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Dickson NR, Beauchamp KD, Perry TS, Roush A, Goldschmidt D, Edwards ML, Blakely LJ. Real-world use and clinical impact of an electronic patient-reported outcome tool in patients with solid tumors treated with immuno-oncology therapy. J Patient Rep Outcomes 2024; 8:23. [PMID: 38416270 PMCID: PMC10899997 DOI: 10.1186/s41687-024-00700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Utilization of electronic patient-reported outcome (ePRO) tools to monitor symptoms in patients undergoing cancer treatment has shown clinical benefits. Tennessee Oncology (TO) implemented an ePRO platform in 2019, allowing patients to report their health status online. We conducted a real-world, multicenter, observational, non-interventional cohort study to evaluate utilization of this platform in adults with solid tumors who initiated immuno-oncology (IO) therapy as monotherapy or in combination at TO clinics. METHODS Patients initiating IO therapy prior to platform implementation were included in a historical control (HC) cohort; those initiating treatment after implementation were included in the ePRO cohort, which was further divided into ePRO users (platform enrollment ≤ 45 days from IO initiation) and non-users. Data were extracted from electronic medical records; patients were followed for up to 6 months (no minimum follow up). Outcomes included patient characteristics, treatment patterns, duration of therapy (DoT), and overall survival (OS). RESULTS Data were collected for 538 patients in the HC and 1014 in the ePRO cohort; 319 in the ePRO cohort were ePRO users (uptake rate 31%). Baseline age was higher, more patients had stage IV disease at diagnosis, and more received monotherapy (82 vs 52%, respectively) in the HC vs the ePRO cohort. Median follow-up was 181.0 days (range 0.0-182.6) in the HC and 175.0 (0.0-184.0) in the ePRO cohort. Median DoT of index IO regimen was 5.1 months (95% confidence interval [CI], 4.4-NE) in the HC cohort vs not estimable (NE) in the ePRO cohort. Multivariable regression adjusting for baseline differences confirmed lower risk of treatment discontinuation in the ePRO vs HC cohort: hazard ratio (HR) 0.83 (95% CI, 0.71-0.97); p < 0.05. The estimated 6-month OS rate was 65.5% in the HC vs 72.4% in the ePRO cohort (p < 0 .01). Within the ePRO cohort, DoT of index IO regimen and OS did not differ between users and non-users. In ePRO users, patient platform use was durable over 6 months. CONCLUSION Improvements in DoT and OS were seen after ePRO platform implementation. Conclusions are limited by challenges in separating the impact of platform implementation from other changes affecting outcomes.
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Affiliation(s)
- Natalie R Dickson
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA
| | | | | | - Ashley Roush
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA
| | | | | | - L Johnetta Blakely
- Tennessee Oncology, 2004 Hayes Street - 8th Floor, Nashville, TN, 37203, USA.
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Thriemer K, Commons RJ, Rajasekhar M, Degaga TS, Chand K, Chau NH, Assefa A, Naddim MN, Pasaribu AP, Rahim AG, Sutanto I, Hien TT, Hailu A, Hasanzai MA, Ekawati LL, Woyessa A, Teferi T, Waithira N, Taylor WRJ, Ley B, Dondorp A, Baird JK, White NJ, Day NP, Price RN, Simpson JA, von Seidlein L. The heterogeneity of symptom reporting across study sites: a secondary analysis of a randomised placebo-controlled multicentre antimalarial trial. BMC Med Res Methodol 2023; 23:198. [PMID: 37667204 PMCID: PMC10476314 DOI: 10.1186/s12874-023-02022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
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.
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Affiliation(s)
- Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
| | - Robert James Commons
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Medical Services, Grampians Health Ballarat, Ballarat, Australia
| | - Megha Rajasekhar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Krisin Chand
- Oxford University Clinical Research Unit, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen Hoang Chau
- Oxford University Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Global Health and Infectious Disease, Chapel Hill, NC, USA
| | | | | | - Awab Ghulam Rahim
- Nangarhar Medical Faculty, Ministry of Higher Education, Nangarhar University, Jalalabad, Afghanistan
| | - Inge Sutanto
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tran Tinh Hien
- Oxford University Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Asrat Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Lenny L Ekawati
- Oxford University Clinical Research Unit, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Adugna Woyessa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tedla Teferi
- Arba Minch General Hospital, Arba Minch, Ethiopia
| | - Naomi Waithira
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Walter R J Taylor
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Arjen Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J Kevin Baird
- Oxford University Clinical Research Unit, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P Day
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Whitfield A, Wardrope A, Ardern K, Garlovsky J, Oto M, Reuber M. Subjective seizure symptom reporting in functional/dissociative seizures and epilepsy: Effects of sampling technique and patient characteristics. Epilepsy Behav 2023; 145:109331. [PMID: 37406557 DOI: 10.1016/j.yebeh.2023.109331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Differences in subjectively reportable ictal experiences between epilepsy and functional/dissociative seizures (FDS) have received less attention than visible manifestations. Patients with FDS (pwFDS) tend to report seizure symptoms differently than patients with epilepsy (pwE). The effects of symptom elicitation method and mediation by psychopathological traits have not been examined and may aid in differentiating the disorders. METHOD Analysis of responses of 24 pwE and 28 pwFDS in interviews exploring ictal experiences through open questioning followed by structured closed questioning using possible symptom prompts (74-item modified Psychosensory-Psychomotor Phenomena Interview, PPPI); self-report of psychological profile (HADS-A, HADS-D, PHQ-15, DES-T, THQ, PCL-C). RESULTS Symptom prompting with PPPI elicited three times more seizure symptoms than open questions in pwE (median 34 vs. 11.5, p = 0.005) and over four times more in pwFDS (42.5 vs. 11, p = 0.001). Intra-ictal symptoms were reported freely more frequently by pwE (median 6.5 vs. 4, p = 0.005), while pwFDS reported more pre-ictal symptoms after prompts (median 6 vs 14.5, p = 0.004). The difference between freely reported and PPPI-elicited symptoms correlated with different psychopathological traits in pwE and pwFDS. Symptoms of anxiety (HADS-A) correlated more strongly with prompted symptoms among pwE than pwFDS (z = 2.731, p = 0.006). CONCLUSION Prompting generates more detailed ictal symptom profiles than simply encouraging patients to narrate their subjective seizure experiences. While pwFDS freely reported fewer symptoms related to the intra-ictal period compared to pwE, pwFDS reported more pre-ictal symptoms than pwE when prompted. Differences in the psychopathological traits associated with the number of peri-ictal symptoms captured by symptom prompting in pwE and pwFDS possibly reflect etiological or psychological differences between these patient groups.
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Affiliation(s)
- Andrew Whitfield
- Greater Glasgow and Clyde NHS Foundation Trust, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom.
| | - Alistair Wardrope
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Kerry Ardern
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Jack Garlovsky
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Maria Oto
- Greater Glasgow and Clyde NHS Foundation Trust, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom; The William Quarrier Scottish Epilepsy Centre, 20 St Kenneth Dr, Govan, Glasgow G51 4QD, United Kingdom
| | - Markus Reuber
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom; Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
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Deshields TL, Penalba V, Arroyo C, Tan B, Tippey A, Amin M, Miller R, Nelson A. The relationship between response style and symptom reporting in cancer patients. Support Care Cancer 2023; 31:312. [PMID: 37126138 DOI: 10.1007/s00520-023-07761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
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.
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Affiliation(s)
- Teresa L Deshields
- Rush University Cancer Center, Rush University College of Medicine, Chicago, IL, USA.
| | | | - Cassandra Arroyo
- Department of Research, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Benjamin Tan
- Department of Medicine, Washington University, St. Louis, MO, USA
| | - Amaris Tippey
- Siteman Cancer Center, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Manik Amin
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Isakoff SJ, Said MR, Kwak AH, Glieberman E, O'Rourke EA, Stroiney A, Spring LM, Moy B, Bardia A, Horick N, Peppercorn JM. Feasibility of introducing a smartphone navigation application into the care of breast cancer patients (The FIONA Study). Breast Cancer Res Treat 2023; 199:501-509. [PMID: 37103597 PMCID: PMC10132949 DOI: 10.1007/s10549-023-06918-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/18/2023] [Indexed: 04/28/2023]
Abstract
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.
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Affiliation(s)
- Steven J Isakoff
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Maya R Said
- Outcomes4Me Inc, One Beacon St, 15th Floor, Boston, MA, 02108, USA
| | - Agnes H Kwak
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
| | - Eva Glieberman
- Outcomes4Me Inc, One Beacon St, 15th Floor, Boston, MA, 02108, USA
| | - Emily A O'Rourke
- Outcomes4Me Inc, One Beacon St, 15th Floor, Boston, MA, 02108, USA
| | - Amanda Stroiney
- Outcomes4Me Inc, One Beacon St, 15th Floor, Boston, MA, 02108, USA
| | - Laura M Spring
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
| | - Nora Horick
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jeffrey M Peppercorn
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
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Emmert NA, Ristow G, McCrea MA, deRoon-Cassini TA, Nelson LD. Comparing Traumatic Brain Injury Symptoms Reported via Questionnaires Versus a Novel Structured Interview. J Int Neuropsychol Soc 2022; 28:143-53. [PMID: 33752775 DOI: 10.1017/S1355617721000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Öztürk ES, Kutlutürkan S. The Effect of the Mobile Application-Based Symptom Monitoring Process on the Symptom Control and Quality of Life in Breast Cancer Patients. Semin Oncol Nurs 2021; 37:151161. [PMID: 34088557 DOI: 10.1016/j.soncn.2021.151161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with breast cancer receiving chemotherapy experience many symptoms. This study set out to determine the effect of the mobile application-based symptom monitoring process on symptom control and quality of life in breast cancer patients. DATA SOURCES The research sample consisted of 57 patients who applied to an outpatient chemotherapy unit of a university hospital. The patients in the intervention group reported symptoms starting from the first day when they received chemotherapy with Msemptom and until the 15th day after chemotherapy. After evaluation of the daily symptom reports of the patients, the patients were instructed via text message to report symptoms as moderate, severe, or very severe symptoms. After the application, the median of the Memorial Symptom Assessment Scale (MSAS)-physical subscale score of the patients in the control group was found to be statistically significantly higher than in the intervention group (P = .028). It was also found that after application, the medians of the European Organization for Research and Treatment of Cancer-Quality of Life (EORTC-QLQC30), symptom scale and nausea-vomiting score (P = .012), QLQ-BR23 Module sexual function (P = .024), and sexual pleasure subscale score (P = .026) were statistically significantly higher than patients in the intervention group. CONCLUSION The process of symptom monitoring with mobile applications is especially effective in controlling physical symptoms. IMPLICATIONS FOR NURSING PRACTICE It is recommended to expand mobile application-based symptom monitoring process in breast cancer patients and to support the patients in using this application-based process.
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Affiliation(s)
- Elif Sözeri Öztürk
- Faculty of Health Sciences, Nursing Department, Gazi University, Ankara, Turkey.
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Wojtusiak J, Bagchi P, Durbha SSKRTN, Mobahi H, Mogharab Nia R, Roess A. COVID-19 Symptom Monitoring and Social Distancing in a University Population. J Healthc Inform Res 2021; 5:114-131. [PMID: 33437913 PMCID: PMC7790352 DOI: 10.1007/s41666-020-00089-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
This paper reports on our efforts to collect daily COVID-19-related symptoms for a large public university population, as well as study relationship between reported symptoms and individual movements. We developed a set of tools to collect and integrate individual-level data. COVID-19-related symptoms are collected using a self-reporting tool initially implemented in Qualtrics survey system and consequently moved to .NET framework. Individual movement data are collected using off-the-shelf tracking apps available for iPhone and Android phones. Data integration and analysis are done in PostgreSQL, Python, and R. As of September 2020, we collected about 184,000 daily symptom responses for 20,000 individuals, as well as over 15,000 days of GPS movement data for 175 individuals. The analysis of the data indicates that headache is the most frequently reported symptom, present almost always when any other symptoms are reported as indicated by derived association rules. It is followed by cough, sore throat, and aches. The study participants traveled on average 223.61 km every week with a large standard deviation of 254.53 and visited on average 5.77 ± 4.75 locations each week for at least 10 min. However, there is no evidence that reported symptoms or prior COVID-19 contact affects movements (p > 0.3 in most models). The evidence suggests that although some individuals limit their movements during pandemics, the overall study population do not change their movements as suggested by guidelines.
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Affiliation(s)
- Janusz Wojtusiak
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, VA USA
| | - Pramita Bagchi
- Department of Statistics, George Mason University, Fairfax, VA USA
| | | | - Hedyeh Mobahi
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, VA USA
| | - Reyhaneh Mogharab Nia
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, VA USA
| | - Amira Roess
- Department of Global and Community Health, George Mason University, Fairfax, VA USA
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Brown DA, Grant G, Evans K, Leung FT, Hides JA. The association of concussion history and symptom presentation in combat sport athletes. Phys Ther Sport 2021; 48:101-108. [PMID: 33406456 DOI: 10.1016/j.ptsp.2020.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE 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. DESIGN Cross-sectional survey. SETTING Data were collected using an online survey instrument. PARTICIPANTS Three hundred and nine adult combat sport athletes. MAIN OUTCOME MEASURES Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Daniel A Brown
- School of Allied Health Science, 170 Kessels Rd, Nathan, Griffith University, Brisbane, QLD, 4111, Australia.
| | - Gary Grant
- School of Pharmacy and Pharmacology, 1 Parklands Dr, Southport, Griffith University, Gold Coast, QLD, 4215, Australia.
| | - Kerrie Evans
- Faculty of Medicine and Health, 75 East Street, Lidcombe, The University of Sydney, NSW, 2141, Australia; Healthia Limited, Australia, 25 Montpelier Road, Bowen Hills, QLD, 4006, Australia.
| | - Felix T Leung
- School of Allied Health Science, 170 Kessels Rd, Nathan, Griffith University, Brisbane, QLD, 4111, Australia.
| | - Julie A Hides
- School of Allied Health Science, 170 Kessels Rd, Nathan, Griffith University, Brisbane, QLD, 4111, Australia.
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Rogowsky R, Laidlaw A, Ozakinci G. 'Having come to university my care was very much in my hands': exploration of university students' perceptions of health care needs and services using the common-sense model of self-regulation. J Behav Med 2020; 43:943-955. [PMID: 32219601 PMCID: PMC7674182 DOI: 10.1007/s10865-020-00147-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Rayna Rogowsky
- School of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, Scotland, UK
| | - Anita Laidlaw
- School of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, Scotland, UK
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, Scotland, UK.
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Savelieva K, Marttila T, Lampi J, Ung-Lanki S, Elovainio M, Pekkanen J. Associations between indoor environmental quality in schools and symptom reporting in pupil-administered questionnaires. Environ Health 2019; 18:115. [PMID: 31881894 PMCID: PMC6935098 DOI: 10.1186/s12940-019-0555-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/18/2019] [Indexed: 05/29/2023]
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.
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Affiliation(s)
- Kateryna Savelieva
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Tero Marttila
- Unit of Civil Engineering, Faculty of Built Environment, Tampere University, 33014 Tampere, Finland
| | - Jussi Lampi
- Department of Health Security, Environmental Health, National Institute for Health and Welfare, 70701 Kuopio, Finland
| | - Sari Ung-Lanki
- Department of Health Security, Environmental Health, National Institute for Health and Welfare, 70701 Kuopio, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Juha Pekkanen
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Department of Health Security, Environmental Health, National Institute for Health and Welfare, 70701 Kuopio, Finland
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Martens AL, Reedijk M, Smid T, Huss A, Timmermans D, Strak M, Swart W, Lenters V, Kromhout H, Verheij R, Slottje P, Vermeulen RCH. Modeled and perceived RF-EMF, noise and air pollution and symptoms in a population cohort. Is perception key in predicting symptoms? Sci Total Environ 2018; 639:75-83. [PMID: 29778684 DOI: 10.1016/j.scitotenv.2018.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
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 (rSp = 0.34) and noise (rSp = 0.40), but less so for RF-EMF (rSp = 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.
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Affiliation(s)
- Astrid L Martens
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorstraat 7, 1081BT Amsterdam, The Netherlands.
| | - Marije Reedijk
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Universiteitsweg 100, 3584CG Utrecht, The Netherlands.
| | - Tjabe Smid
- Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorstraat 7, 1081BT Amsterdam, The Netherlands.
| | - Anke Huss
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands.
| | - Danielle Timmermans
- Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorstraat 7, 1081BT Amsterdam, The Netherlands; National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721MA Bilthoven, The Netherlands.
| | - Maciej Strak
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands.
| | - Wim Swart
- National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721MA Bilthoven, The Netherlands.
| | - Virissa Lenters
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands.
| | - Hans Kromhout
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands.
| | - Robert Verheij
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513CR Utrecht, The Netherlands.
| | - Pauline Slottje
- Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorstraat 7, 1081BT Amsterdam, The Netherlands.
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Universiteitsweg 100, 3584CG Utrecht, The Netherlands; Imperial College, Department of Epidemiology and Public Health, South Kensington Campus, SW7 2AZ London, United Kingdom.
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13
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Penalba V, Deshields TL, Klinkenberg D. Gaps in communication between cancer patients and healthcare providers: symptom distress and patients' intentions to disclose. Support Care Cancer 2018; 27:2039-2047. [PMID: 30220028 DOI: 10.1007/s00520-018-4442-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/23/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Valentina Penalba
- Siteman Cancer, Barnes-Jewish Hospital, Washington University School of Medicine, 4921 Parkview Place, MS: 90-35-703, St. Louis, MO, 63110, USA.
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Sundberg K, Wengström Y, Blomberg K, Hälleberg-Nyman M, Frank C, Langius-Eklöf A. Early detection and management of symptoms using an interactive smartphone application (Interaktor) during radiotherapy for prostate cancer. Support Care Cancer 2017; 25:2195-2204. [PMID: 28236145 PMCID: PMC5445148 DOI: 10.1007/s00520-017-3625-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/06/2017] [Indexed: 12/22/2022]
Abstract
Purpose Patients undergoing radiotherapy for prostate cancer suffer from a variety of symptoms which influence health-related quality of life. We have developed an application (Interaktor) for smartphones and tablets for early detection, reporting and management of symptoms, and concerns during treatment for prostate cancer. The study evaluates the effect on symptom burden and quality of life when using the application for real-time symptom assessment and management during radiotherapy for localized prostate cancer. Methods A non-randomized controlled study was used at two university hospitals in Sweden where 64 patients constituted a control group and 66 patients made up an intervention group. The intervention group was asked to report symptoms via the application daily during the treatment as well as 3 weeks after. The EORTC QLQ-C30 and its module PR25 and the Sense of Coherence questionnaire were administered at three time points in both groups. Results The intervention group rated significantly lower levels of fatigue and nausea at the end of radiotherapy. Moreover, they had significantly less burden in emotional functioning, insomnia, and urinary-related symptoms at the end of treatment as well as 3 months later compared with the control group. In the multivariate analyses, with education and sense of coherence as covariates, the intervention group still significantly rated emotional functioning (p = 0.007), insomnia (p = 0.017), and urinary-related symptoms (p = 0.008) as better than the control group at T2. Conclusion Study findings suggest that Interaktor could be an efficient mHealth tool for facilitating supportive care needs during cancer treatment.
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Affiliation(s)
- Kay Sundberg
- Department of NVS, Division of Nursing, Karolinska Institutet, 23 300, Huddinge, 14183, Stockholm, Sweden. .,Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden.
| | - Yvonne Wengström
- Department of NVS, Division of Nursing, Karolinska Institutet, 23 300, Huddinge, 14183, Stockholm, Sweden.,Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Catharina Frank
- Department of NVS, Division of Nursing, Karolinska Institutet, 23 300, Huddinge, 14183, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Department of NVS, Division of Nursing, Karolinska Institutet, 23 300, Huddinge, 14183, Stockholm, Sweden
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Wright BK, McFarlane AC, Clarke DM, Sim MR, Kelsall HL. Symptom attribution and symptom reporting in Australian Gulf War veterans. J Psychosom Res 2015; 79:674-9. [PMID: 26386619 DOI: 10.1016/j.jpsychores.2015.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/06/2015] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To better understand the consistent elevated symptom reporting by Gulf War veterans; we compared Australian Gulf War veterans and military-comparison group on symptom attributional styles and the relationship with total number and grouping of somatic and psychological symptoms. METHOD Postal questionnaires were completed by Australian Gulf War veterans (n=697) and military-comparison group (n=659) in 2000-2002 and 2011-2012. Data were collected on deployments, military-psychological stressors, symptom reporting, symptom factors and attributional style (normalising, psychologising, somatising, mixed-attribution). RESULTS Gulf War veterans did not differ in attributional style from comparison group (p>0.05); normalising was the predominant style. Groups were combined for analyses. Psychologisers reported the highest overall symptoms (mean(M)=10.95, standard deviation(SD)=9.15), the most psychophysiological (M=1.71, SD=2.82), cognitive (M=5.79, SD=5.09) and arthro-neuromuscular symptoms (M=1.53, SD=1.73). Psychologisers and somatisers reported significantly more symptoms across overall symptoms, all three symptom factors and psychological distress than normalisers. Normalisers consistently reported fewest overall symptoms (M=2.85, SD=4.49), psychophysiological (M=0.40, SD=0.98), cognitive (M=1.14, SD=2.22), and arthro-neuromuscular symptoms (M=0.72, SD=1.31). Persistent symptoms, rather than remitted, between baseline and follow-up were associated with increased rates of psychologising and mixed-attribution compared with normalising. For incident symptoms a similar pattern was observed, some symptoms also showed increased rates of somatising. CONCLUSIONS In veterans, psychologising was associated with higher symptom reporting, whilst somatisers and mixed-attribution also demonstrated higher reporting than normalisers. Symptom persistence and incidence were associated with symptom attribution. The findings indicate that attributional style is associated with patterns of symptom reporting and highlights both past and present symptoms may influence attributional style.
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Affiliation(s)
- Breanna K Wright
- Department of Epidemiology & Preventive Medicine, Monash University, Australia.
| | | | | | - Malcolm R Sim
- Department of Epidemiology & Preventive Medicine, Monash University, Australia
| | - Helen L Kelsall
- Department of Epidemiology & Preventive Medicine, Monash University, Australia.
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Crichton F, Petrie KJ. Health complaints and wind turbines: The efficacy of explaining the nocebo response to reduce symptom reporting. Environ Res 2015; 140:449-455. [PMID: 25981871 DOI: 10.1016/j.envres.2015.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND A number of people are reporting an environmental sensitivity to sub-audible windfarm sound (infrasound), characterised by the experience of recurrent non-specific symptoms. A causal link between exposure and symptoms is not indicated by empirical evidence. Research indicates symptoms may be explained by the nocebo response, whereby health concerns and negative expectations, created from social discourse and media reports, trigger symptom reporting. OBJECTIVE The experimental aim was to test whether providing a nocebo explanation for symptoms, to individuals reporting symptomatic experiences during infrasound exposure, would ameliorate symptoms during further exposure. METHOD Sixty-six volunteers were randomly assigned to nocebo explanation or biological explanation groups. Participants were concurrently exposed to infrasound and audible windfarm sound, while reporting on current symptoms and mood, during two exposure sessions. Preceding session one, participants watched a presentation integrating media warnings about purported health risks posed by windfarm infrasound. Before session two, nocebo explanation participants viewed material outlining how nocebo responding could explain symptom reporting. Instead biological explanation participants watched material presenting pathophysiological theories for symptoms. RESULTS During session one, participants reported increased symptoms and mood deterioration from baseline assessment. During session two symptom reporting and mood deterioration was maintained by biological explanation participants, while mood and symptoms reported by nocebo explanation participants returned to baseline levels. CONCLUSION Results indicate that providing an explanation of the nocebo response, followed by exposure to infrasound, has the potential to operate as an intervention to reduce symptomatic experiences in people reporting symptoms attributed to windfarm generated infrasound.
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Abstract
Concussions from sport present a substantial public health burden given the number of youth, adolescent and emerging adult athletes that participate in contact or collision sports. Athletes who fail to report symptoms of a suspected concussion and continue play are at risk of worsened symptomatology and potentially catastrophic neurologic consequences if another impact is sustained during this vulnerable period. Understanding why athletes do or do not report their symptoms is critical for developing efficacious strategies for risk reduction. Psychosocial theories and frameworks that explicitly incorporate context, as a source of expectations about the outcomes of reporting and as a source of behavioral reinforcement, are useful in framing this problem. The present study quantifies the pressure that athletes experience to continue playing after a head impact--from coaches, teammates, parents, and fans--and assesses how this pressure, both independently and as a system, is related to future concussion reporting intention. Participants in the study were 328 male and female athletes from 19 teams competing in one of seven sports (soccer, lacrosse, basketball, softball, baseball, volleyball, field hockey) at four colleges in the northeast region of the United States. Results found that more than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year. Results of a latent profile mixture model indicated that athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future than were athletes who had not experienced pressure from all sources, or only pressure from coaches and teammates. These findings underscore the importance of designing interventions that address the system in which athletes make decisions about concussion reporting, including athletes' parents, rather than focusing solely on modifying the individual's reporting cognitions.
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Affiliation(s)
- Emily Kroshus
- Harvard School of Public Health, Department of Social and Behavioral Science, USA; National Collegiate Athletic Association, Sport Science Institute, USA; Harvard University, Edmond J. Safra Center for Ethics, USA.
| | - Bernice Garnett
- University of Vermont, College of Education and Social Services, Department of Education, USA.
| | | | - Christine M Baugh
- Harvard University, Edmond J. Safra Center for Ethics, USA; Harvard University, Interfaculty Initiative in Health Policy, USA; Boston Children's Hospital, Division of Sports Medicine, USA.
| | - Jerel P Calzo
- Boston Children's Hospital, Division of Adolescent & Young Adult Medicine, USA; Harvard Medical School, Department of Pediatrics, USA.
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