Schizotypy, Lifestyle Behaviors, and Health Indicators in a Young Adult Sample

Problematic lifestyle behaviors and high rates of physical illness are well documented in people with schizophrenia, contributing to premature mortality. Yet, there is a notable absence of research examining general lifestyle and health issues in participants at risk for psychosis. This form of research may help identify concerns that exist during prodromal periods related to future outcomes. Accordingly, the current study examined lifestyle and health in a nonclinical sample of 530 young adults with varying levels of schizotypy. Increasing symptom severity was associated with greater somatic symptoms and poorer sleep quality across positive, negative, and disorganized domains. Elevated negative and disorganized symptoms were associated with significantly reduced health-related quality of life, while evidence for reduced engagement in health behaviors was largely limited to those with elevated negative schizotypy. No relationships emerged between symptom presentation/severity and body mass index or substance use, although zero-order correlations suggested an association between disorganized schizotypy and nicotine use. The pattern of relationships in the current study was consistent with findings from the ultra-high risk and clinical literature suggesting that lifestyle and health concerns may exist on a continuum with psychosis. Future research should seek to clarify if these patterns are associated with long-term physical or mental health outcomes.

SARS-CoV-2 and endemic coronaviruses: Comparing symptom presentation and severity of symptomatic illness among Nicaraguan Children

It has been proposed that as SARS-CoV-2 transitions to endemicity, children will represent the greatest proportion of SARS-Co-V-2 infections as they currently do with endemic coronavirus infections. While SARS-CoV-2 infection severity is low for children, it is unclear if SARS-CoV-2 infections are distinct in symptom presentation, duration, and severity from endemic coronavirus infections in children. We compared symptom risk and duration of endemic coronavirus infections from 2011-2016 with SARS-CoV-2 infections from March 2020-September 2021 in a Nicaraguan pediatric cohort. Respiratory samples were collected from participants that met testing criteria and blood samples were collected annually. Respiratory samples were tested for each of the endemic coronaviruses from 2011-2016 and for SARS-CoV-2 from 2020-2021 via rt-PCR. 2021 blood samples were tested for SARS-CoV-2 antibodies and a subset of 2011-2016 blood samples from four-years-old participants were tested for endemic coronavirus antibodies. By April 2021, 854 (49%) active participants were ELISA positive for SARS-CoV-2 antibodies. Most participants had antibodies against one alpha and one beta coronavirus by age four. We observed 595 symptomatic endemic coronavirus infections from 2011-2016 and 121 symptomatic with SARS-CoV-2 infections from March 2020-September 2021. Symptom presentation of SARS-CoV-2 infection and endemic coronavirus infections were very similar, and SARS-CoV-2 symptomatic infections were as or less severe on average than endemic coronavirus infections. This suggests that, for children, SARS-CoV-2 may be just another endemic coronavirus. However, questions about the impact of variants and the long-term effects of SARS-CoV-2 remain.

COVID-19 symptoms at time of testing and association with positivity among outpatients tested for SARS-CoV-2

Introduction Symptoms associated with SARS-CoV-2 infection remain incompletely understood, especially among ambulatory, non-hospitalized individuals. With host factors, symptoms predictive of SARS-CoV-2 could be used to guide testing and intervention strategies. Methods Between March 16 and September 3, 2020, we examined the characteristics and symptoms reported by individuals presenting to a large outpatient testing program in the Southeastern US for nasopharyngeal SARS-CoV-2 RNA RT-PCR testing. Using self-reported symptoms, demographic characteristics, and exposure and travel histories, we identified the variables associated with testing positive using modified Poisson regression. Results Among 20,177 tested individuals, the proportion positive was 9.4% (95% CI, 9.0–9.8) and was higher for men, younger individuals, and racial/ethnic minorities (all P<0.05); the positivity proportion was higher for Hispanics (26.9%; 95% CI. 24.9–29.0) compared to Blacks (8.6%; 95% CI, 7.6–9.7) or Whites (5.8%; 95% CI, 5.4–6.3). Individuals reporting contact with a COVID-19 case had the highest positivity proportion (22.8%; 95% CI, 21.5–24.1). Among the subset of 8,522 symptomatic adults who presented for testing after May 1, when complete symptom assessments were performed, SARS-CoV-2 RNA PCR was detected in 1,116 (13.1%). Of the reported symptoms, loss of taste or smell was most strongly associated with SARS-CoV-2 RNA detection with an adjusted risk ratio of 3.88 (95% CI, 3.46–4.35). The presence of chills, fever, cough, aches, headache, fatigue and nasal congestion also significantly increased the risk of detecting SARS-CoV-2 RNA, while diarrhea or nausea/vomiting, although not uncommon, were significantly more common in those with a negative test result. Symptom combinations were frequent with 67.9% experiencing ≥4 symptoms, including 19.8% with ≥8 symptoms; report of greater than three symptoms increased the risk of SARS-CoV-2 RNA detection. Conclusions In a large outpatient population in the Southeastern US, several symptoms, most notably loss of taste or smell, and greater symptom burden were associated with detection of SARS-CoV-2 RNA. Persons of color and those with who were a contact of a COVID-19 case were also more likely to test positive. These findings suggest that, given limited SARS-CoV-2 testing capacity, symptom presentation and host characteristics can be used to guide testing and intervention prioritization.

High frequency of otolaryngology/ENT encounters in Canadian primary care despite low medical undergraduate

Otolaryngology involves the treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. Many medical students in Canada have limited experiences in ENT and a vast majority of these students go on to pursue a career as primary care physicians. Physicians at a primary care facility classified patient’s visits as either being “ENT” related or not, to assess the amount of ENT related concerns they typically encounter. The data was collected separately in the summer and winter months to assess any seasonal variability. One in eight patient encounters presented with an ENT related concern. The percentage of ENT related symptom presentation visits in the pediatric population for both data collection periods (29%) was more than three times that of the adult population (9%). The rate of ENT symptom presentation in both adult and pediatric populations was not affected by seasonality. Primary care physicians will encounter new patients presenting with ENT related concerns quite frequently. This is especially true in the pediatric patient population. Increased ENT medical education is both necessary and essential for undergraduate medical students, residents, and primary care physicians.

Detection of Feigning of Different Symptom Presentations With the PAI and IOP-29

This study examined the effectiveness of the negative distortion measures from the Personality Assessment Inventory (PAI) and Inventory of Problems-29 (IOP-29), by investigating data from a community and a forensic sample, across three different symptom presentations (i.e., feigned depression, posttraumatic stress disorder [PTSD], and schizophrenia). The final sample consisted of 513 community-based individuals and 288 inmates (total N = 801); all were administered the PAI and the IOP-29 in an honest or feigning conditions. Statistical analyses compared the average scores of each measure by symptom presentation and data source (i.e., community vs. forensic sample) and evaluated diagnostic efficiency statistics. Results suggest that the PAI Negative Impression Management scale and the IOP-29 are the most effective measures across all symptom presentations, whereas the PAI Malingering Index and Rogers Discriminant Function generated less optimal results, especially when considering feigned PTSD. Practical implications are discussed.

Retinal Hemorrhage after SARS-CoV-2 Vaccination

To report retinal vein occlusion (RVO) and age-related macular degeneration (AMD)-related submacular hemorrhage developing after administration of SARS-CoV-2 vaccines, a single-center, retrospective observational case series was conducted. Clinical data including fundus photographs and optical coherence tomography (OCT) scans were reviewed. Twenty-three eyes of 21 patients were included with the median age at symptom presentation being 77 years (range: 51–85 years). Twelve eyes (52.2%) had submacular hemorrhage and 11 (47.8%) had RVO. Twelve patients (60.9%) had been vaccinated with the Pfizer vaccine (BNT162b2) and 8 with the AstraZeneca (ChAdOx1) vaccine. Sixteen patients (76.2%) experienced ocular disease exacerbation after the first vaccination and 4 (19.0%) after the second vaccination. The median visual acuity (logarithm of the minimal angle of resolution; logMAR) before symptom development was 0.76 (interquartile range: 0.27–1.23); the median logMAR at symptom presentation was 1.40 (interquartile range 0.52–1.70). The median time between vaccination and symptom exacerbation was 2.0 days (interquartile range: 1.0–3.0 days). Five patients (23.8%) underwent tests for hematological abnormalities, including the presence of anti-PF4 antibodies; all were negative. Further studies with larger patient group for evaluation of effect of SARS-CoV-2 vaccination on retinal hemorrhage are necessary.

Assessment of correlations between risk factors and symptom presentation among defined at-risk groups following a confirmed COVID-19 diagnosis

This study analyzes the specific linkages between symptoms within individual COVID patients belonging to at-risk groups. The goal was to determine how strongly linked patient symptoms are within these at-risk groups to find any associations between factors such as comorbidities and COVID symptoms. In this study, de-identified patient data from the N3C database was utilized in order to link representative immunocompromised states with specific symptoms, and non-immunocompromised state with the same, to determine if the strength of the correlation changes for these at-risk groups. Multiple autoimmune disorders resulting in immunocompromised state were analyzed, to determine if severity of immune response and inflammatory action plays a role in any potential differences. An exploratory approach using statistical methods and visualization techniques appropriate to multidimensional data sets was taken. The identified correlations may allow pattern analysis in disease presentation specific to a given population, potentially informing pattern recognition, symptom presentation, and treatment approaches in patients with immune comorbidities.

Qntifying and Examining Reserve in Symptomatic Former National Football League Players

Background: Repetitive head impacts (RHI) from contact sports have been associated with cognitive and neuropsychiatric disorders. However, not all individuals exposed to RHI develop such disorders. This may be explained by the reserve hypothesis. It remains unclear if the reserve hypothesis accounts for the heterogenous symptom presentation in RHI-exposed individuals. Moreover, optimal measurement of reserve in this population is unclear and likely unique from non-athlete populations. Objective: We examined the association between metrics of reserve and cognitive and neuropsychiatric functioning in 89 symptomatic former National Football League players. Methods: Individual-level proxies (e.g., education) defined reserve. We additionally quantified reserve as remaining residual variance in 1) episodic memory and 2) executive functioning performance, after accounting for demographics and brain pathology. Associations between reserve metrics and cognitive and neuropsychiatric functioning were examined. Results: Higher reading ability was associated with better attention/information processing (β=0.25; 95%CI, –0.13–0.64), episodic memory (β=0.27; 95%CI, 0.16–0.38), semantic fluency (β=0.24; 95%CI, 0.01–0.47; β=0.38; 95%CI, –0.14–0.90), and behavioral regulation (β=–0.26; 95%CI, –0.78–0.27) performance. There were no effects for other individual-level proxies. Residual episodic memory variance was associated with better attention/information processing (β=0.45; 95%CI, –0.34–1.24), executive functioning (β=0.36; 95%CI, –3.14–3.86), and semantic fluency (β=0.38; 95%CI, –0.08–0.84) performance. Residual executive functioning variance was associated with better attention/information processing (β=0.44; 95%CI, 0.39–0.49) and episodic memory (β=0.37; 95%CI, 0.36–0.39) performance. Conclusion: Traditional reserve proxies (e.g., years of education, occupational attainment) have limitations and may be unsuitable for use in elite athlete samples. Alternative approaches of reserve quantification may prove more suitable for this population.

A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy

Background Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). Methods The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’ training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time, medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. Results A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. Conclusions Expanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. Trial registration ISRCTN, ISRCTN17235323. Registered 07/05/2021 - Retrospectively registered