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The Mini-Mental Status Examination (MMSE) is routinely used in neuro-oncology clinics to rule out cognitive impairment. However, the MMSE is known to have poor sensitivity to mild cognitive impairment, raising concern regarding its continued use. More comprehensive cognitive screeners are available, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and may be better able to assess for cognitive dysfunction.This retrospective cross-sectional study compared the relative rates of impairment using the MMSE-2 and RBANS in a sample of neuro-oncology patients (N = 81). A preliminary analysis of the sensitivity and specificity of the MMSE-2 to the level of cognitive impairment identified on the RBANS was conducted; in addition, we examined whether an adjustment of the MMSE-2 cut-off score improved consensus with a positive screening on the RBANS.The MMSE-2 failed to identify over half of the patients with cognitive dysfunction that were identified on the RBANS. Further analysis showed limited sensitivity of the MMSE-2 to the level of impairment detected on the RBANS, and an adjustment of the cut-off score did not improve the sensitivity or specificity of the MMSE-2.These results provide caution for neuro-oncology clinics using the MMSE. If providers continue to rely on the MMSE to screen for cognitive impairment alone, they may fail to identify individuals with mild cognitive impairments.

BACKGROUND: CogMed Working Memory Training (CWMT) is a computer-based program shown to improve working memory (WM) among those with cognitive impairments. No study to date has investigated its feasibility, acceptability, and satisfaction in adult patients with glioma, despite the well-documented incidence of WM impairment in this population. METHODS: Twenty patients with glioma and objective and/or perceived WM deficits enrolled in the study: 52% high-grade, 60% female, Mage = 47 (range = 21–72 years). Adverse events were monitored to determine safety. Feasibility and acceptability were assessed based on established metrics. Satisfaction was explored by exit-interviews. Neurocognitive tests and psychological symptoms were analyzed at baseline and post-CWMT to estimate effect sizes. RESULTS: Of 20 enrolled patients, 16 completed the intervention (80% retention rate). Reasons for withdrawal included time burden (n = 2); tumor-related fatigue (n = 1) or loss to follow-up (n = 1). No adverse events were determined to be study-related. Adherence was 69% with reasons for nonadherence similar to those for study withdrawal. The perceived degree of benefit was only moderate. Baseline to post-CWMT assessments showed medium to large effects on neurocognitive tasks. Psychological symptoms remained stable throughout the study period. CONCLUSIONS: CWMT was found to be safe and acceptable in adult patients with glioma. Enrollment, retention rates, and treatment adherence were all adequate and comparable to studies recruiting similar populations. Only moderate perceived benefit was reported despite demonstrated improvements in objectively-assessed WM. This may indicate that the time commitment and intervention intensity (5 weeks of 50-min training sessions on 5 days/week) outweighed the perceived benefits of the program. (Trial Registration Number: NCT03323450 registered on 10/27/2017).

Primary brain tumor (PBT) patients may experience existential distress; however, few studies have examined this issue. The objectives of this study were to (1) systematically review PBT representation in psycho-oncology literature regarding fear/anxiety related to progression, recurrence, and death and (2) preliminarily assess the prevalence of fear of dying in a sample of PBT patients. Systematic searching of three databases yielded 1555 articles for review. Of these, 327 studies met inclusion criteria (patient sample N = 132,951). Only eight studies (0.18% of the participants) included patients with a PBT diagnosis, potentially due to exclusion criteria such as cognitive impairment or specific treatment parameters which may prohibit PBT patient participation. Review of the results from the eight included studies revealed mixed methods and limited demographic analyses; existential distress was correlated with heightened depression and anxiety, and overall worsened quality of life. From the original data collection, approximately one-third of PBT patients endorsed fear of dying, which was positively related to depression severity. Taken together, results suggest that PBT patients are considerably underrepresented in existential psycho-oncology literature, despite preliminary findings suggesting prevalence of these concerns. Future research on existential distress in neuro-oncology is warranted.

Objective Fear of cancer recurrence (FCR) is related to psychological distress and poor quality of life in cancer patients and their caregivers. However, no studies have investigated FCR in neuro-oncology. Given the varied prognosis, treatment, and disease trajectory of brain cancer, FCR may affect patients and their caregivers differently. Methods Eighty adult primary brain tumor (PBT) patients and 52 caregivers completed questionnaires assessing FCR and psychological distress (depressive symptoms, generalized anxiety, and death anxiety). Differences in patient and caregiver FCR by demographic and medical characteristics were examined. Using multilevel modeling, the Actor-Partner Interdependence Model (APIM) was used to investigate the interrelationship between patient and caregiver FCR with demographics and psychological distress measures. Results Caregivers reported significantly higher FCR than patients. There were no effects of demographic or medical characteristics on patient FCR. Time since diagnosis was negatively related to caregiver FCR. All measures of psychological distress exerted a significant actor effect on FCR among both patients and caregivers. Two partner effects were found: caregiver depressive symptoms and death anxiety negatively predicted patients' FCR. Conclusions This is the first investigation of FCR in PBT patients and their caregivers. Most demographic and medical characteristics were not related to patient or caregiver FCR. Caregiver FCR may be higher at the time of diagnosis and decrease over time. APIMs revealed actor effects on patient and caregiver FCR for all measures of psychological distress. Results demonstrated the dyadic effects of a brain tumor diagnosis, emphasizing the need to include caregivers in psychotherapy for neuro-oncology patients.

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.

Key Points Question Does a psychosocial aftercare program (PAC) after in-hospital intensive interdisciplinary pain treatment (IIPT) for pediatric patients with chronic pain improve functional outcomes? Findings In this randomized clinical trial including 419 patients aged 8 to 17 years randomized and 222 patients analyzed at 6 months, PAC significantly improved all pain-related as well as emotional outcome parameters compared with treatment as usual. Meaning These findings suggest PAC should be considered in IIPT for pediatric chronic pain and its effectiveness tested in other pediatric psychosomatic conditions., This randomized clinical trial evaluates the effectiveness of a psychosocial aftercare program for pediatric patients with severe chronic pain vs usual care after discharge from intensive interdisciplinary pain treatment., Importance Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients. Objective To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. Design, Setting, and Participants This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. Interventions Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. Main Outcomes and Measures The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. Results A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = −8.84; P

Objective FOXG1 syndrome is a rare neurodevelopmental disorder associated with heterozygous FOXG1 variants or chromosomal microaberrations in 14q12. The study aimed at assessing the scope of structural cerebral anomalies revealed by neuroimaging to delineate the genotype and neuroimaging phenotype associations. Methods We compiled 34 patients with a heterozygous (likely) pathogenic FOXG1 variant. Qualitative assessment of cerebral anomalies was performed by standardized re-analysis of all 34 MRI data sets. Statistical analysis of genetic, clinical and neuroimaging data were performed. We quantified clinical and neuroimaging phenotypes using severity scores. Telencephalic phenotypes of adult Foxg1+/- mice were examined using immunohistological stainings followed by quantitative evaluation of structural anomalies. Results Characteristic neuroimaging features included corpus callosum anomalies (82%), thickening of the fornix (74%), simplified gyral pattern (56%), enlargement of inner CSF spaces (44%), hypoplasia of basal ganglia (38%), and hypoplasia of frontal lobes (29%). We observed a marked, filiform thinning of the rostrum as recurrent highly typical pattern of corpus callosum anomaly in combination with distinct thickening of the fornix as a characteristic feature. Thickening of the fornices was not reported previously in FOXG1 syndrome. Simplified gyral pattern occurred significantly more frequently in patients with early truncating variants. Higher clinical severity scores were significantly associated with higher neuroimaging severity scores. Modeling of Foxg1 heterozygosity in mouse brain recapitulated the associated abnormal cerebral morphology phenotypes, including the striking enlargement of the fornix. Interpretation Combination of specific corpus callosum anomalies with simplified gyral pattern and hyperplasia of the fornices is highly characteristic for FOXG1 syndrome.

Adult primary brain tumor (PBT) survivors report persistent cognitive difficulties before, during, and after treatment, which are problematic for everyday functioning. Cognitive domains often affected by cancer treatment appear to be attention and executive functioning (EF). One validated measure developed to assess an individual's EF within daily living is the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). To date, no published research has investigated the EF profile of PBT patients using the BRIEF-A. Seventy-four PBT patients completed the BRIEF-A. Descriptive analyses were conducted to determine the self-reported EF profile in PBT patients. T-tests preliminarily compared the performance of PBT patients to four other comparison groups: mild cognitive impairment (MCI; n = 23), attention-deficit/hyperactivity disorder-unmedicated (ADHD-U; n = 27), traumatic brain injury (TBI; n = 23), and healthy controls (HC; n = 26). PBT BRIEF-A group means were average across subscales and indexes, yet the prevalence of significant elevations ranged from 12 to 50%. The Metacognition Index demonstrated 38% elevation prevalence compared to 22% in Behavioral Regulation. Approximately 61% of the sample had at least one clinically elevated scaled score. PBT patients reported significantly more EF impairment than HC and significantly less than ADHD-U. No significant differences were found between the PBT and MCI groups or PBT and TBI groups. Despite group means not reaching clinical impairment, a substantial proportion of patients with PBTs endorse executive dysfunction. Elevations were most prominent in metacognitive abilities over behavioral dysregulation. Notably, the EF profile of PBT patients was remarkably similar to that of MCI and TBI, increased when compared to HC, and well below ADHD-U.

Improvements in stable, or dispositional, mindfulness are often assumed to accrue from mindfulness training and to account for many of its beneficial effects. However, research examining these assumptions has produced mixed findings, and the relation between dispositional mindfulness and mindfulness training is actively debated. A comprehensive meta-analysis was conducted on randomized controlled trials (RCTs) of mindfulness training published from 2003-2014 to investigate whether (a) different self-reported mindfulness scale dimensions change as a result of mindfulness training, (b) key aspects of study design (e.g., control condition type, population type, and intervention type) moderate training-related changes in dispositional mindfulness scale dimensions, and (c) changes in mindfulness scale dimensions are associated with beneficial changes in mental health outcomes. Scales from widely used dispositional mindfulness measures were combined into 5 categories for analysis: Attention, Description, Nonjudgment, Nonreactivity, and Observation. A total of 88 studies (n = 5,787) were included. Changes in scale dimensions of mindfulness from pre to post mindfulness training produced mean difference effect sizes ranging from small to moderate (g = 0.28-0.49). Consistent with the theorized role of improvements in mindfulness in training outcomes, changes in dispositional mindfulness scale dimensions were moderately correlated with beneficial intervention outcomes (r = .27-0.30), except for the Observation dimension (r = .16). Overall, moderation analyses revealed inconsistent results, and limitations of moderator analyses suggest important directions for future research. We discuss how the findings can inform the next generation of mindfulness assessment. (PsycINFO Database Record

Objectives To fill gaps in the literature on the effects of mindfulness for healthcare professionals (HCPs), the current pragmatic trial investigated feasibility, acceptability, and effectiveness of Mindfulness for Interdisciplinary Healthcare Professional (MIHP) students on stress and work-relevant outcomes in the absence of offering school-based incentives. Design A partially randomized waitlist-controlled design (intention-to-treat sample: 22 in the mindfulness group, 26 in the control group) was employed. Intervention MIHP is an eight-week intervention that incorporates meditation training, yoga, and discussion on the application of mindfulness principles to stressors commonly faced by HCPs and students. Main outcome measures Domains of feasibility and acceptability; Maslach Burnout Inventory and other validated measures of psychological functioning; cognitive task performance on the Trail Making Test A & B; and the Work Productivity and Activity Impairment plus Classroom Impairment Questionnaire. Results Results supported the feasibility and acceptability of MIHP but found randomization to be unacceptable. Small to large effects were found for MIHP, relative to the control group, on outcomes of burnout, perceived stress, mindfulness, and activity impairment. No effect of MIHP was found on cognitive performance or work productivity outcomes. Conclusions Preferential group allocation improved retention relative to randomization in the absence of school-based incentives. Results suggest that MIHP is feasible and acceptable and may have benefit for improving mindfulness and reducing burnout, stress, and activity impairment. Cognitive performance, work absenteeism, and work impairment did not change following MIHP. Results support future investigations into the effects of participant compensation on MIHP’s dissemination and effectiveness.

Primary headache disorders such as migraine and tension-type headache begin as early as childhood or adolescence. Prevalence increases during primary school and adolescence. In tension-type headache, central pain sensitization and activation of central nociceptive neurons plays an important role. Migraine is a primary brain disorder with abnormalities in pain modulating systems and cortical stimulus processing. Bio-psycho-social factors play a decisive role in both types of headache. Secondary headaches due to an inflammatory or a structural brain alteration are rare. Diagnosis is based on clinical criteria. Typical recurrent headaches are diagnosed by patient's history and physical examination. In case of abnormalities, further diagnostic is needed. Treatment of tension-type headache is focused on multimodal pain therapy, treatment of migraine is focused on medication of attacks and secondary headaches need treatment of the underlying disease. Treatment goals are the reduction of pain perception, promotion of control and self-efficacy experiences, the increase of physical performance as well as the resumption of normal everyday structures and social contacts as a prerequisite for an increasing pain reduction.Primäre Kopfschmerzerkrankungen wie Spannungskopfschmerzen und Migräne beginnen in der Kindheit und werden mit der Einschulung und Pubertät häufiger. Bei Spannungskopf-schmerzen spielt die zentrale Schmerzsensibilisierung und Aktivierung zentraler nozizeptiver Neurone eine wichtige Rolle. Die Migräne ist eine primäre Erkrankung des Gehirns mit Auffälligkeiten schmerzmodulierender Systeme und der kortikalen Reizverarbeitung. Bei beiden Kopfschmerzformen spielen bio-psycho-soziale Faktoren eine entscheidende Rolle. Sekundäre Kopfschmerzen durch eine entzündliche oder strukturelle hirnorganische Ursache sind selten. Die Diagnose erfolgt anhand der Anamnese und der körperlichen Untersuchung sowie apparativer Untersuchungen bei Auffälligkeiten. Bei Spannungskopfschmerzen steht die multimodale Schmerztherapie im Vordergrund, bei Migräne die medikamentöse Therapie der Attacken und bei sekundären Kopfschmerzen die Behandlung der Grunderkrankung. Behandlungsziele sind die Minderung der Schmerzwahrnehmung, Förderung von Kontroll- und Selbstwirksamkeitserfahrungen, die Steigerung der körperlichen Leistungsfähigkeit sowie die Wiederaufnahme normaler Alltagsstrukturen und sozialer Kontakte als Voraussetzung für eine zunehmende Schmerzminderung.

Objective Major depression with peripartum onset (MDP) has been associated with multiple adverse offspring health outcomes. The biological mechanisms underlying this relationship remain unclear, but DNA methylation (DNAm) represents a plausible mechanism for mediating MDP exposures and changes in offspring development, behavior, and health. Advances in DNAm research necessitate reevaluating the MDP-DNAm literature to determine how well past studies conform with current best practices. Method Five databases were searched to identify studies of prenatal-onset MDP and DNAm. Quality scores were assigned to each article independently by two raters using a novel scale specific for MDP-DNAm research. Results Nineteen studies met inclusion criteria. Quality scores ranged from 10 to 17 out of 24 points (M = 12.8; SD = 1.9), with higher scores indicating increased study rigor. Poor covariate reporting was the most significant contributor to lower scores. Conclusion No longitudinal MDP-DNAm studies exist. Earlier MDP-DNAm studies should be interpreted with caution, and future research must commit to sharing methodology and data to facilitate cross-study comparisons and maximize dataset utility.

Introduction The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study. Subjects and methods Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted. Results A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout. Discussion These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.

In social contexts, the dynamic nature of others' emotions places unique demands on attention and emotion regulation. Mindfulness, characterized by heightened and receptive moment-to-moment attending, may be well-suited to meet these demands. In particular, mindfulness may support more effective cognitive control in social situations via efficient deployment of top-down attention. To test this, a randomized controlled study examined effects of mindfulness training (MT) on behavioral and neural (event-related potentials [ERPs]) responses during an emotional go/no-go task that tested cognitive control in the context of emotional facial expressions that tend to elicit approach or avoidance behavior. Participants (N = 66) were randomly assigned to four brief (20 min) MT sessions or to structurally equivalent book learning control sessions. Relative to the control group, MT led to improved discrimination of facial expressions, as indexed by d-prime, as well as more efficient cognitive control, as indexed by response time and accuracy, and particularly for those evidencing poorer discrimination and cognitive control at baseline. MT also produced better conflict monitoring of behavioral goal-prepotent response tendencies, as indexed by larger No-Go N200 ERP amplitudes, and particularly so for those with smaller No-Go amplitude at baseline. Overall, findings are consistent with MT's potential to enhance deployment of early top-down attention to better meet the unique cognitive and emotional demands of socioemotional contexts, particularly for those with greater opportunity for change. Findings also suggest that early top-down attention deployment could be a cognitive mechanism correspondent to the present-oriented attention commonly used to explain regulatory benefits of mindfulness more broadly.

The present study investigated whether a brief yoga intervention would be feasible and acceptable for dental students. Based on empirical evidence about state mindfulness (SM), change in self-reported SM was assessed as a measure of the intervention’s feasibility and acceptability. A repeated-measures within-subjects design was used. Participants were third- and fourth-year dental and dental hygiene students (76% female). The State Mindfulness Scale (SMS), a validated self-report measure of SM with 2 subscales, Mind and Body, was used. Students (n = 132) completed the SMS immediately prior to and following a 1-hour yoga intervention. Dispositional mindfulness, burnout, perceived stress, and depressive symptoms were also investigated as moderators of changes in state mindfulness to determine whether psychological variables had an effect on feasibility in this sample. Total SM significantly increased from pre- to post-intervention, t(46) = 10.26, P < .001. An analysis of covariance showed a significant interaction effect in the relationship between pre-/post-intervention SM of Mind ( β = 0.51, P = .048), such that higher levels of stress saw greater increases in SM of Mind. No other psychological variables were significant moderators. A brief yoga intervention for dental students significantly increased SM, suggesting that yoga interventions may be feasible and acceptable in this population. The results of moderation analyses suggest that a brief yoga intervention may be especially effective at increasing SM for those with high levels of stress. Future research should use a randomized control group to test group differences in SM after a brief yoga intervention for dental students.

High levels of stress and related burnout in healthcare professionals (HCPs) are prevalent and costly conditions. Mindfulness training has received recent attention as a possible prevention/intervention strategy to enhance resilience to stress and reduce risk of burnout in HCPs. The purpose of this mixed-methods pilot study was to evaluate the preliminary feasibility, acceptability, and preliminary effects of an 8-week mindfulness curriculum for interprofessional HCPs and trainees (n = 27). Qualitative findings supported feasibility and acceptability of the course for a wide variety of HCP disciplines, including nursing, dentistry, medicine, pharmacy, social work, mental health, and clinical research. Despite being limited by a small sample size, there were statistically significant reductions in perceived stress, anxiety, and specific aspects of burnout from pre-to post-intervention and there was a trend in an enhanced sense of personal accomplishment over time.

Hydroxychloroquine (HCQ) is one of the drugs frequently used for the treatment of interstitial lung disease (ILD) in children (chILD). This use is off-label and studies to analyze the effect and safety of HCQ in chILD are lacking. Therefore, a literature research on the usage of chloroquine (CQ) and HCQ in these conditions was done. Eighty-five case reports and small series in the period from 1984 to 2013 were identified in which children with different diagnoses of ILD were treated with CQ or HCQ, sometimes in combination with other medication including steroids. A favorable response to HCQ or CQ was reported in 35 cases, whereas in the other cases the effect was negative or not clear. The dose of HCQ used was between 5 and 10 mg/kg body weight/day (bw/d). No pharmacokinetic studies have been done. The side effect profile in children seemed to be similar to that in adults. Most often gastrointestinal symptoms were reported. Three patients were found developing retinal changes during the treatment with CQ, whereas in none of the patients treated with HCQ retinal changes were reported. Based on retrospective case reports and small series likely to be reported with bias, the use of HCQ in chILD might be classified as safe. As no prospective data on efficacy and safety of HCQ in chILD are available, systematic collection is necessary. This may be achieved by web-based registers like the European Management Platform for Childhood Interstitial Lung Diseases. Prospective and controlled investigations of HCQ in patients with chILD are mandatory.