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BACKGROUND: Depression is an important predictor of post therapy quality of life (QOL) in head and neck (H&N) cancer patients. In addition, depression rates may vary among cultures. OBJECTIVE: As part of a larger cross cultural study on post therapy QOL differences in H&N cancer patients, the goal of this project was to translate a well-validated English language depression scale into Swahili, and then validate this scale in Kenyan H&N cancer patients. METHODS, SETTINGS AND SUBJECTS: In Part 1 of the study, we translated the Patient Health Questionnaire-9 (PHQ-9) into Swahili, adhering to established International Quality of Life Association (IQOLA) guidelines. In Part 2, we psychometrically validated the newly translated scale using a prospective study of 48 patients at the Kenyatta National Hospital ENT clinic in Nairobi, Kenya. RESULTS: The Swahili PHQ-9 had good test retest reliability (Intraclass correlation coefficient, 0.71) and internal consistency (Cronbach's alpha = 0.80). It also had good construct validity, as scores correlated strongly with TNM stage (Chi square = 123, p < 0.05), and with the compositeand global scores of an H&N cancer specific QOL scale (UW-QOL, r = -0.87, p < 0.05). CONCLUSION: The Swahili version of the PHQ-9 is a reliable scale in Kenyan H&N cancer patients, and is a valuable tool in screening for and monitoring of depression as a function of QOL in this population. [ABSTRACT FROM AUTHOR]

Objective: To determine whether psychiatric illness is a risk factor for subsequent traumatic brain injury (TBI).Methods: Case control study in a large staff model health maintenance organisation in western Washington State. Patients with TBI, determined by International classification of diseases, 9th revision, clinical modification (ICD-9-CM) diagnoses, were 1440 health plan members who had TBI diagnosed in 1993 and who had been enrolled in the previous year, during which no TBI was ascertained. Three health plan members were randomly selected as control subjects, matched by age, sex, and reference date. Psychiatric illness in the year before the TBI reference date was determined by using computerised records of ICD-9-CM diagnoses, psychiatric medication prescriptions, and utilisation of a psychiatric service.Results: For those with a psychiatric diagnosis in the year before the reference date, the adjusted relative risk for TBI was 1.7 (95% confidence interval (CI) 1.4 to 2.0) compared with those without a psychiatric diagnosis. Patients who had filled a psychiatric medication prescription had an adjusted relative risk for TBI of 1.6 (95% CI 1.2 to 2.1) compared with those who had not filled a psychiatric medication prescription. Patients who had utilised psychiatric services had an adjusted relative risk for TBI of 1.3 (95% CI 1.0 to 1.6) compared with those who had not utilised psychiatric services. The adjusted relative risk for TBI for patients with psychiatric illness determined by any of the three psychiatric indicators was 1.6 (95% CI 1.4 to 1.9) compared with those without any psychiatric indicator.Conclusion: Psychiatric illness appears to be associated with an increased risk for TBI. [ABSTRACT FROM AUTHOR]

As the number of people with cancer increases, so does the number of informal caregivers. These caregivers frequently have multiple unmet needs and experience numerous burdens. Here we explore the crucial roles of these caregivers and categorize their unmet needs into four areas: information, relationship and communication, emotional support, and practical or financial needs. We provide evidence on emerging interventions aimed at supporting caregivers, including patient/caregiver assessments, education, collaborative care, financial assistance, wellness, informational programs, and an integrated caregiver clinic. Finally, we delve into the vital role that patient advocacy groups play in addressing the unmet needs of cancer patients and their caregivers by providing comprehensive support, including education, resources, counseling, guidance, and financial aid. Plain Language Summary As the number of people living with cancer increases, the number of informal caregivers is also increasing. Most often, these caregivers are family members, friends, or spouses of the person with cancer. Caregivers of patients with cancer help with medical tasks and routine chores, like driving, and even personal care, such as bathing. Caregiving can be challenging, emotionally taxing, and time-consuming, all while being unpaid. In this review, we identify four unmet needs of caregivers of patients with cancer and examine how they are being addressed. First, caregivers need cancer care information that is presented in an understandable way. This will help the caregiver and the patient make better decisions about cancer care and treatment. Second, caregivers need better relationships and communication with the patient's clinicians. In addition, caregivers must also navigate, and sometimes mend, challenging relationships with the patients that they care for. Third, caregivers need more emotional support, including the option for counseling and therapy. Fourth, caregivers may need practical and financial support, particularly since the time demands and stress of caregiving can disrupt their ability to earn a living. Although many attempts have been made to address these caregiver needs, gaps still remain. Increasing awareness of information targeting caregivers and patients could reduce their uncertainty and help with decision-making. Even when resources are available, caregivers may not always be aware of or linked to them. Patient advocacy groups play a critical role in connecting caregivers with available resources. They also provide a variety of support services, including education, navigation, and financial assistance. Article highlights Caregivers play a critical role in cancer care Informal caregivers provide unpaid, ongoing care or assistance to a patient with cancer. Caregiver burden & unmet needs Most caregivers of patients with cancer are overburdened. The unmet needs of caregivers can be divided into four categories: informational, relationship/communication, emotional, and practical/financial. Informational There is a need for "objective" and "trusted" medical information and advice about the patient's condition and treatment plan written in plain language. Caregivers may need information to assist patients in decision-making about care and treatment options. Relationship/communication Caregivers often face challenging relationships with the patients they care for, who are often family members and/or they struggle with complex extended family dynamics. There may be barriers that prevent open communication between caregivers and the patient's clinicians. Although telehealth provides benefits to patients and caregivers, there are barriers that prevent access. Emotional Nearly half of caregivers struggle with depression and anxiety. Caregivers are often challenged by mental healthcare needs, which are not covered by the same insurance plans that cover the patient's medical care. Practical/financial Caregiving can often amount to a full-time job. The considerable commitment required to care for a cancer patient can have a significant practical and financial impact, potentially affecting the caregiver's employment and their family/home needs. Evidence on interventions to support caregivers: a work in progress Caregiver assessments during patient medical visits are feasible and beneficial. Programs designed to provide information and education to patients and caregivers reduce uncertainty and assist in decision-making. Collaborative care consisting of a team-based approach with an oncologist, care manager, and mental health professional who collaborate to enhance psychosocial outcomes is effective in reducing depression and improving quality of life for patients and caregivers. Massage and mindfulness training may reduce the physical and emotional stress and suffering of caregivers. An innovative caregiver clinic based in Toronto, Canada, takes an integrated approach and provides psychosocial support to caregivers, much like patients receive. A call to action: how patient advocacy groups can help in the caregiving process Importantly, patient advocacy groups fill many gaps that may not otherwise be addressed by other interventions due to access and availability barriers. They play critical roles in supporting patients and their caregivers by providing resources including education, information, counseling, navigation, and financial assistance. They also engage in policy and legislative advocacy efforts on behalf of patients with cancer and their caregivers. [ABSTRACT FROM AUTHOR]

The two-week Home Base Intensive Clinical Program (ICP) provides treatment to veterans and active duty service members suffering from primary diagnoses of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, or depression. First launched in 2015, this paper provides a programmatic update, including new treatment components implemented since inception, and examines outcomes for all participants who entered the program from September 2015 to July 2024 (n = 2561). The Home Base ICP provides a massed care approach through daily individual Prolonged Exposure, Cognitive Processing Therapy, Unified Protocol, or cognitive rehabilitation, along with groups targeting coping skills. Participants entering the program are provided with core group programming, as well as individualized therapy sessions tailored to their unique needs and symptom presentation. Supplemental dual recovery support is also available for all participants with co-occurring substance use or behavioral addiction concerns. Participants' support people receive education, support, and case management services. Participants have a multidisciplinary team comprising therapists, psychopharmacology providers, case managers, nurses, and wellness providers. Results demonstrate that program participants exhibited statistically significant reductions in PTSD symptoms (Cohen's d = 0.80), depression (d = 0.68), post-concussion symptoms (d = 0.71), and increased satisfaction in social roles (d = -0.65). Completion rate was 94.60% (n = 2422), suggesting that the Home Base ICP is a well-received and effective model of care for veterans and service members. [ABSTRACT FROM AUTHOR]

Background: The mental health of patients with chronic liver disease (CLD) warrants greater attention and understanding, especially concerning its risk factors. Method: Patients from our hospital's hepatology clinic were consecutively enrolled and completed a questionnaire assessing anxiety, depression, and sleep quality using the GAD-7, PHQ-9, and PSQI scales, respectively. Reliability and validity were evaluated with Cronbach's α and Kaiser-Meyer-Olkin (KMO). Continuous and categorical variables were analyzed using the Mann-Whitney U and Chi-square tests. Univariate and multivariate logistic regression were used to identify risk factors, while restricted cubic spline (RCS) were used to explored non-linear associations. Subgroup analyses were stratified by sex, age, and education. Result: A total of 1030 questionnaires were collected, and after quality control, 1003 were included. 56.2% (564/1003), 53.2% (534/1003), and 67.4% (676/1003) individuals had anxiety, depression, and sleep disorders. Differences in age, gender, and education level were observed (P <0.05). Subgroup analysis showed similar demographic trends. Univariate and multivariate regression analysis found age negatively correlated with anxiety (OR=0.98, 95%CI=0.97-0.99, P =0.02) and depression (OR=0.98, 95%CI=0.96-0.99, P <0.001), but positively correlated with sleep disorders (OR=1.03, 95%CI= 1.01-1.05, P < 0.001); males are less prone to anxiety (OR=0.68, 95%CI=0.52-0.88, P =0.004) and sleep disorders (OR=0.72, 95%CI: 0.55-0.94, P =0.02); university degree is more susceptible to depression (OR=1.36, 95%CI=1.04-1.77, P =0.02) and anxiety (OR=1.45, 95%CI=1.11-1.89, P =0.007). RCS analysis suggested a linear relationship between the age and affective disorders among different population. Conclusion: Young individuals, female, and those with higher education are more vulnerable to mental health, warranting increased attention. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic Brain Injury (TBI) is any injury to the brain resulting from an external force leading to complications. TBI affects 27–69 million people yearly, with high incidence in low- and middle-income countries (LMICs), mainly attributed to motor traffic accidents. Within three to six months following moderate-to-severe TBI, the relative risk of any psychiatric disorder is significantly higher than in the general population. Post-TBI neuropsychiatric disorders include depression with a prevalence of up to 53%, apathy up to 72%, Posttraumatic stress disorder (26%), anxiety (9%), manic symptoms (5–9%) and psychosis (3 to 8%). This study aims to determine the incidence and predictors of post-TBI neuropsychiatric manifestations among patients admitted at Referral hospitals in Dodoma. Methods and analysis: This is a prospective longitudinal observational study in which patients admitted with moderate to severe TBI will be recruited. Patients will be followed for six months, the diagnostic MINI International Neuropsychiatric Interview (MINI) tool will be used to assess TBI, and the severity and progression of symptoms will be evaluated using PHQ-9 for depressive symptoms, GAD-7 for anxiety symptoms, PCL-5 for Posttraumatic Stress Disorders (PTSD), MoCA for cognitive assessment, AES for apathy and YMRS for manic symptoms at one, three and six months. Logistic regression will be analysed to determine the association between predictors and neuropsychiatric outcomes. Conclusion: Given the dearth of understanding of the burden of neuropsychiatric complications and associated outcomes in sub-Saharan Africa, the study will shed light on the incidence and factors contributing to post-TBI neuropsychiatric complications and, thus, provide a platform for further research and design of necessary interventional programs for the population at risk. [ABSTRACT FROM AUTHOR]

Background: Worldwide, mild traumatic brain injury, synonymous with concussion, affects more than 30–50 million each year. The incidence of concussion in Denmark is estimated to be about 20,000 yearly. Although complete resolution normally occurs within a few weeks, up to a third develop persistent post-concussion symptoms (PPCS) beyond 3 months. Evidence for effective treatment strategies is scarce. The objective of this study is to evaluate the efficacy of the novel intervention GAIN Lite added to enhanced usual care (EUC) for adults with mild-to-moderate PPCS compared to EUC only. Methods: An open-label, parallel-group, two-arm randomised controlled superiority trial (RCT) with 1:1 allocation ratio. Potential participants will be identified through the hospital's Business Intelligence portal of the Central Denmark Region or referred by general practitioners within 2–4 months post-concussion. Participants with mild-to-moderate PPCS will be randomly assigned to either (1) EUC or (2) GAIN Lite added to EUC. GAIN Lite is characterised as a complex intervention and has been developed, feasibility-tested and process evaluated before effect evaluation in the RCT. GAIN Lite contains an initial remote interview, self-administrated e-learning videos and voluntary remote counselling with an allocated occupational- or physiotherapist. Sixty-six participants will be recruited to each group. Primary outcomes are mean changes in PPCS and limitations in daily life from baseline to 24 weeks after baseline. Discussion: GAIN Lite is a low-intensity intervention for adults with mild-to-moderate PPCS. Offering a remote intervention may improve access to rehabilitation and prevent chronification for individuals with mild-to-moderate PPCS. Moreover, GAIN Lite will facilitate access to healthcare, especially for those with transportation barriers. Overall, GAIN Lite may provide an accessible, flexible and convenient way to receive treatment based on sound theories and previous evidence of effective interventions for adults with mild-to-moderate PPCS. Trial registration: ClinicalTrials.gov NCT05233475. Registered on February 10, 2022. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric disorders are highly disabling in traumatic brain injury (TBI) patients, and psychopharmacological treatments often fail to adequately mitigate their detrimental effects. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment in neurology and psychiatry, showing potential in treating psychiatric disorders. Objective: This study investigates the efficacy of a novel, dual-site sequential rTMS protocol designed to treat neuropsychiatric symptoms in a TBI patient who was refractory to conventional treatments. Methods: A 34-year-old woman with severe head trauma and complex psychopathology underwent 20 daily sessions of focal-coil rTMS, combining inhibitory stimulation (1 Hz) on the right dorsolateral prefrontal cortex (DLPFC) and excitatory (10 Hz) on the left DLPFC, guided by a neuronavigation system. Psychiatric and neurocognitive assessments were conducted at baseline and at 2, 4, and 8 weeks following the beginning of rTMS treatment. Results: After 2 weeks of treatment, the patient showed decreased impulsivity and obsessive-compulsive symptoms, along with improvements in attention and processing speed. After 4 weeks, impulsivity further declined, though no other significant changes were noted. At 8 weeks, a persistent positive effect was observed, including enhanced positive emotions. Discussion: These findings suggest that guided, alternating neurostimulation of the DLPFC may modulate activity within cortico-striato-thalamo-cortical circuits, providing a promising alternative for managing neuropsychiatric symptoms in TBI patients who are resistant to traditional treatments. [ABSTRACT FROM AUTHOR]

Objective: Generalized Anxiety Disorder is an international mental health problem. Prevalence for anxiety disorders reported in perinatal period is high and related with adverse parental and child outcomes. Thus, the objective of this study was to investigate the psychometric properties and factorial validity of General Anxiety Disorder-7 questionnaire (GAD-7) in the context of postpartum mothers. Methods: In this cross-sectional study, 278 mothers (mean age 31.09; SD = 4.42) were recruited at the Neonatology, Gynecology, and Obstetrics Ward. Generalized Anxiety Disorder was assessed with GAD-7, stress with Parental Stress Scale (PSS), while risk of depression with Edinburgh Postpartum Depression Scale (EPDS). Confirmatory factor analysis (CFA) was used to verify factor structure of GAD-7 and the internal consistency was evaluated using reliability coefficients: Cronbach's Alpha and McDonald's Omega. Results: The internal consistency of the GAD-7 was high (Cronbach's Alpha = 0.90 and MacDonald's Omega = 0.91). GAD-7 had significant correlations with the variables examined for construct validity, stress (PSS; r = 0.35, p < 0.01) and risk of depression (EPDS; r = 0.76, p < 0.01). The Confirmatory Factor Analysis results supported a good fit of the data to the model: χ²(df) = 14.19 (14), p = 0.44; Comparative Fit Index (CFI) = 0.99; Tucker-Lewis Index (TLI) = 0.99; Root Mean Square Error of Approximation (RMSEA) = 0.007 (90% C.I. 0.000; 0.059). Conclusion: GAD-7 has satisfactory psychometric properties. GAD-7 had significant correlations with the variables examined for construct validity with PSS and EPDS. GAD-7 is a reliable instrument for screening anxiety symptoms in perinatal period in research and clinical setting. [ABSTRACT FROM AUTHOR]

Background: Depression and suicidal tendencies are notably prevalent among adolescents, yet few studies have revealed the impact of social status on them. This study aimed to explore the mediating and moderating effects of anxiety and psychological resilience on family status, school status, depression, and suicidal ideation. Methods: A total of 1,190 secondary school students aged 13 to 17 years (mean age: 13.57 ± 2.02 years) were evaluated depression, anxiety, and suicidal ideation using the PHQ-8 and GAD-7 questionnaires. Subjective family and school status were also assessed. Data analysis was conducted using Mplus, SPSS's Process, and the RSA 3.0 plugin. Results: Subjective family/school status, anxiety, psychological resilience, depression, and suicidal ideation were significantly correlated. Anxiety played a partial mediating role in the influence of subjective family status and subjective school on depression and suicidal ideation, and psychological resilience moderated the impact of anxiety on adolescent depression and suicidal ideation (βdepression = −0.05, p < 0.01; βsuicidal ideation = −0.06, p < 0.05). Conclusions: Subjective family status and school status played important roles in depression and suicidal ideation in adolescents, and anxiety and psychological resilience played mediating and moderating roles. [ABSTRACT FROM AUTHOR]

Purpose: A "Smart Cancer Care" platform that integrates patient-reported outcomes (PROs) with management has been established in Korea. This study focused on improving health behaviors and connecting patients to welfare services by introducing and assessing the feasibility of "Smart Cancer Care 2.0," an enhanced version designed for monitoring complications post-cancer treatment. Materials and Methods: Smart Cancer Care 2.0 was developed by conducting a literature review and consulting with expert panels to identify symptoms or variables requiring monitoring and management guidelines based on the treatment type. Qualitative and quantitative surveys were conducted to assess the feasibility of the app and web system based on the experiences of patients with cancer and healthcare workers. Results: A total of 81 symptoms or variables (chemotherapy-, surgery-, radiotherapy-, rehabilitation-, and health management-related) were selected for management in Smart Cancer Care 2.0. PROs for these symptoms were basically categorized into three severity grades: preventive management, self-treatment, and consultation with a healthcare worker or visit to a healthcare institution. The overall mean scores in the feasibility evaluation by patients and healthcare workers were 3.83 and 3.90 points, respectively, indicating high usefulness. Conclusion: Smart Cancer Care 2.0 leverages the existing information and communication technologies–based platform, Smart Cancer Care, and further includes health behaviors and welfare services. Smart Cancer Care 2.0 may play a crucial role in establishing a comprehensive post-discharge management system for patients with cancer as it provides suitable interventions based on patients' responses and allows the regularly collected PROs to be easily viewed for streamlined care. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews and meta-analyses reveal the importance of an accepting attitude towards cancer for mental health and functional coping. The aim of this study was to examine the psychometric properties of the German translation of the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire (Mack et al., 2008) and to investigate its associations with mental health, health-related quality of life (HRQoL) and related constructs. Methods: The German version of the PEACE (PEACE-G) was created and validated with cancer patients in a cross-sectional two center questionnaire study. Construct validity was tested with confirmational factor analyses (CFA); Cronbach's alpha was used to determine internal consistency of items. We further examined associations with depression (PHQ-8), anxiety (GAD-7), distress (NCCN distress thermometer), HRQoL (SF-12), psychological flexibility (AAQ-II), resilience (RS-11) and acceptance scales, to evaluate concurrent and divergent validity. Results: N = 213 cancer patients with different tumor entities participated in this study. Results of the CFA replicated the two-factor solution of the original PEACE (peaceful acceptance and struggle with illness) with satisfactory psychometric properties. Peaceful acceptance showed negative associations with depression, anxiety, distress, psychological inflexibility, and positive associations with HRQoL, acceptance, resilience, and mindfulness. Results of sensitivity analyses indicate a third factor (injustice/anger). Conclusions: The results demonstrate the validity and reliability of PEACE-G in cancer patients and point to the essential role of acceptance- and mindfulness-based interventions in psycho-oncology. Further studies are needed to investigate the different facets of struggle with the cancer illness. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is common after traumatic brain injury (TBI), frequently limits daily activities, and is associated with negative outcomes such as decreased community participation. Despite the negative impact of chronic pain, few people with TBI receive effective treatment. This paper describes a collaborative care (CC) intervention, TBI Care, adapted specifically to treat chronic pain in people living with TBI, emphasizing expert clinician input, cognitive behavioral therapy (CBT) techniques, and other nonpharmacological approaches for decreasing pain interference. Methods: 79participantsengagedintheCCintervention fromtwoacademicmedical rehabilitation clinics with weekly assessments of pain intensity, interference, and medication use. Participant feedback on the intervention was gathered by interview with the care manager (CM) at the last treatment session and/or booster session. Provider feedback was gathered by a confidential survey post intervention. Results: Ninety percent of participants received at least 11 of the target 12 sessions with a care manager (CM), the majority occurring over the phone. Participants endorsed an average of 7 pain locations. All participants received pain education, skills in self-monitoring, goal setting/behavioral activation and relaxation training. Pain interference scores (impact on activity and enjoyment), tracked weekly by the CM, significantly decreased across sessions. 89% of participants received recommendations for CBT skills, 65% received referrals for additional treatments targeting pain interference, and 43% received care coordination. 75% of participants reported 6 or more medications/supplements at both the first and last session, with changes recommended primarily for headache treatment. Feedback from participants and providers was positive. Discussion: TBI Care, a novel patient-centered CC approach, was flexibly delivered, tailored to the needs of those living with TBI and chronic pain, with a high level of participant engagement, and satisfaction among participants and providers. This approach, prioritizing pain self-management strategies and other non-pharmacological approaches, along with optimizing pharmacological treatment, led to significant reductions in self-reported pain interference and intensity during the intervention. Using a CC model in TBI is feasible and successfully improved access to evidence-based treatments for chronic pain as well as outcomes for pain interference and intensity. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related anxiety significantly impacts maternal and fetal health in low- and middle-income countries (LMICs), including those within Sub-Saharan Africa (SSA). Most studies conducted to evaluate pregnancy-related anxiety in LMICs have utilized scales developed in high-income countries, despite significant variations in pregnancy-related anxiety due to socioeconomic and cultural contexts. This review surveyed existing literature in order to identify which scales have been used to measure pregnancy-related anxiety in SSA. Methods: A systematic search was conducted in PubMed, Health and Psychosocial Instruments, and APA PsycNet for relevant studies published in the English language up to March 22, 2023. Eligible studies focused on anxiety in pregnant populations within SSA, using validated scales or tools. Screening followed PRIMSA guidelines, with blinded review at the abstract/title level and subsequent full-text review. Data was extracted and analyzed to identify trends and characteristics of the screening tools used. Results: From 271 articles, 37 met inclusion criteria, identifying 24 different tools used to measure anxiety in pregnant women in SSA. The most common tools were the Generalized Anxiety Disorder 7-item scale (seven uses), State-Trait Anxiety Inventory (five uses), and the Self-Reporting Questionnaire 20 (five uses). Seven tools were pregnancy-specific, with only two designed specifically for SSA: the Risk Factor Assessment (RFA), and the 4-Item Screening Tool. Studies were most frequently conducted in South Africa, followed by Tanzania, Ethiopia, Nigeria, and Ghana. Conclusions: This scoping review illustrates that only two tools (the RFA and 4-item Screening Tool) were created to assess pregnancy-related anxiety specifically in SSA. This highlights the need for more culturally sensitive tools tailored to the specific contexts of pregnant populations in SSA. [ABSTRACT FROM AUTHOR]

Background: Chronic insomnia, affecting 15.9% of the population, is characterized by sustained hyperarousal and heightened somatic, cognitive, and cortical activity. Despite its prevalence, the precise impact of chronic insomnia on cognitive domains, particularly attention, working memory, and executive function, remains inadequately understood. Aim: This study aims to systematically investigate the cognitive functioning of adults with chronic insomnia. Methodology: A meticulously matched cohort of 80 participants, comprising 40 with chronic insomnia and 40 controls, participated in this cross-sectional study. The diagnosis followed strict criteria outlined in the International Classification of Sleep Disorders-3. Neuropsychological assessments, including the Digit Span Test, Stroop Test, and Trail Making Test, were employed to scrutinize attention, working memory, and executive function. Robust metrics, such as the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), supported the investigative approach. Results: Analysis revealed notable deficits in backward digit span, digit symbol substitution test, and Stroop Test (cards B and C) among chronic insomnia subjects compared to non-insomniac counterparts. Trail Making Test B indicated prolonged completion times in the chronic insomnia cohort. Despite comparable levels of anxiety and depressive symptoms, the chronic insomnia group exhibited higher ISI and PSQI scores, indicating the severity of their sleep disturbances. Conclusion: This cross-sectional analysis reveals cognitive deficits associated with chronic insomnia, specifically impacting attention, working memory, and executive function. Even with meticulous demographic controls, chronic insomnia leaves a discernible impact on cognitive functions. The study underscores the need for precise cognitive evaluations to reveal the latent impact of chronic insomnia, offering insights for targeted interventions. [ABSTRACT FROM AUTHOR]

As there are internal and external demands from students to actively engage in several activities in school settings, most of them feel bored, frustrated, and nonadaptive in responding to those demands. This has increased the high prevalence of school maladjustment and academic stress in students, especially among minority groups and rural populations. Based on this, we investigated the impact of rational emotive behaviour therapy on academic stress and school adjustment among students in rural inclusive schools. This study was implemented using a pretest–posttest control group design. After obtaining permission for the study, 94 students who provided consent, participated in the study. These students were randomly assigned to two arms, treated, and assessed three times using two dependent measures. A multivariate statistic was used to test the effect of the intervention on the dependent variables. The results showed a significant effect of the rational emotive behaviour therapy (REBT) group on academic stress management among students. It also showed no significant effect of the REBT group in improving academic adjustment among students the result reveals that gender is not a significant moderator of academic stress management and school adjustment in schools and no significant interaction effect of group and gender. In conclusion, the application of REBT is useful and beneficial in managing academic stress among the rural student population and calls for advancement. Unlike academic stress, REBT does not have a significant impact in improving school adjustment among rural students. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) and repetitive head impacts (RHI) have been linked to increased risk for multiple types of neurodegenerative disease, higher dementia risk, and earlier age of dementia symptom onset, suggesting transdiagnostic implications for later-life brain health. Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) represent a spectrum of clinical phenotypes that are neuropathologically diverse. FTD/PPA diagnoses bring unique challenges due to complex cognitive and behavioral symptoms that disproportionately present as an early-onset dementia (before age 65). We performed a detailed characterization of lifetime head trauma exposure in individuals with FTD and PPA compared to healthy controls to examine frequency of lifetime TBI and RHI and associated clinical implications. Methods: We studied 132 FTD/PPA (age 68.9 ± 8.1, 65% male) and 132 sex-matched healthy controls (HC; age 73.4 ± 7.6). We compared rates of prior TBI and RHI (contact/collision sports) between FTD/PPA and HC (chi-square, logistic regression, analysis of variance). Within FTD/PPA, we evaluated associations with age of symptom onset (analysis of variance). Within behavioral variant FTD, we evaluated associations with cognitive function and neuropsychiatric symptoms (linear regression controlling for age, sex, and years of education). Results: Years of participation were greater in FTD/PPA than HC for any contact/collision sport (8.5 ± 6.7yrs vs. 5.3 ± 4.5yrs, p =.008) and for American football (6.2yrs ± 4.3yrs vs. 3.1 ± 2.4yrs; p =.003). Within FTD/PPA, there were dose-dependent associations with earlier age of symptom onset for TBI (0 TBI: 62.1 ± 8.1, 1 TBI: 59.9 ± 6.9, 2 + TBI: 57.3 ± 8.4; p =.03) and years of American football (0yrs: 62.2 ± 8.7, 1-4yrs: 59.7 ± 7.0, 5 + yrs: 55.9 ± 6.3; p =.009). Within bvFTD, those who played American football had worse memory (z-score: -2.4 ± 1.2 vs. -1.4 ± 1.6, p =.02, d = 1.1). Conclusions: Lifetime head trauma may represent a preventable environmental risk factor for FTD/PPA. Dose-dependent exposure to TBI or RHI influences FTD/PPA symptom onset and memory function in bvFTD. Clinico-pathological studies are needed to better understand the neuropathological correlates linking RHI or TBI to FTD/PPA onset and symptoms. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is defined as acquired cerebral damage caused by an external mechanical impact, which has the potential to lead to transient or enduring debilitation. TBI is associated with many forms of long-lasting psychiatric conditions, including anxiety disorders. As anxiety is highly debilitating by causing impaired social functioning and decreased quality of life for the afflicted, especially in the form of anxiety disorders such as generalized anxiety disorder, certain efforts have been made to explore the factors associated with it, and one such factor is TBI. Methods: We searched PubMed, Scopus, and Web of Science on January 26th, 2024 for observational case–control or cohort or cross-sectional studies assessing the incidence of anxiety symptoms or disorders in patients with TBI compared to healthy individuals or the same individuals if pre-TBI information regarding anxiety was available. We calculated the pooled incidence and relative risk (RR) and 95% confidence interval (95CI) using the inverse variance method. Publication bias was assessed using Eggers's regression test. Quality assessment was performed using the Newcastle–Ottawa scale. Sub-group analyses were conducted for the type of anxiety (anxiety disorder vs anxiety symptoms), TBI severity, and type of anxiety disorders. Results: The incidence rate of anxiety after traumatic brain injury was 17.45% (95CI: 12.59%, 22.31%) in a total of 705,024 individuals. Moreover, TBI patients were found to be 1.9 times as likely to have anxiety compared to their non-TBI counterparts [Random effects model RR = 1.90 [1.62; 2.23], p-value < 0.0001] using a population of 569,875 TBI cases and 1,640,312 non-TBI controls. Sub-group analysis revealed TBI severity was not associated with anxiety and generalized anxiety disorder was the most common type of anxiety disorder reported post-TBI. Conclusion: Patients who have experienced a TBI exhibit a significantly greater incidence of anxiety symptoms and anxiety disorders in the aftermath when compared to healthy individuals. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is one of the most common cancers among women, which reduces the quality of life and causes depression. The present study was conducted with aim to compare the effect of acupressure and aromatherapy on depression and quality of life of breast cancer patients. Methods: In this randomized clinical trial study, 96 women with breast cancer who visited the clinic or chemotherapy unit at Baqiyatullah and Shahid Chamran hospitals in Tehran were randomly assigned to three groups: aromatherapy, acupressure, and control. The data collection tool was the standard questionnaire for assessing the quality of life in breast cancer patients and Beck's depression questionnaire. Data analysis was performed using SPSS software (version 21) and ANOVA and paired t-test. Results: In terms of quality of life, both in functional and symptomatic dimensions, the aromatherapy and acupressure groups had significantly better performance than the control group (p=0.003 and p<0.001, respectively). Additionally, both the aromatherapy and acupressure groups demonstrated a significant reduction in depression scores compared to the control group (p<0.001). Conclusion: Aromatherapy and acupressure significantly improve quality of life and reduce depression in patients with breast cancer. These interventions can be utilized as complementary methods in managing the physical and psychological symptoms of these patients. Further research with larger sample size is needed to confirm the long-term efficacy and explore the broader applicability of these approaches. [ABSTRACT FROM AUTHOR]

Chronic neuroinflammation and microglial activation are key mediators of the secondary injury cascades and cognitive impairment that follow exposure to repetitive mild traumatic brain injury (r-mTBI). Peroxisome proliferator-activated receptor-γ (PPARγ) is expressed on microglia and brain resident myeloid cell types and their signaling plays a major anti-inflammatory role in modulating microglial responses. At chronic timepoints following injury, constitutive PPARγ signaling is thought to be dysregulated, thus releasing the inhibitory brakes on chronically activated microglia. Increasing evidence suggests that thiazolidinediones (TZDs), a class of compounds approved from the treatment of diabetes mellitus, effectively reduce neuroinflammation and chronic microglial activation by activating the peroxisome proliferator-activated receptor-γ (PPARγ). The present study used a closed-head r-mTBI model to investigate the influence of the TZD Pioglitazone on cognitive function and neuroinflammation in the aftermath of r-mTBI exposure. We revealed that Pioglitazone treatment attenuated spatial learning and memory impairments at 6 months post-injury and reduced the expression of reactive microglia and astrocyte markers in the cortex, hippocampus, and corpus callosum. We then examined whether Pioglitazone treatment altered inflammatory signaling mechanisms in isolated microglia and confirmed downregulation of proinflammatory transcription factors and cytokine levels. To further investigate microglial-specific mechanisms underlying PPARγ-mediated neuroprotection, we generated a novel tamoxifen-inducible microglial-specific PPARγ overexpression mouse line and examined its influence on microglial phenotype following injury. Using RNA sequencing, we revealed that PPARγ overexpression ameliorates microglial activation, promotes the activation of pathways associated with wound healing and tissue repair (such as: IL10, IL4 and NGF pathways), and inhibits the adoption of a disease-associated microglia-like (DAM-like) phenotype. This study provides insight into the role of PPARγ as a critical regulator of the neuroinflammatory cascade that follows r-mTBI in mice and demonstrates that the use of PPARγ agonists such as Pioglitazone and newer generation TZDs hold strong therapeutic potential to prevent the chronic neurodegenerative sequelae of r-mTBI. [ABSTRACT FROM AUTHOR]

Posttraumatic headache (PTH) is common following traumatic brain injury and impacts quality of life. We investigated descending pain modulation as one possible mechanism for PTH and correlated it to clinical measures. Pain-related evoked potentials (PREP) were recorded in 26 PTH-patients and 20 controls after electrical stimulation at the right hand and forehead with concentric surface electrodes. Conditioned pain modulation (CPM) was assessed using painful cutaneous electric stimulation (PCES) on the right hand as test stimulus and immersion of the left hand into 10 °C-cold water bath as conditioning stimulus based on changes in pain intensity and in amplitudes of PCES-evoked potentials. All participants completed questionnaires assessing depression, anxiety, and pain catastrophising. PTH-patients reported significantly higher pain ratings during PREP-recording in both areas despite similar stimulus intensity at pain threshold. N1P1-amplitudes during PREP and CPM-assessment were lower in patients in both areas, but statistically significant only on the hand. Both, PREP-N1-latencies and CPM-effects (based on the N1P1-amplitudes and pain ratings) were similar in both groups. Patients showed significantly higher ratings for anxiety and depression, which did not correlate with the CPM-effect. Our results indicate generalized hyperalgesia for electrical stimuli in both hand and face in PTH. The lacking correlation between pain ratings and EEG parameters indicates different mechanisms of pain perception and nociception. [ABSTRACT FROM AUTHOR]

Background: Symptoms reported by patients who sustain a concussion are non-specific. As such, clinicians are better able to manage patients when a standardized clinical exam is performed to sub-type the driver(s) of symptoms. Aerobic exercise and multimodal rehabilitation have consistently shown to be a possibly effective means to manage this population; however, the optimal training prescription is unclear. Thus, there is a need to further examine the effectiveness of personalized rehabilitative treatments. Our primary aim is to evaluate the response to personalized therapy on recovery, as measured by The Rivermead Post-concussion Symptoms Questionnaire (RPQ) when compared to an active control. Methods: We will conduct a multi-center 12-week case-crossover randomized controlled trial. 50 participants will be recruited from out-patient University Health Network clinics and community-based clinical practices around the greater Toronto area. Participants will be randomized at baseline to Group A: a personalized care program followed by an active control or Group B: an active control followed by a personalized care program. Participants will be included should they be 21 years of age and older and have symptoms that have persisted beyond 4 weeks but less than 1 year. Participants will undergo 6-weeks of care in their respective streams. After 6-weeks, participants will undergo a re-examination. They will then crossover and undertake the alternative treatment for 6 weeks. At the end of 12 weeks, participants will undertake the endpoint examinations. The primary outcome will be the Rivermead Postconcussion Questionnaire (RPQ). The secondary outcomes will be changes in standardized clinical examination, Neck Disability Index (NDI), Patient Health Questionnaire (PHQ-9) and an electroencephalography (EEG) via NeuroCatch™. The statistical analysis to be performed is composed of an adjusted model using an analysis of variance, specifically using an unpaired t-test to test for associations between variables and outcomes. Discussion: Given the recommendations from reviews on the topic of rehabilitation for adults with persistent concussion symptoms, we are undertaking a controlled trial. The documented high costs for patients seeking care for persistent symptoms necessitate the need to evaluate the effectiveness of a personalized rehabilitative program compared to the current standard of care. Trial registration: ClinicalTrials.gov ID: NCT06069700. [ABSTRACT FROM AUTHOR]

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Previous research has indicated the suitability of behavioural activation (BA) as an intervention for reducing depression in older adults. However, little research has investigated the potential of BA to increase active engagement and well-being in older adults. The current pilot study sought to investigate the usefulness and acceptability of BA to promote well-being in a group of non-clinical older adults. Participants (N = 18) aged between 65 and 86 (M = 77.82, SD = 5.59) who were retired and living independently in the community were provided a 6-week BA program predominantly delivered online. Treatment retention, self-ratings, and participants' compliance to treatment principles indicate preliminary feasibility for the use of BA as an approach for increasing active engagement in older adult populations. Participants also provided feedback on their experiences with the program post-intervention via individual structured interviews. Thematic analysis of these data revealed that participants found the program to be beneficial in terms of increased self-awareness and social engagement, and provided several recommendations for improving acceptability of the program and workbook. The unexpected events relating to the first wave of the novel coronavirus (COVID-19) led to necessary adaptations to delivery modalities, and provided the researchers with an opportunity to investigate the use of a structured well-being program on a high-risk population during a pandemic. Our findings support the proposition that BA is a suitable intervention for increasing engagement and well-being in older adults, provide insight into adapting programs for older adults, and suggest next steps for testing intervention efficacy. [ABSTRACT FROM AUTHOR]

Background: Physical activity has health benefits for adults with acquired brain injury, but it is a challenge to increase physical activity during inpatient rehabilitation. The objectives of this pilot study were to determine whether a physiotherapy-supervised inpatient walking program was feasible and able to improve physical activity and sedentary behaviour in the short and medium term. Methods: Adults with acquired brain injury receiving inpatient rehabilitation undertook twice-weekly supervised walks plus behavioural therapy for 4 weeks. Feasibility was measured via recruitment, participation and drop out rates, adverse events and intervention delivery costs. Physical activity and sedentary behaviour were measured with an activPAL. Assessments were conducted at baseline, post-intervention and 3–6 months post-intervention. Results: The program was safe to deliver (no adverse events), recruitment rate was 55% (16/29) and the participation rate for eligible individuals was high (14/19, 74%). However, the program had a high drop out rate (7/16, 44%) and physical activity and sedentary behaviour did not significantly change during the 4-week intervention. Costs were AU$427.71/participant. Physical activity and sedentary behaviour did improve 3–6 months after the intervention (vs baseline, on average: +3913 steps per day, 95% CI: 671, 7156). Conclusion: This pilot study demonstrated a supervised physiotherapy walking program is safe and feasible to recruit in an inpatient setting. However, drop out during the study was high and behaviour change did not occur. More work is required to boost physical activity during sub-acute rehabilitation for acquired brain injury. Physical activity is important for the health of adults with acquired brain injury. This pilot study trialled a combination walking and behaviour change program with adults receiving rehabilitation in hospital, finding that while patients were interested in the program, they did not become more active as a result. This study does highlight the challenges for clinicians and for patients in increasing activity during rehabilitation in hospital. [ABSTRACT FROM AUTHOR]

Purpose of Review.: To review the literature on the social ecology of neurogenic lower urinary tract dysfunction through a multi-level framework. Recent Findings.: Neurogenic lower urinary tract dysfunction is a complex collection of symptoms, which significantly affects and is affected by various levels of the social experience across all levels, including individual, interpersonal, community, and societal. Individual factors include the profound effects on both overall and bladder-specific QOL, the significant psychosocial comorbidity, and the burden of unmet social needs. Interpersonal relationships—including social, romantic and sexual, and caregiver—are complex and have unique considerations. In the community, experiences in the workplace, schools, and healthcare settings, and interactions with public restrooms can be challenging for those with NLUTD, and special considerations are often overlooked by more able-bodied people. Finally, the economic burden and overall healthcare utilization of those with NLUTD is vast and likely greater than other non-neurogenic bladder conditions. Summary: There is a growing body of literature on the social ecology of NLUTD, however the literature to date remains sparce, and there is much room for further investigation. A better understanding of factors at each level may allow for better overall understanding of the lived experience of those with NLUTD. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) represents a major cause of death and disability worldwide. Brain damage is associated with physical and psychological difficulties among TBI survivors. Diverse face-to-face and telehealth programs exist to help survivors cope with these burdens. However, the effectiveness of telehealth interventions among TBI survivors remains inconclusive. Methods: A systematic review and meta-analysis of randomized control trials were conducted. Relevant full-text articles were retrieved from seven databases, from database inception to January 2022, including Academic Search Complete, CINAHL, EMBASE, Cochrane, MEDLINE, PubMed, and Web of Science. Bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was performed using a random-effects model to calculate the pooled effect size of telehealth interventions for TBI survivors. STATA 16.0 was used for statistical analysis. Results: In total, 17 studies (N = 3158) applying telehealth interventions among TBI survivors were included in the analysis. Telehealth interventions decreased neurobehavioural symptom (standardized mean difference: −0.13; 95% confidence interval [CI]: −0.36 to 0.10), reduce depression (standardized mean difference: −0.32; 95% CI: −0.79 to 0.14), and increase symptom management self-efficacy (standardized mean difference: 0.22; 95% CI: 0.02–0.42). Discussion: Telehealth interventions are promising avenues for healthcare delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, combining traditional treatment with rehabilitation to increase symptom management self-efficacy among TBI patients during recovery. Future telehealth programs can focus on developing the contents of telehealth modules based on evidence from this study. [ABSTRACT FROM AUTHOR]

Background Patients with head and neck cancer present particularly considerable levels of emotional distress. However, the actual rates of clinically relevant mental health symptoms and disorders among this population remain unknown. Methods A Preferred Reporting Items for Systematic Review and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology–compliant systematic review and quantitative random-effects meta-analysis was performed to determine suicide incidence and the prevalence of depression, anxiety, distress, posttraumatic stress, and insomnia in this population. MEDLINE, Web of Science, Cochrane Central Register, KCI Korean Journal database, SciELO, Russian Science Citation Index, and Ovid-PsycINFO databases were searched from database inception to August 1, 2023 (PROSPERO: CRD42023441432). Subgroup analyses and meta-regressions were performed to investigate the effect of clinical, therapeutical, and methodological factors. Results A total of 208 studies (n = 654 413; median age = 60.7 years; 25.5% women) were identified. Among the patients, 19.5% reported depressive symptoms (95% confidence interval [CI] = 17% to 21%), 17.8% anxiety symptoms (95% CI = 14% to 21%), 34.3% distress (95% CI = 29% to 39%), 17.7% posttraumatic symptoms (95% CI = 6% to 41%), and 43.8% insomnia symptoms (95% CI = 35% to 52%). Diagnostic criteria assessments revealed lower prevalence of disorders: 10.3% depression (95% CI = 7% to 13%), 5.6% anxiety (95% CI = 2% to 10%), 9.6% insomnia (95% CI = 1% to 40%), and 1% posttraumatic stress (95% CI = 0% to 84.5%). Suicide pooled incidence was 161.16 per 100 000 individuals per year (95% CI = 82 to 239). Meta-regressions found a statistically significant higher prevalence of anxiety in patients undergoing primary chemoradiation compared with surgery and increased distress in smokers and advanced tumor staging. European samples exhibited lower prevalence of distress. Conclusions Patients with head and neck cancer presented notable prevalence of mental health concerns in all domains. Suicide remains a highly relevant concern. The prevalence of criteria-meeting disorders is significantly lower than clinically relevant symptoms. Investigating the effectiveness of targeted assessments for disorders in highly symptomatic patients is essential. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) is a global public health problem. Different studies related to prognostic models have been performed previously to predict the outcome after TBI. The comparison between Rotterdam and Helsinki scores has been done in patient population in other countries. The main objective of this study is to compare these two scoring systems for prediction of outcome after TBI in Nepalese patient population. Materials and Methods: This is a prospective observational study done in the Department of Neurosurgery, Tribhuvan University Teaching Hospital from December 2019 to March 2021. Patients with TBI (mild complicated, moderate and severe) presenting to the hospital within 24 hours of injury were included. Their outcome was predicted on the basis of Rotterdam and Helsinki scores as per the Extended Glasgow Outcome Scale (GOSE) at the time of discharge and in six months. Results: A total of 88 patients with a mean age of 34.4 + 15.33 years were included with a male: female ratio of 6.3:1. The most common mode of injury was fall from height [43(48.9%)] followed by road traffic accidents [29(33%)] and physical assaults [14(15.9%)]. The majority of patients had a mild complicated head injury [56(63.6%)].81.8% patients had a favorable outcome in six months. The Rotterdam score had an AUC of (0.781 and 0.753) for mortality and unfavorable outcome. Similarly the Helsinki score had an AUC of (0.775 and 0.748) for mortality and unfavorable outcome respectively. Conclusion: Both scoring systems have high prediction for both unfavourable outcomes and mortality after TBI. However for prediction of outcome Rotterdam score was slightly superior to Helsinki Score but for mortality prediction Helsinki score was slightly better than the Rotterdam Score. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50–80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs. [ABSTRACT FROM AUTHOR]