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Women are more directly involved in combat operations today than ever before, currently making up 18.6% of officers and 16.8% of enlisted personnel in the United States military. However, women continue to be under-represented in military research. Studies that do consider gender differences in traumatic brain injury (TBI) outcomes have shown that women report significantly more post-concussive symptoms than men. Conclusions for true gender differences related to TBI are hard to make without controlling for non-TBI factors. The effects previously identified in the literature may be an artifact of how men and women differ in their response to injury, unrelated to the neurological recovery process associated with TBI. The objective of this study was to examine the effects of gender specifics on mild TBI (mTBI) sequelae on injured and uninjured control groups, and to investigate the role of post-traumatic stress disorder (PTSD) on symptom reporting. It should be noted that the terms "gender" and "men/women" are used in this article in place of "sex" or "males/females" given that we are not discussing biological attributes. A total of 966 United States military service members and veterans were included in the study. Of the total sample, 455 men and 46 women were in the mTBI group, 285 men and 31 women were in the injured controls group (IC), and 111 men and 38 women in the non-injured controls group (NIC). Post-concussive and quality of life symptoms were compared for men and women while controlling for combat exposure. MTBI and IC groups were also stratified by PTSD presentation. Measures used included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist (PCL-C), Traumatic Brain Injury Quality of Life (TBI-QOL), and Combat Exposure Scale. In the mTBI group, women had worse scores on NSI total, NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety, Fatigue, and Headache scales (n2 = 0.018–0.032, small to small-medium effect sizes). When PTSD was present, women had worse scores on the NSI Somatosensory cluster only (n2 = 0.029, small-medium effect size). In contrast, when PTSD was absent, women had worse scores than men on the NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety and Headache scales (n2 = 0.032–0.063, small to medium effect sizes). In the IC group, women had worse scores on the NSI Cognitive cluster and the TBI-QOL Fatigue and Pain Interference scales (n2 = 0.024–0.042, small to small-medium effect sizes). However, group differences were no longer found when stratified by PTSD sub-groups. In the NIC group, there were no significant group differences for any analyses. We were able to identify symptoms unique to women recovering from mTBI that were not present following other forms of physical injury or in healthy controls. However, the impact of PTSD exacerbates the symptom profile and its comorbidity with mTBI equates to most of the noted gender differences. [ABSTRACT FROM AUTHOR]

The Child Sport Concussion Assessment Tool, fifth edition (SCAT5), remains the consensus instrument for concussion evaluation in youth athletes. Both child and parent are recommended to complete the athlete background and symptom reporting. To determine the level of agreement between child and parent medical history and symptom reporting and quantify their performance on the Child SCAT5 in male football athletes. Cross-sectional study. National Collegiate Athletic Association Division I college football facility. A total of 157 youth male football athletes (age = 10.7 ± 1.3 years) participating in a university-sanctioned youth football camp and their parent or legal guardian. Youth athletes and their parent completed the athlete background (demographics, diagnosed medical history) and symptom evaluation (symptom items, total number of symptoms, and symptom severity score) of the Child SCAT5 and were instructed not to discuss reporting with each other during testing. Cronbach α tests were conducted to determine the internal consistency, and descriptive statistics determined the level of agreement between medical history, symptom reporting, and baseline performance. The internal consistency of the symptom items was high for both child (Cronbach α = 0.91) and parent (α = 0.92). Agreement on medical history ranged from 67% (learning disability or dyslexia) to 85% (attention-deficit/hyperactivity disorder), with 82% agreement on sustaining a previous concussion. Fourteen youth athletes reported having been hospitalized for a head injury, with zero matched parent confirmations. Individual symptom agreement ranged from 70.7% (gets distracted easily) to 94.9% (going to faint). Agreement was 35% on total number of symptoms and severity. Abnormal scoring ranged from 2% (going to faint) to 25% (headache) for child and 2% (double vision) to 28% (gets distracted easily) for parent reporting. Fair agreement was shown between children and their parent on medical history and self-reported symptoms on the Child SCAT5 at baseline. When available, child and parent reporting should be used for concussion assessment and clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract Introduction Symptoms reported following the administration of investigational drugs play an important role in decisions for registration and treatment guidelines. However, symptoms are subjective, and interview methods to quantify them are difficult to standardise. We explored differences in symptom reporting across study sites of a multicentre antimalarial trial, with the aim of informing trial design and the interpretation of safety and tolerability data. Methods Data were derived from the IMPROV trial, a randomised, placebo-controlled double blinded trial of high dose primaquine to prevent Plasmodium vivax recurrence conducted in eight study sites in Afghanistan, Ethiopia, Indonesia and Vietnam. At each follow up visit a 13-point symptom questionnaire was completed. The number and percentage of patients with clinically relevant symptoms following the administration of primaquine or placebo, were reported by study site including vomiting, diarrhoea, anorexia, nausea, abdominal pain and dizziness. Multivariable logistic regression was used to estimate the confounder-adjusted site-specific proportion of each symptom. Results A total of 2,336 patients were included. The greatest variation between sites in the proportion of patients reporting symptoms was for anorexia between day 0 and day 13: 97.3% (361/371) of patients in Arba Minch, Ethiopia, reported the symptom compared with 4.7% (5/106) of patients in Krong Pa, Vietnam. Differences attenuated slightly after adjusting for treatment arm, age, sex, day 0 parasite density and fever; with the adjusted proportion for anorexia ranging from 4.8% to 97.0%. Differences between sites were greater for symptoms graded as mild or moderate compared to those rated as severe. Differences in symptom reporting were greater between study sites than between treatment arms within the same study site. Conclusion Despite standardised training, there was large variation in symptom reporting across trial sites. The reporting of severe symptoms was less skewed compared to mild and moderate symptoms, which are likely to be more subjective. Trialists should clearly distinguish between safety and tolerability outcomes. Differences between trial arms were much less variable across sites, suggesting that the relative difference in reported symptoms between intervention and control group is more relevant than absolute numbers and should be reported when possible. Trial registration Clinicaltrials.gov: NCT01814683; March 20th, 2013.

Introduction: Symptoms reported following the administration of investigational drugs play an important role in decisions for registration and treatment guidelines. However, symptoms are subjective, and interview methods to quantify them are difficult to standardise. We explored differences in symptom reporting across study sites of a multicentre antimalarial trial, with the aim of informing trial design and the interpretation of safety and tolerability data. Methods: Data were derived from the IMPROV trial, a randomised, placebo-controlled double blinded trial of high dose primaquine to prevent Plasmodium vivax recurrence conducted in eight study sites in Afghanistan, Ethiopia, Indonesia and Vietnam. At each follow up visit a 13-point symptom questionnaire was completed. The number and percentage of patients with clinically relevant symptoms following the administration of primaquine or placebo, were reported by study site including vomiting, diarrhoea, anorexia, nausea, abdominal pain and dizziness. Multivariable logistic regression was used to estimate the confounder-adjusted site-specific proportion of each symptom. Results: A total of 2,336 patients were included. The greatest variation between sites in the proportion of patients reporting symptoms was for anorexia between day 0 and day 13: 97.3% (361/371) of patients in Arba Minch, Ethiopia, reported the symptom compared with 4.7% (5/106) of patients in Krong Pa, Vietnam. Differences attenuated slightly after adjusting for treatment arm, age, sex, day 0 parasite density and fever; with the adjusted proportion for anorexia ranging from 4.8% to 97.0%. Differences between sites were greater for symptoms graded as mild or moderate compared to those rated as severe. Differences in symptom reporting were greater between study sites than between treatment arms within the same study site. Conclusion: Despite standardised training, there was large variation in symptom reporting across trial sites. The reporting of severe symptoms was less skewed compared to mild and moderate symptoms, which are likely to be more subjective. Trialists should clearly distinguish between safety and tolerability outcomes. Differences between trial arms were much less variable across sites, suggesting that the relative difference in reported symptoms between intervention and control group is more relevant than absolute numbers and should be reported when possible. Trial registration: Clinicaltrials.gov: NCT01814683; March 20th, 2013. [ABSTRACT FROM AUTHOR]

Purpose: There is limited research regarding the characteristics of those from the general population who seek care following acute concussion. Methods: To address this gap, a large cohort of 473 adults diagnosed with an acute concussion (female participants = 287; male participants = 186) was followed using objective measures prospectively over 16 weeks beginning at a mean of 5.1 days post-injury. Results: Falls were the most common mechanism of injury (MOI) (n = 137, 29.0%), followed by sports-related recreation (n = 119, 25.2%). Male participants were more likely to be injured playing recreational sports or in a violence-related incident; female participants were more likely to be injured by falling. Post-traumatic amnesia (PTA) was reported by 80 participants (16.9 %), and loss of consciousness (LOC) was reported by 110 (23.3%). In total, 54 participants (11.4%) reported both PTA and LOC. Male participants had significantly higher rates of PTA and LOC after their injury compared to their female counterparts. Higher initial symptom burden was associated with a longer duration of recovery for both male and female participants. Female participants had more symptoms and higher severity of symptoms at presentation compared to male participants. Female participants were identified to have a longer recovery duration, with a mean survival time of 6.50 weeks compared to 5.45 weeks in male participants (p < 0.0001). A relatively high proportion of female and male participants in this study reported premorbid diagnoses of depression and anxiety compared to general population characteristics. Conclusion: Although premorbid diagnoses of depression and/or anxiety were associated with higher symptom burden at the initial visit, the duration of symptoms was not directly associated with a pre-injury history of psychological/psychiatric disturbance. This cohort of adults, from the general population, seeking care for their acute concussion attained clinical and functional recovery over a period of 4-12 weeks. [ABSTRACT FROM AUTHOR]

Background: The population of individuals affected by breast cancer is growing, and with advances in cancer treatment implemented into usual care, there is an urgent need to improve the recognition, monitoring and treatment of therapy-induced adverse effects. This study aims to explore the use of an in-app electronic questionnaire to assess and monitor chemotherapy-related symptoms in early breast cancer patients treated with perioperative chemotherapy. Method: Between December 2019 and June 2021, 72 female study participants used the mobile app Centrum Chorób Piersi UCK and completed an in-app questionnaire about the 14 most common chemotherapy-related symptoms. Replies including symptoms with a critical value triggered automatic email alerts to the nursing team. Results: Acceptance of the study was higher among younger women and patients originating from rural areas, while possible digital exclusion among patients >60 years was observed during the enrolment process. A total of 55 participants completed the electronic questionnaire at least once and generated 553 responses with 1808 specific problems reported. Fatigue (n = 428) was the most common problem, and fever (n = 5) the least reported problem. A total of 21 participants triggered alerts with responses containing symptoms with critical value assessment (n = 89). Significant negative correlation was observed between the number of responses and time from the first chemotherapy administration; however, the number of responses was not determined by any sociodemographic or medical factors. Significant positive correlations were identified between the number of communicated problems and participants' age. The usage of our electronic symptom assessment questionnaire decreased substantially after the period of active encouragement during the study enrolment. Conclusions: Not all societies are ready for innovative eHealth solutions. Patients' age should be carefully considered when app-based interventions are introduced to usual cancer care. Additional support is suggested for older patients to improve their awareness and participation in eHealth interventions. More research involving older participants is needed to explore and address their particular needs and perspectives on eHealth solutions. [ABSTRACT FROM AUTHOR]

The majority of Canadians agree they have the right to end-of-life care in their own homes. While a palliative approach to care in the home setting has been demonstrated to be beneficial for patients and the healthcare system, it has rarely been well-integrated through an eHealth approach. Thus, in 2018, we piloted the RELIEF app, a digital symptom self-reporting tool for patients with palliative care needs. This was followed by the initiation of an extension phase of RELIEF in the home care setting. In this commentary, we share the implementation perspectives and experiences of the researchers and healthcare workers involved in this home care phase. It was mainly expressed that there were challenges with nurses feeling involved, supporting the research program, and using the technology, while patients and family caregivers had challenges using the app and cooperating with staff. We describe our lessons learned from these experiences and future changes to be enacted. A detailed report of this trial will be made available in future publications.

Purpose: Patients with breast cancer (BC) face complex medical information and decisions. The Outcomes4Me mobile app provides evidence-based BC education, symptom management tracking and clinical trial matching. This study sought to evaluate the feasibility of introducing this app into routine BC care. Methods: In this pilot study among BC patients undergoing therapy at an academic cancer center, patients were followed for 12 weeks with survey administration and electronic health record (EHR) abstraction at baseline and completion. Feasibility was defined as 40% of patients engaging with the app 3 or more times during the study. Additional endpoints included app usability (system usability scale), patient care experience, symptom evaluation, and clinical trial matching. Results: The study enrolled 107 patients from 6/01/2020 to 3/31/2021. Utilization of the app was deemed feasible with 60% of patients engaging with the app at least 3 times. SUS score of 70 indicated above average usability. New diagnosis and higher education level was associated with greater app engagement, with usability similar across all age groups. 41% of patients found the app helped track symptoms. Cognitive and sexual symptoms were infrequently reported, but were more frequently captured in the app than in the EHR. After using the app, 33% of patients reported increased interest in clinical trial enrollment. Conclusion: Introducing the Outcomes4Me patient navigation app into routine BC care is feasible and may improve the patient experience. These results support further evaluation of this mobile technology platform to improve BC education, symptom management, and decision making. Clinical trial registry: Clinicaltrials.gov registration #: NCT04262518 [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between daily fluctuations in symptoms and sedentary behavior (SB) during chemotherapy (CT) for breast cancer. Methods: Breast cancer patients (N = 68, Mage = 48.5 ± 10.4 yr) undergoing CT wore an activity monitor on their hip to assess daily SB and completed prompts assessing symptoms (affect, anxiety, depression, fatigue, pain, and physical and cognitive functioning) for 10 consecutive days (3 d pre-CT, day of, and 6 d post-CT) at the beginning, middle and end cycles of CT. Mixed models assessed the bidirectional between-person (BP) and within-person (WP) associations of current day symptoms with minutes of SB measured on 1) the same day and 2) the next day, controlling for relevant covariates. Results: Within person same-day results revealed a significant association between affect, anxiety, fatigue, physical functioning, pain, and cognitive functioning and same-day SB. Worse than average symptom ratings on a given day were associated with more SB that day. There was a significant WP relationship between previous-day anxiety, depression, and physical function and next-day SB (i.e., worse than average symptom ratings the previous day were associated with more SB the next day). Within person same-day results revealed a significant association between same-day SB and affect, anxiety, fatigue, pain, physical functioning, and cognitive functioning. The WP relationships were significant for previous-day SB and next-day affect and pain (i.e., higher than average SB associated with lower ratings). Relationships persisted when controlling for moderate-to-vigorous physical activity. There were no significant BP results. Conclusions: Higher symptom ratings were associated with increased SB and higher SB was associated with worse symptoms. Future work should identify SB reduction intervention approaches tailoring to daily symptom burden during CT for breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: Patient-reported outcomes are considered the gold standard for documenting treatment-related toxicities and cancer-related symptoms in the management of oncology patients. Poor concordance between patients and health care professionals (HCPs) on patients’ symptoms has been documented. The purpose of this study is to examine the association between social desirability, a response style, and symptom reporting in a colorectal cancer clinic. Methods: Patients being treated for colorectal cancer completed a social desirability measure and a symptom measure before their appointment in the oncology clinic. The HCP who saw the patient completed a symptom measure for the patient after the clinic visit. Results: One hundred sixty-nine patients consented to participate in the study. The majority of the patients had stage 4 disease. There was a statistically significant positive correlation between social desirability and overall reported symptom burden. There was a statistically significant negative correlation between social desirability and concordance between the patient and the HCP on the patient’s symptoms. Social desirability scores were stable over the course of 1 year. Conclusion: Sensitivity to social desirability effects seems to play an important role in patient self-report of symptoms. As social desirability is a stable quality, patients sensitive to it may be persistently at risk for undertreatment of symptoms due to limited symptom reporting. [ABSTRACT FROM AUTHOR]

PurposeThere is limited research regarding the characteristics of those from the general population who seek care following acute concussion.MethodsTo address this gap, a large cohort of 473 adults diagnosed with an acute concussion (female participants = 287; male participants = 186) was followed using objective measures prospectively over 16 weeks beginning at a mean of 5.1 days post-injury.ResultsFalls were the most common mechanism of injury (MOI) (n = 137, 29.0%), followed by sports-related recreation (n = 119, 25.2%). Male participants were more likely to be injured playing recreational sports or in a violence-related incident; female participants were more likely to be injured by falling. Post-traumatic amnesia (PTA) was reported by 80 participants (16.9 %), and loss of consciousness (LOC) was reported by 110 (23.3%). In total, 54 participants (11.4%) reported both PTA and LOC. Male participants had significantly higher rates of PTA and LOC after their injury compared to their female counterparts. Higher initial symptom burden was associated with a longer duration of recovery for both male and female participants. Female participants had more symptoms and higher severity of symptoms at presentation compared to male participants. Female participants were identified to have a longer recovery duration, with a mean survival time of 6.50 weeks compared to 5.45 weeks in male participants (p < 0.0001). A relatively high proportion of female and male participants in this study reported premorbid diagnoses of depression and anxiety compared to general population characteristics.ConclusionAlthough premorbid diagnoses of depression and/or anxiety were associated with higher symptom burden at the initial visit, the duration of symptoms was not directly associated with a pre-injury history of psychological/psychiatric disturbance. This cohort of adults, from the general population, seeking care for their acute concussion attained clinical and functional recovery over a period of 4–12 weeks.

Symptom reports correspond less to physiological dysfunction in persons with high levels of symptoms in daily life and in patients with functional somatic symptoms, suggesting poor symptom perception. In this study, we investigated whether interoception was impacted by the meaning of the context and by habitual symptom reporting. Eight inspiratory resistances that were equidistant in intensity were administered to healthy women (N = 124) varying in habitual symptom reporting. One group was asked to categorise them as benign sensations vs. as bodily symptoms that could suggest a disease (disease context group). Another group was asked to categorise them as low- vs. high-intensity sensations (neutral context group). Perceived differences in intensity within- vs. between-category and unpleasantness, categorisation threshold, and the reliability of categorising each stimulus were examined in relation to context (disease, neutral) and symptom reporting levels in daily life. Context (neutral vs. disease) impacted intensity and unpleasantness perception. Processing of respiratory interoceptive stimulation was more detailed, elaborate, and cautious when categorising stimuli as signalling health or disease vs. as low- or high-intensity. Individual differences in habitual symptoms had no effect. The pattern of results suggests that these categorisation effects indicate flexible, context-sensitive interoceptive processing, which may characterise healthy individuals. [ABSTRACT FROM AUTHOR]

AbstractObjective To explore associations between general practice patients’ SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors.Design A cross-sectional study. Data were collected from GP and patient questionnaires.Setting General practices in Southeast Norway.Subjects 47 general practitioners (GPs) who included 866 consecutive patients.Main outcome measures SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses.Results Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH.Conclusion The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.

The majority of Canadians agree they have the right to end-of-life care in their own homes. While a palliative approach to care in the home setting has been demonstrated to be beneficial for patients and the healthcare system, it has rarely been well-integrated through an eHealth approach. Thus, in 2018, we piloted the RELIEF app, a digital symptom self-reporting tool for patients with palliative care needs. This was followed by the initiation of an extension phase of RELIEF in the home care setting. In this commentary, we share the implementation perspectives and experiences of the researchers and healthcare workers involved in this home care phase. It was mainly expressed that there were challenges with nurses feeling involved, supporting the research program, and using the technology, while patients and family caregivers had challenges using the app and cooperating with staff. We describe our lessons learned from these experiences and future changes to be enacted. A detailed report of this trial will be made available in future publications. [ABSTRACT FROM AUTHOR]

The lack of timely symptom reporting remains a barrier to effective symptom management and comfort for patients with cancer-related palliative care needs. Poor symptom management at home can lead to unwanted outcomes, such as emergency department visits and death in hospital. We developed and evaluated RELIEF, a remote symptom self-reporting app for community patients with palliative care needs. A pilot feasibility study was conducted at a large, community hospital in Ontario, Canada. Patients self-reported their symptoms each morning using validated clinical symptom measures and RELIEF would alert for worsening or severe symptoms. RELIEF alerts were monitored by palliative care nurses who would then contact patients to determine if appropriate clinical intervention could be initiated to avoid unnecessary emergency department visits. A total of 20 patients were recruited to use RELIEF for two months. Patients completed 80% of daily self-report assessments; 133 alerts were trigged, half of which required clinical intervention. No patient visited the emergency department for symptom management during the study. Clinical staff estimated five emergency department visits were avoided because of RELIEF—saving an estimated cost of over CAD 60,000. RELIEF is a feasible and acceptable method for the remote monitoring of patients with palliative care needs through regular symptom self-reporting.

To determine if: 1) personality factors associated with health risk behaviors and 2) social determinants of health (SDOHs) associated with less privilege are associated with: 1) greater likelihood of diagnosed SRC, 2) less honesty and comfortability in symptom reporting, and 3) faster return-to-play (RTP) in adolescent athletes. Retrospective, cross-sectional, survey study. Participants completed an online survey following recruitment from medical clinics, high school sports camps, Twitter, or a university subject pool. Adolescent participants played a high school sport in the past year, denied history of moderate to severe traumatic brain injury, and either endorsed or denied diagnosed SRC in the past year (N = 317; Mage = 17.8, SD = 0.97, female = 55.0%, White race = 81.4%). N/A. All outcome measures were assessed via online survey. - Days to RTP following diagnosed SRC - evaluated using survival analysis. - Medically diagnosed SRC incidence; honesty and comfortability in symptom reporting - evaluated using logistic regression. - Higher socioeconomic status (SES; HR=1.126, CI=[1.017-1.247], p=.023) and female sex (HR=1.470, CI=[1.016-2.126], p=.041) were significantly associated with earlier RTP. - Lower conscientiousness (OR=0.823, CI=[0.704-0.961], p=.014), higher agreeableness (OR=1.220, CI=[1.047-1.423], p=.011), female sex (OR=0.509, CI=[0.271-0.954], p=.035), lower SES (OR=0.806, CI=[0.677-0.960], p=.016), and increased pressure to continue to playing while symptomatic ("pressure"; OR=1.271, CI=[1.030-1.569], p=.025) were significantly associated with an increased odd of sustaining SRC. - Higher openness to experience (OR=1.448, CI=[1.027-2.041], p=.035), lower impulsivity (OR=0.891, CI=[0.803-0.989], p=.031), female sex (OR=2.610, CI=[1.110-6.136], p=.028), and lower pressure (OR=1.319, CI=[1.012-1.720], p=.041) were positively associated with greater comfort and more honesty in symptom reporting. Personality and SDOHs have differential and meaningful associations with RTP, SRC incidence, and symptom reporting in adolescent athletes. These findings could be used to inform and tailor SRC prevention and intervention efforts for specific groups. Future work should continue to investigate symptom reporting – especially if influenced by personality and SDOHs factors – as an intervention target to reduce SRC risk. None. [ABSTRACT FROM AUTHOR]

Objective To describe self-reported symptoms among patients in general practice and to explore the relationships between symptoms experienced by patients and diagnoses given by general practitioners. Design Doctor–patient questionnaires focusing on patients’ self-reported symptoms during the past 7 days and the doctors’ diagnoses. Setting General practices in urban and suburban areas in Southeast Norway. Subjects Forty-seven general practitioners who included 866 patients aged ≥18 years on a random day in practice. Results The most frequently reported symptoms were tiredness (46%), lower back pain (43%), neck pain (41%), headache (39%), shoulder pain (36%), and sleep problems (35%). Women had a significantly higher prevalence than men for 16 of 38 symptoms (p

This study examined the association between past concussions and current preseason symptom reporting and cognitive performance in 9,257 youth ages 11–13. Participants completed neurocognitive testing prior to participating in a school sports between 2009 and 2019. We stratified the sample by gender and number of prior concussions and assessed group differences on the Post-Concussion Symptom Scale total score and the ImPACT cognitive composite scores. Those with≥2 prior concussions reported more symptoms than those with 0 concussions (d=0.43–0.46). Multiple regressions examining the contribution of concussion history and developmental/health history to symptom reporting showed the most significant predictors of symptoms scores were (in descending order): treatment for a psychiatric condition, treatment for headaches, history of learning disability (in boys only), history of attention-deficit/hyperactivity disorder, and age. Concussion history was the weakest statistically significant predictor in boys and not significant in girls. Cognitively, boys with 1 prior concussion had worse speed those with 0 concussions (d=0.11), and girls with≥2 prior concussions had worse verbal/visual memory than girls with 0 concussions (ds=0.38–0.39). In summary, youth with≥2 prior concussions reported more symptoms than those with no concussions. Boys with multiple concussions performed similarly on cognitive testing, while girls had worse memory scores. [ABSTRACT FROM AUTHOR]

To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors. A cross-sectional study. Data were collected from GP and patient questionnaires. General practices in Southeast Norway. 47 general practitioners (GPs) who included 866 consecutive patients. SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses. Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH. The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice. There is a high prevalence of poor SRH in general practice patients. The likelihood of reporting poor SRH is partly independent of the diagnosis given. The number of symptoms was the factor strongest associated with poor SRH. [ABSTRACT FROM AUTHOR]

To examine sense of smell as a biomarker for both severity and duration of post-concussion symptoms. Participants were recruited prospectively from an outpatient concussion clinic. Sense of smell was assessed using the University of Pennsylvania Smell Identification Test (UPSIT) within 7 days, and 4, 8 – or 16-weeks post-injury. UPSIT normative data were used as normal controls. The main outcomes were: symptom severity on the Sport Concussion Assessment Tool 3 (SCAT3) symptom inventory and time to physician-declared recovery. A total of 167 participants (mean age 32.9 [SD, 12.2] years, 59% female [n = 99]) were classified at 1 week post injury as follows: severe hyposmia in 5 (3%), moderate hyposmia in 10 (6%), mild hyposmia in 48 (29%), and normosmia in 104 (62%) individuals. A convenience sample of 81 individuals with concussion were tested at follow-up. Acute impairment of sense of smell following concussion was not associated with symptom severity on the SCAT3 or time to recovery. Sense of smell was stable from baseline to follow-up in this population. This study provides evidence that routine testing of sense of smell in individuals with concussion is not warranted as a biomarker for severity of concussion and concussion recovery. [ABSTRACT FROM AUTHOR]

Objective: Mild traumatic brain injury (mTBI) symptoms are typically assessed via questionnaires in research, yet questionnaires may be more prone to biases than direct clinical interviews. We compared mTBI symptoms reported on two widely used self-report inventories and the novel Structured Interview of TBI Symptoms (SITS). Second, we explored the association between acquiescence response bias and symptom reporting across modes of assessment. Method: Level 1 trauma center patients with mTBI (N = 73) were recruited within 2 weeks of injury, assessed at 3 months post-TBI, and produced nonacquiescent profiles. Assessments collected included the SITS (comprising open-ended and closed-ended questions), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Sport Concussion Assessment Tool-3 (SCAT-3) symptom checklist, and Minnesota Multiphasic Personality Inventory-2 Restructured Form True Response Inconsistency (TRIN-r) scale. Results: Current mTBI symptom burden and individual symptom endorsement were highly concordant between SITS closed-ended questions, the RPQ, and the SCAT-3. Within the SITS, participants reported significantly fewer mTBI symptoms to open-ended as compared to later closed-ended questions, and this difference was weakly correlated with TRIN-r. Symptom scales were weakly associated with TRIN-r. Conclusions: mTBI symptom reporting varies primarily by whether questioning is open- vs. closed-ended but not by mode of assessment (interview, questionnaire). Acquiescence response bias appears to play a measurable but small role in mTBI symptom reporting overall and the degree to which participants report more symptoms to closed- than open-ended questioning. These findings have important implications for mTBI research and support the validity of widely used TBI symptom inventories. [ABSTRACT FROM AUTHOR]

The lack of timely symptom reporting remains a barrier to effective symptom management and comfort for patients with cancer-related palliative care needs. Poor symptom management at home can lead to unwanted outcomes, such as emergency department visits and death in hospital. We developed and evaluated RELIEF, a remote symptom self-reporting app for community patients with palliative care needs. A pilot feasibility study was conducted at a large, community hospital in Ontario, Canada. Patients self-reported their symptoms each morning using validated clinical symptom measures and RELIEF would alert for worsening or severe symptoms. RELIEF alerts were monitored by palliative care nurses who would then contact patients to determine if appropriate clinical intervention could be initiated to avoid unnecessary emergency department visits. A total of 20 patients were recruited to use RELIEF for two months. Patients completed 80% of daily self-report assessments; 133 alerts were trigged, half of which required clinical intervention. No patient visited the emergency department for symptom management during the study. Clinical staff estimated five emergency department visits were avoided because of RELIEF--saving an estimated cost of over CAD 60,000. RELIEF is a feasible and acceptable method for the remote monitoring of patients with palliative care needs through regular symptom self-reporting. [ABSTRACT FROM AUTHOR]

Research suggests coaches play a central role in establishing a context conducive to concussion reporting, particularly via direct verbal communication about concussion. Informed by qualitative interviews and stakeholder feedback, we developed a web-based concussion education platform for collegiate coaches (GoHuddle). The goal of GoHuddle is to encourage concussion safety-supportive coach communication using behavioral modeling and experiential learning. We then conducted a pre-post survey study to examine the impact of engaging with the platform on coach concussion communication, with outcomes of: (a) expected likelihood of communicating with athletes about concussive symptom reporting; (b) expected likelihood of pressuring medical staff to return athletes to play; and (c) belief in the usefulness of engaging in the communication described in a and b (i.e., response efficacy). We also assessed feasibility and acceptability of the platform in the collegiate sport context. The platform was sent to 435 coaches at five institutions, and 334 (77%) completed surveys (70% male, 37.8 years mean age). After completing GoHuddle, coaches had 2.5 greater odds of expecting to discuss concussion with their team (odds ratio [OR] 2.53, p < 0.001). Response efficacy for talking about concussion also increased significantly post-intervention (OR 3.78, p < 0.001). No significant change was seen in expectancies regarding pressure on medical staff to return athletes to play "as soon as possible." A high proportion (82%) of coaches would recommend this platform for coach concussion education. In conclusion, this study suggests GoHuddle is a feasible and acceptable approach to coach concussion education, and use of this platform holds promise for shifting coach communication about concussion. [ABSTRACT FROM AUTHOR]

Little is known whether parent's indoor environment quality (IEQ)‐related symptoms or health perceptions influence the risk of self‐ or parent‐reported symptoms in their children. We assessed (i) the association of parents' IEQ‐related symptoms with IEQ‐related symptoms in their children at school and (ii) whether parental IEQ‐related health worry increases the risk for children's symptoms. We used two Finnish studies: a national, population‐based survey of indoor air and related health problems (n = 611 parents) and a subset of survey for all primary school pupils (grade 3–6) and their parents in Helsinki, which also included school IEQ‐related symptoms reported by children (n = 1617 parent‐child dyads). In the school survey, parent's own symptoms increased strongly their reporting of their children's symptoms at school (aOR 4.0, 95% CI 2.7–6.0 for parents experiencing a lot of symptoms) and also symptoms reported by the child itself (aOR 2.2, 95% CI 1.5–3.1). Similar, but slightly weaker associations were seen with parental IEQ‐related health worries. Results remained unchanged when adjusted for the IEQ of school buildings or parental and children's allergic diseases. Similar associations were seen in the national survey between parent's symptoms at work and child's symptoms at school. The results suggest that parents' health perceptions may increase the reporting of children's IEQ‐related symptoms even more than is typically seen for many indoor air contaminants. [ABSTRACT FROM AUTHOR]

Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. [ABSTRACT FROM AUTHOR]

Abstract Background The associations between indoor environmental quality (IEQ) in homes and symptom reporting of children have been extensively studied, but only few large-scale studies have been done in schools. We examined associations between expert-assessed IEQ in schools and pupils’ reporting of different symptoms, and whether associations were stronger if participants relate symptoms to the school environment. Methods The questionnaire survey was done in all primary and secondary schools in two areas of Helsinki, Finland. Primary school pupils (grade 3–6, n = 8775, 99 school-buildings) and secondary school pupils (grade 7–9, n = 3410, 30 school-buildings) reported their symptoms. Symptoms were combined into respiratory, lower respiratory, eye, skin, and general symptom groups. Surveys were also done among the parents of the primary school pupils (grade 1–6, n = 3540, 88 school buildings), but results are reported only in the supplement due to the low response rate (20% in 2017 and 13% in 2018). The associations between IEQ and symptoms were analyzed using multilevel logistic regression analysis. Results Several of the IEQ indicators were highly correlated and indicators were therefore mainly analyzed by combining them into a summary score and into latent classes. Dose-response associations were found between IEQ problems and higher reporting of respiratory and general symptoms among both primary and secondary school pupils. Some associations were also observed with lower respiratory and skin symptoms, but not with eye symptoms. The associations were somewhat stronger with symptoms related to the school environment compared to symptoms reported without such relation: for a unit change in IEQ summary score and respiratory symptoms in primary schools, odds ratios were 1.07 (95% CI 1.02–1.06) and 1.04 (95% CI 1.04–1.10), and in secondary schools 1.09 (95% CI 1.01–1.09) and 1.05 (95% CI 1.02–1.17), respectively. Conclusions Expert-assessed IEQ problems in schools were associated with increased reporting of especially respiratory and general symptoms. The associations were only somewhat stronger in magnitude for symptoms reported in relation to the school environment compared to symptoms reported without such relation.

To describe self-reported symptoms among patients in general practice and to explore the relationships between symptoms experienced by patients and diagnoses given by general practitioners. Doctor–patient questionnaires focusing on patients' self-reported symptoms during the past 7 days and the doctors' diagnoses. General practices in urban and suburban areas in Southeast Norway. Forty-seven general practitioners who included 866 patients aged ≥18 years on a random day in practice. The most frequently reported symptoms were tiredness (46%), lower back pain (43%), neck pain (41%), headache (39%), shoulder pain (36%), and sleep problems (35%). Women had a significantly higher prevalence than men for 16 of 38 symptoms (p < 0.05). The mean number of symptoms was 7.5 (range, 0–32; women, 8.1; men, 6.5, p < 0.05). Regression analysis showed that patients who received a social security grant had 59% more symptoms than those who were employed and that people with asthenia and depression/anxiety had 44% and 23% more symptoms, respectively than those with all other diagnoses. The patterns of symptoms reported showed similar patterns across the five most prevalent diagnoses. Patients in general practice report a number of symptoms and share a common pattern of symptoms, which appear to be partly independent of the diagnoses given. These findings suggest that symptoms are not necessarily an indication of disease. Patients consulting general practitioners have a high number of self-reported symptoms. The most frequent symptoms are tiredness, lower back pain, neck pain, headache, shoulder pain, and sleep problems. Patients diagnosed with asthenia and depression/anxiety report the highest number of symptoms. Selected diagnoses show similar patterns in symptom distribution. Symptoms are not necessarily an indication of disease. [ABSTRACT FROM AUTHOR]

Background: Cleaning tasks pose risks of hazardous chemical exposure and adverse health effects for cleaning workers. We examined gender differences among cleaning staff in the experience of chemical‐related symptoms and in reporting to supervisors. Methods: We analyzed cross‐sectional reports from 171 university hospital or campus cleaning staff on chemical exposures to cleaning products, experience of acute symptoms, reporting of symptoms to supervisors, as well as demographic and psychosocial factors (risk perception, job demand/control, supervisor/co‐worker support, and safety climate). Results were analized using multivariable logistic regression, adjusting for demographic, job, and psychosocial factors. Interactions of gender and psychosocial variables were also examined. Results: Men and women reported different frequencies for exposure‐related tasks. Acute symptoms of chemical exposure were more prevalent in women compared with men (46.0% vs. 25.4%; adjusted odds ratio [OR] = 2.63; 95% confidence interval [CI] 1.27–5.46). Women were more concerned about exposure to cleaning chemicals (p = 0.029) but reported symptoms to their supervisor less often than men (18.5% vs. 40.6%, adjusted OR = 0.28; 95% CI 0.09–0.93). More supervisor support was significantly associated with less frequent symptom experience among women (OR = 0.83; 95% CI 0.70–0.99). Asian workers and less educated workers were less likely than others to report symptoms to supervisors. Gender differences in symptom reporting to supervisors were not explained by psychosocial factors. Conclusions: Women may have increased susceptibility or perception of symptoms from cleaning compared to men, but this may be mitigated by supervisor support. Female Asian workers with lower education may perceive more significant barriers in reporting work‐related symptoms to supervisors. Further research is needed to explore factors related to underreporting. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. Cross-sectional survey. Data were collected using an online survey instrument. Three hundred and nine adult combat sport athletes. Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. A history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of 'high' total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting 'high' total symptoms and symptoms severity scores. Athletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion. • Although concussion is prevalent in combat sports, athletes appear to not seek medical attention. • Many combat sport athletes return to contact after 2 days following a concussion. • Combat sport athletes with a history of concussion report higher concussion-related symptoms. • Athletes with a history of concussion and a history of neck injury have greater odds of presenting with high symptom scores. [ABSTRACT FROM AUTHOR]

Background: Blast exposure is a potential hazard in modern military operations and training, especially for some military occupations. Helmets, peripheral armor, hearing protection, and eye protection worn by military personnel provide some acute protection from blast effects but may not fully protect personnel against cumulative effects of repeated blast overpressure waves experienced over a career. The current study aimed to characterize the long-term outcomes of repeated exposure to primary blast overpressure in experienced career operators with an emphasis on the assessment of hearing and vestibular outcomes.Methods: Participants included experienced “breachers” (military and law enforcement explosives professionals who gain entry into structures through controlled detonation of charges) and similarly aged and experienced “non-breachers” (non-breaching military and law enforcement personnel). Responses to a clinical interview and performance on audiological and vestibular testing were compared.Results: Hearing loss, ringing in the ears, irritability, and sensitivity to light or noise were more common among breachers than non-breachers. Breachers reported more combat exposure than non-breachers, and subsequently, memory loss and difficulty concentrating were associated with both breaching and combat exposure. Vestibular and ocular motor outcomes were not different between breachers and non-breachers.Conclusion: Hearing-related, irritability, and sensitivity outcomes are associated with a career in breaching. Future studies examining long-term effects of blast exposure should take measures to control for combat exposure.

Objective: Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concern noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire.Methods: Study 1: A total of 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). Thirty-two individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26).Results: HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing.Conclusion: HSR, SFD, and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs.

Background: Blast exposure is a potential hazard in modern military operations and training, especially for some military occupations. Helmets, peripheral armor, hearing protection, and eye protection worn by military personnel provide some acute protection from blast effects but may not fully protect personnel against cumulative effects of repeated blast overpressure waves experienced over a career. The current study aimed to characterize the long-term outcomes of repeated exposure to primary blast overpressure in experienced career operators with an emphasis on the assessment of hearing and vestibular outcomes. Methods: Participants included experienced "breachers" (military and law enforcement explosives professionals who gain entry into structures through controlled detonation of charges) and similarly aged and experienced "non-breachers" (non-breaching military and law enforcement personnel). Responses to a clinical interview and performance on audiological and vestibular testing were compared. Results: Hearing loss, ringing in the ears, irritability, and sensitivity to light or noise were more common among breachers than non-breachers. Breachers reported more combat exposure than non-breachers, and subsequently, memory loss and difficulty concentrating were associated with both breaching and combat exposure. Vestibular and ocular motor outcomes were not different between breachers and non-breachers. Conclusion: Hearing-related, irritability, and sensitivity outcomes are associated with a career in breaching. Future studies examining long-term effects of blast exposure should take measures to control for combat exposure. [ABSTRACT FROM AUTHOR]

The health care needs and service experiences of higher education students require more research attention, given the increase in students who have a long-term illness, medical condition, or disability ("condition"). It is also important to consider the experiences of rising numbers of international students. This exploratory qualitative study used face-to-face interviews and the common-sense model of self-regulation to investigate students' perceptions and coping behaviours, in a higher education institution in the UK. Thematic analysis was used to analyse the data. Twenty students who self-identified as having a condition were interviewed. This study adds depth to the understanding of the connections between students' health-related experiences and their personal, academic, and post-graduation aspirations and the support needs of students, including international students. To optimise institutional support, innovations in partnerships with local care organisations and within the university, staff training about conditions, peer mentorship, and information outreach especially to international students, should be considered. [ABSTRACT FROM AUTHOR]

Objective: The use of health apps is increasing worldwide, with a common feature being daily symptom tracking. However, symptom tracking has been shown to increase symptom reporting. This study investigated whether using a menstrual-monitoring app with a symptom-tracking feature increases symptom reporting compared to an app without this feature or no app at all.Design: Experimental study.Methods: Ninety-one participants were randomly allocated to use either a menstrual-monitoring app with a symptom tracker or a simple calendar app, or to a no app control group. The number of period-related symptoms as well as general symptom reporting was assessed at baseline prior to group allocation and then 1 and 4 months later. The change in the proportion of people classified as high symptom reporters was also examined.Results: We found that the symptom-tracking app group reported significantly more period-related symptoms at 4 months than the calendar app group (mean difference = 1.16 symptoms, p = .010). At the 4-month time point, significantly more participants in the symptom-tracking group were now classified as high period symptom reporters (baseline 50%, 4 months 70%, p = .031), while the other two groups did not change from baseline. There were no differences in general symptom reporting across the three groups.Conclusion: A period-monitoring app with a symptom tracker may increase the reporting of period symptoms. This effect does not appear to generalize to broader symptom reporting. Further research is needed to support these findings and to examine the impact of symptom-tracking apps on daily functioning and health anxiety. Statement of contribution What is already known on this subject? The experience of transient symptoms is common in day-to-day life. These symptoms often do not have an underlying cause or are a sign of illness. Actively tracking symptoms has been shown to result in greater symptom reporting, symptom severity, and slower recovery from injury. The use of health apps is increasing, with a common feature being symptom tracking. Menstrual-monitoring apps, in particular, frequently require users to track symptoms. What does this study add? Using a menstrual-monitoring app with a symptom tracker for 4 months increases the number of period-specific symptoms reported compared a basic calendar app. A greater proportion of people were now classified as high period symptom reporters after using the symptom-tracking app. These effects do not seem to generalize to broader non-specific symptom reporting. [ABSTRACT FROM AUTHOR]

Objective: Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concern noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Methods: Study 1: A total of 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). Thirty-two individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26). Results: HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing. Conclusion: HSR, SFD, and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs. [ABSTRACT FROM AUTHOR]

Purpose/Objective: The purpose of this study was 2-fold: (a) to evaluate whether perception of work ability is associated with employment status in a sample of combat-exposed veterans, and (b) to determine whether the same sets of variables that are associated with employment status are also associated with perception of work ability. Research Method/Design: In this cross-sectional study, veterans (N = 83) underwent a neuropsychological assessment and completed questionnaires assessing demographic characteristics, combat-related experiences, and psychiatric and neurobehavioral/health-related symptoms. Primary outcomes of interest were employment status (unemployed vs. employed) and veterans' perception of whether their ability to work has declined due to an ongoing condition (yes vs. no). Results: A chi-square analysis revealed a significant relationship between perception of work ability and employment status. Additionally, psychiatric and neurobehavioral/health-related symptoms were associated with employment status and perception of work ability, whereas demographic characteristics (i.e., service-connected disability rating) and combat-related experiences (i.e., mTBI history) were only associated with perception of work ability. Objective cognitive functioning was not associated with employment status or perception of work ability. Conclusions/Implications: Although preliminary, results suggest that perception of work ability is an important factor to consider when evaluating employment-related outcomes in veterans. Moreover, results indicate that while there is some overlap among the variables associated with employment status and perception of work ability, additional variables are linked with perception of work ability. Taken together, these findings suggest that perception of one's ability to work and factors that influence it may be particularly important treatment targets in the veteran population. Impact and Implications: This is one of the first studies to examine the relationship between perceptions of work ability and actual employment status in a sample of combat-exposed veterans. Study findings indicate that work perception is related to actual employment status. Furthermore, psychiatric and neurobehavioral/health-related symptoms are associated with both employment status and perception of ability to work, but additional variables are related to perception, including demographic characteristics and combat-related experiences. Our findings suggest that symptom reduction and psychoeducation may lead to improved perception of work ability and, in turn, actual employment. The information from this study may ultimately be used clinically to address objective barriers to working, as well as negative beliefs about one's ability to work. [ABSTRACT FROM AUTHOR]

Background: The associations between indoor environmental quality (IEQ) in homes and symptom reporting of children have been extensively studied, but only few large-scale studies have been done in schools. We examined associations between expert-assessed IEQ in schools and pupils' reporting of different symptoms, and whether associations were stronger if participants relate symptoms to the school environment.Methods: The questionnaire survey was done in all primary and secondary schools in two areas of Helsinki, Finland. Primary school pupils (grade 3-6, n = 8775, 99 school-buildings) and secondary school pupils (grade 7-9, n = 3410, 30 school-buildings) reported their symptoms. Symptoms were combined into respiratory, lower respiratory, eye, skin, and general symptom groups. Surveys were also done among the parents of the primary school pupils (grade 1-6, n = 3540, 88 school buildings), but results are reported only in the supplement due to the low response rate (20% in 2017 and 13% in 2018). The associations between IEQ and symptoms were analyzed using multilevel logistic regression analysis.Results: Several of the IEQ indicators were highly correlated and indicators were therefore mainly analyzed by combining them into a summary score and into latent classes. Dose-response associations were found between IEQ problems and higher reporting of respiratory and general symptoms among both primary and secondary school pupils. Some associations were also observed with lower respiratory and skin symptoms, but not with eye symptoms. The associations were somewhat stronger with symptoms related to the school environment compared to symptoms reported without such relation: for a unit change in IEQ summary score and respiratory symptoms in primary schools, odds ratios were 1.07 (95% CI 1.02-1.06) and 1.04 (95% CI 1.04-1.10), and in secondary schools 1.09 (95% CI 1.01-1.09) and 1.05 (95% CI 1.02-1.17), respectively.Conclusions: Expert-assessed IEQ problems in schools were associated with increased reporting of especially respiratory and general symptoms. The associations were only somewhat stronger in magnitude for symptoms reported in relation to the school environment compared to symptoms reported without such relation. [ABSTRACT FROM AUTHOR]

Primary objective: The impact of noise sensitivity (NS) on the daily functioning of people who have experienced a traumatic brain injury (mTBI) is an understudied area, particularly following mTBI. The primary objective of this cross-sectional study was to investigate clinical markers of NS in a sample of New Zealand adults following mTBI. Research design: Cross-sectional study. Methods and procedures: A community-based sample of 151 adults who had experienced a brain injury in the last two weeks completed assessments estimating cognitive functioning, postconcussion symptoms (including NS), and affective state. Results: Over half the sample (59%) reported some degree of NS. Exploratory statistical analyses indicated that NS was associated with being female, living in a rural area, number of previous brain injuries, cognitive flexibility scores, reaction time, perceptions of recovery, anxiety, and depression. Regression analyses revealed that anxiety was the dominant correlate of NS (B =.120, p <.001, 95% CI [0.069, 1.71]). Conclusions: As the first study to explore the correlates of NS following mild TBI, the findings have important clinical and research implications. The present findings suggest that treatment approaches targeting anxiety may be effective in reducing NS in people who have experienced a brain injury. Moreover, evidence is presented suggesting that NS is unlikely to reflect malingering, and should be treated as a genuine somatic symptom of brain injury. [ABSTRACT FROM AUTHOR]

Purpose: Good communication between patients and healthcare professionals (HCPs) is an important contributor to patient well-being. Few studies have focused on the gaps in communication between patients and HCPs about symptoms. This study examined patients' perspectives on symptom distress, intention to discuss symptoms, and actual symptom discussion in medical oncology visits.Methods: This was a cross-sectional descriptive study. Ninety-four patients provided demographic and clinical information and completed the Memorial Symptom Assessment Scale. Patients also answered questions about their plans for communication-and after the visit, their actual communication-with their medical team about their symptoms.Results: Patients reported many symptoms by questionnaire; however, they did not plan to discuss-nor actually discussed-most of their symptoms with their HCPs. For all symptoms, fewer than 42% of patients with the symptom intended to discuss it (except for lack of energy and pain) and less than 50% actually discussed the symptom. For bothersome symptoms, less than 42% of those with the symptom intended to discuss it (except for lack of energy) and less than 40% actually discussed the symptom. Psychological symptoms were endorsed by 24-41% of patients, depending on the symptom; however, of those endorsing a symptom, most did not discuss it with an HCP.Conclusions: Results of this study support the perception of communication gaps between patients and HCPs about symptoms. Better understanding of these gaps is needed to ensure that patient-centered care is delivered and that patients' symptoms can be appropriately managed in oncology clinics. [ABSTRACT FROM AUTHOR]

We compared two modes of ascertaining symptom information in baseline concussion testing with 754 NCAA Division II collegiate athletes. All athletes reported symptoms in both a face-to-face structured clinical interview using the SCAT3 symptom scale items and the similar symptom self-report scale in the computerized ImPACT test. Males reported significantly more symptoms and with greater severity during the interview compared to the computerized self-report. If males report symptoms according to a different format in posttrauma assessments than baseline, differences may reflect mode of testing and not change due to concussion. [ABSTRACT FROM AUTHOR]

Background Psychosocial research has shown that perceived exposure can influence symptom reporting, regardless of actual exposure. The impact of this phenomenon on the interpretation of results from epidemiological research on environmental determinants of symptoms is unclear. Objective Our aim was to compare associations between modeled exposures, the perceived level of these exposures and reported symptoms (non-specific symptoms, sleep disturbances, and respiratory symptoms) for three different environmental exposures (radiofrequency electromagnetic fields (RF-EMF), noise, and air pollution). These environmental exposures vary in the degree to which they can be sensorially observed. Methods Participant characteristics, perceived exposures, and self-reported health were assessed with a baseline (n = 14,829, 2011/2012) and follow-up (n = 7905, 2015) questionnaire in the Dutch population-based Occupational and Environmental Health Cohort (AMIGO). Environmental exposures were estimated at the home address using spatial models. Cross-sectional and longitudinal regression models were used to examine the associations between modeled and perceived exposures, and reported symptoms. Results The extent to which exposure sources could be observed by participants likely influenced correlations between modeled and perceived exposure as correlations were moderate for air pollution (r Sp  = 0.34) and noise (r Sp  = 0.40), but less so for RF-EMF (r Sp  = 0.11). Perceived exposures were consistently associated with increased symptom scores (respiratory, sleep, non-specific). Modeled exposures, except RF-EMF, were associated with increased symptom scores, but these associations disappeared or strongly diminished when accounted for perceived exposure in the analyses. Discussion Perceived exposure has an important role in symptom reporting. When environmental determinants of symptoms are studied without acknowledging the potential role of both modeled and perceived exposures, there is a risk of bias in health risk assessment. However, the etiological role of exposure perceptions in relation to symptom reporting requires further research. [ABSTRACT FROM AUTHOR]

Psychological accounts of symptom perception put forward that symptom experiences consist of sensoryperceptual and affective-motivational components. This division is also suggested by psychometric studies investigating the latent structure of symptom reporting. To corroborate the view that the general and symptom-specific factors of a bifactor model represent affective and sensory components, respectively, we performed bifactor models applying confirmatory factor analytic approaches to the Patient Health Questionnaire-15 and the Checklist for Symptoms in Daily Life completed by 1053 undergraduate students. Additionally, we explored the association of latent factors with negative affectivity (NA). For both questionnaires, a bifactor model with one general and several symptom-specific factors revealed the best fit to the data. NA yielded large associations with the general factor, but smaller ones with somatic symptomspecific factors in both questionnaires. The observed latent structure supports a distinction between sensoryperceptual and affective-motivational components, and the association between the NA and the general factor confirms the affective tone of the latter. [ABSTRACT FROM AUTHOR]