veterans, although data in this regard primarily come from the United States Veterans Affairs System, meaning less is known regarding veterans of other countries and regions. The present study evaluated veterans living in Northern Ireland (NI), a region with historic high rates of both chronic pain and psychosocial difficulties associated with the decades-long period of civil and military conflict preceding the 1999 armistice (the Good Friday Agreement). Unique to the Northern Ireland military operation was the initiation of Home Service battalions comprised of local recruits, a role with increased risk due to the conflict's nature and the fact that they were serving as a military and security presence in their home region. Methods: A cross-sectional assessment of veterans living in Northern Ireland (N = 722) provided details of service type (Home Service vs other service), current health conditions (including chronic pain), and current psychosocial functioning (including physical and mental health QoL, anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms). Results: Findings indicated that those with chronic pain had worse QoL, anxiety, depression, and PTSD. Those with chronic pain were also more likely to have served in the Home Services, be unemployed, and be receiving disability payment. Contrary to hypotheses, there was no interaction between chronic pain and service type. Conclusions: These results extend previous work with veterans to the unique circumstances of a post-conflict military that engaged in operations within its own country and underscore the need for coordinated, efficacious interventions for co-morbid chronic pain and anxiety, depression, and PTSD. [ABSTRACT FROM AUTHOR]

Fibromyalgia (FM) is a complex chronic disorder characterized by widespread pain as the primary symptom. To evaluate the effect of health education on the severity of various symptoms in patients with FM, seven databases were searched from inception to August 2024 to identify randomized controlled trials evaluating the effects of health education for FM. The primary outcome was overall symptom severity, and the secondary outcomes were pain, depression, anxiety, sleep quality, fatigue, physical function and self-efficacy. The Cochrane Risk-of-Bias tool for randomized trials and the Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality of the included studies and the certainty of evidence, respectively. Treatment effects were estimated by calculating Hedges' g and the corresponding 95% confidence intervals. Meta-analysis included a total of 13 trials. The results revealed that health education significantly reduced overall symptom severity, depression and anxiety and increased sleep quality and physical function among patients with FM (all P values < 0.05). However, no significant effects were observed on pain, fatigue and self-efficacy. Health education may be a beneficial intervention for FM patients, particularly for mitigating symptom severity. Health-care providers should implement health education interventions to empower patients to effectively manage their symptoms. [ABSTRACT FROM AUTHOR]