Journal of Psychosomatic Research

IntroductionSymptom perception is highly subjective and influenced by the complex interplay of biopsychosocial factors. This study aimed to explore whether negative affect induction using the Affect and Symptoms Paradigm (ASP) influences symptom perception in patients with non-dialysis chronic kidney disease (ND-CKD) and healthy controls. MethodsParticipants watched three picture series with varying affective content (positive, negative, neutral) from the International Affective Picture System (IAPS). After each picture set, participants rated symptom levels (10-item symptom checklist), affective state (Positive and Negative Affect Schedule) and arousal levels (Self-Assessment-Manikin-System). ResultsIn N = 115 individuals with ND-CKD from the SOMA.CK study (mean age = 62.95, SD = 12.60) and 100 age- and gender-matched healthy controls (mean age = 60.00, SD = 12.80) negative pictures significantly increased negative affectivity and arousal. All participants reported significantly higher symptom levels after negative versus positive and neutral pictures. No significant group differences in overall symptom levels emerged. Habitual symptoms did not moderate symptom levels after negative affect induction, although high habitual symptom reporters showed higher symptom levels across all picture categories. In the CKD group symptom levels were moderated by difficulties in identifying feelings and in controls by suppression as emotion regulation strategy. ConclusionNegative affect induction increases symptom levels, even in a chronic illness such as CKD. These results are in line with the predictive processing model which suggests that symptom perception develops from a complex inferential process of somatosensory input in light of pre-existing symptom representations in memory (priors). HighlightsO_LIPatients with ND-CKD and healthy controls reported higher symptom levels after negative pictures C_LIO_LIHabitual symptoms did not moderate symptom levels after negative pictures C_LIO_LIDifficulties in identifying feelings moderated symptom levels in the CKD group C_LIO_LISuppression moderated symptom levels in the HC group C_LIO_LISymptoms after negative pictures predicted CKD-specific symptom burden at 6 months C_LI

Background and hypothesis.The increased anxiety owing to the COVID-19 pandemic has been suggested to contribute to unhealthy lifestyles and depression in patients undergoing haemodialysis (HD). Therefore, this study aimed to evaluate the degree of fear of COVID-19 after vaccination dissemination and the independent impact of high-order health literacy (HL) on fear, which have not been adequately investigated. Methods.This multicentre cross-sectional study, conducted in 2022, after the widespread availability of the COVID-19 vaccination in Japan, included adults undergoing in-centre HD. Multidimensional HL was measured using the 14-item Functional, Communicative, and Critical Health Literacy Scale. Fear of COVID-19 was measured using the 7-item Japanese version of the Fear of COVID-19 Scale. COVID-19 fear scores in patients with HD were compared with scores of adults in April 2020 (the beginning of the pandemic) using an unpaired t-test. The association between multidimensional HL and COVID-19 fear scores was estimated using a multivariable-adjusted general linear model. Results.A total of 446 patients were analysed, of whom 431 (97%) and nine (2%) received three and two doses of vaccination, respectively. Their COVID-19 fear scores were significantly lower than those of the general population at the beginning of the pandemic (p < 0.001; mean difference -4.4 [95% confidence interval (CI): -5.1 - -3.7]; standardised effect size [ES] 0.77). Higher functional HL was associated with less fear (per 1-pt higher: -2.8 [95% CI: -1.7 - -0.3]; standardised ES -0.51), whereas higher critical HL was associated with greater fear (per 1-pt higher: 3.2 [95% CI: 0.7 - 3.0]; standardised ES 0.80). Communicative HL was not associated with fear. Conclusion.Patients fear of low-functional HL, despite widespread vaccination, can be reduced by providing health information in an easy-to-understand manner. Thus, the fear of sceptics owing to excessive critical HL and honest explanations by healthcare providers may be important. Key learning points What was knownHeightened anxiety stemming from the COVID-19 pandemic exacerbates unhealthy lifestyles and depression, particularly in patients undergoing haemodialysis. Health literacy plays a crucial role in individuals with kidney disease and may mitigate anxiety. Comprehensive data on whether multidimensional health literacy (functional, critical, and communicative) independently correlates with fear of COVID-19, particularly in the context of patients undergoing haemodialysis are lacking. This study addsCOVID-19 fear scores were notably lower in patients undergoing haemodialysis who received the COVID-19 vaccination than in the general population at the onset of the pandemic. Elevated functional health literacy correlated with reduced fear, whereas higher critical health literacy was linked to increased fear. Potential impactFear among individuals with low functional health literacy can be alleviated by delivering health information in a clear and accessible manner, whereas transparent and honest communication from healthcare providers is crucial for patients with heightened fear owing to critical health literacy, who may be sceptical of accurate information.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID are persistent multi-system illnesses affecting many patients. With no known effective FDA-approved treatments for either condition, patient-reported outcomes of treatments are invaluable for guiding management strategies in patient care and generating new avenues for research. Here, we present the results of an ME/CFS and Long COVID treatment survey with responses from 3,925 patients. We assessed the experiences of these patients with more than 150 treatments, as well as their demographics, symptoms, and comorbidities. Patients with each condition who participated in the study shared similar symptom profiles, including all the core symptoms of ME/CFS, e.g., 89.7% of ME/CFS and 79.4% of Long COVID reported post-exertional malaise (PEM). Treatments with the greatest perceived benefits were identified, which had varied effects on different core symptoms. In addition, treatment responses were significantly correlated (R{superscript 2} = 0.68) between the two patient groups. Patient subgroups with distinct profiles of symptoms and comorbidities showed varied responses to treatments, e.g., a POTS-dominant cluster benefiting from autonomic modulators and a cognitive-dysfunction cluster from CNS stimulants. This study underscores the symptomatic and therapeutic similarities between ME/CFS and Long COVID and highlights the commonalities and nuanced complexities of infection-associated chronic diseases and related conditions. Insights from patient-reported experiences, in the absence of approved treatments, provide urgently needed real-world evidence for targeted therapies in patient care and for developing future clinical trials. (Disclaimer: The findings presented in this paper are based on patient-reported information and are intended for research purposes only. They should not be interpreted as medical advice. Patients are advised to consult their healthcare provider before initiating or altering any treatment.)

We aimed to describe the characteristics and current practices of Swiss health professionals who manage patients with occupational burnout (POB), namely the general practitioners (GP), psychiatrist-psychotherapists (PP), occupational physicians (OP) and psychologists. Among 3216 respondents, 2951 reported to consult POB, and 1130 (713 physicians and 410 psychologists) to treat them. The study showed that POB management constitutes 5 to 25% of health care professionals consultations, with an inequal distribution of POBs across professionals specialties and specializations, but also across geographic regions. The profile of POB consulted also differs across professionals. Work psychologists see more often POB at early burnout stage, GPs have most patients with moderate burnout, while PPs report the largest proportion of patients with severe burnout. The treatment practices depend on burnout severity. Psychiatrists and physicians with double specialty (GP-OPs and GP-PPs) treat patients with more severe burnout than GPs. Psychologists treating patients with severe burnout collaborate with other health professionals and contact the POBs employer and/or health insurance. Treatment practices and burnout severity are not associated with the proportion of relapsed patients and patients who return to work. Yet, the former is associated with professionals age, sex, and specialty. Physicians with waiting time >3 months have a higher proportion of relapsed patients. GPs prescribe most often sick leaves, while PPs are the most frequent prescribers of pharmacological treatment. PPs collaborate significantly more often than GPs with pharmacologists and contact POBs employer and health insurance. Among psychologists, work psychologists differ from other psychologists by a more frequent POB (psycho)education and coaching, namely on how to negotiate with employer and family, as well as on physical exercise. They also more often contact POBs employer. Besides profession and specialization, we observed important regional variation in treatment modalities chosen by both physicians and psychologists.

BackgroundThis study explores the link between asthma and memory decline, with a focus on Alzheimers disease, a disease characterized by memory loss that can be intervened with asthma medication. Research design and methodsIn this study, the National Health and Nutrition Examination Survey (NHANES) database combined with Mendelian randomization (MR) was utilized to explore the association between asthma and memory loss. ResultsThe asthma was significantly associated with memory loss, both as an independent exposure factor and after adjusting for various covariates (model 1: odds ratio (OR) = 1.83, 95% confidence intervals (CI) = 1.22-2.74, p = 0.004; model 2: OR = 2.06, 95% CI = 1.34-3.16, p = 0.001; model 3: OR = 1.93, 95% CI = 1.24-3.00, p = 0.004). ROC curve indicated that asthma had a good predictive effect on memory loss (AUC = 0.717). Through MR analysis, there was a significant causal effect of asthma on memory loss (OR = 1.256, 95% CI = 1.015-1.553, p < 0.05). This was consistent with NHANES analysis results, further strengthening association between the two. ConclusionMemory loss was associated with asthma, and the risk increased with the probability of asthma. This provided valuable insights for future research.

BackgroundThe COVID-19 pandemic has had a profound impact on the mental health of people worldwide. Mental health also impacts on physical health. In the context of viral illnesses, viral challenge studies have shown that indices of mental health are associated with susceptibility to viral infections, including coronaviruses. Research conducted during the pandemic has shown that people with a history of mental health conditions were at increased risk of infection, hospitalisation, and mortality. However, the relationship between mental health conditions and vaccine outcomes such as vaccine intentions, uptake, and vaccine breakthrough is not yet well-understood. MethodsWe conducted a systematic search on the topics of COVID-19 vaccine intentions, vaccine uptake, and vaccine breakthrough, in relation to mental health conditions, in four databases: PubMed, MEDLINE, SCOPUS, and PsychINFO, as well as the publication lists of Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), OpenSAFELY, and QResearch. Inclusion criteria focus on studies reporting either of the aforementioned COVID-19 vaccine outcomes among people with mental health conditions. ResultsThirty-three out of 251 publications met our inclusion criteria for this review. Overall, the evidence is inconclusive regarding the level of intention to accept the COVID-19 vaccine among people with mental health conditions. However, people with mental health conditions were more likely to have lower uptake of the COVID-19 vaccine, compared to people without. Common barriers to COVID-19 vaccine uptake include concerns about the safety, effectiveness, and side effects of the vaccines. Limited evidence also suggests that vaccine breakthrough may be a particular risk for those with substance use disorder. ConclusionsOur findings revealed a possible intention-behaviour gap for receiving the COVID-19 vaccine among people with mental health conditions, yielding interventions to encourage vaccine uptake in this population. There is also the need to enhance our understanding of COVID-19 vaccine breakthrough in people with mental health conditions.

ObjectivesDepressive disorders are common in the primary care setting. Primary care practitioners must deal with different disorders and keep up with evidence-based treatment. Clinical practice guidelines (CPG) offer accessible information about up-to-date care but are poorly implemented. Research on the implementation of CPGs has focused on the practitioners perspective but has neglected the patients perspective largely. This scoping review aimed to identify terms related to the concept of patients perspectives on depression treatment in primary care building a comprehensive framework and to identify researched barriers and facilitators to partaking in care. MethodsWe conducted a scoping review on Medline and Psycinfo. Eligible publications contained information from the patients point of view on depression treatment in primary care in OECD member states. We used the PCC-framework to obtain inclusion criteria. Publications until August 2nd 2023 were considered. ResultsWe included 232 publications. Current literature focuses on behavioral and easily collected measures like satisfaction and on patient-sided barriers and facilitators to adherence. Other treatment-related behaviors are less researched. Patients often report exclusively or mainly physical symptoms in their visits which can impede diagnosis. ConclusionThis review provides a comprehensive framework for the concept. Research on the patients perspective on depression treatment in primary care is still inconclusive. RegistrationThis review is registered via OSF (https://osf.io/p9rnc).

Modified electroconvulsive therapy (MECT) is an effective treatment for mood and psychiatric disorders and provides rapid and significant improvements in severe symptoms of several mental health conditions. We attempted to compare the urinary proteome of each depressive patient before and after electroconvulsive therapy. The common biological processes enriched by differential proteins through GO analysis with most patients mainly included cell adhesion (9/9 patients), immune response (7/9), axon guidance (7/9), and oxidation stress (7/9). Moreover, the common biological pathways identified by Ingenuity Pathway Analysis software showed that acute phase response signaling (7/9 patients), NRF2-mediated oxidative stress response (7/9), synaptogenesis signaling pathway (5/9), and ephrin B signaling (5/9) were all upregulated among each patient and were involved in promoting synaptic plasticity and neuroplasticity. Common biological processes and pathways in urine were reported to be related to the mechanism of MECT in the treatment of mental illnesses. In addition, the common differential proteins CSPG4, CBG, APP, NCAM1, and ARSA were suspected to be related to memory loss, memory damage, and memory formation, which might be the effects of MECT.

BackgroundThe COVID-19 pandemic has had a significant negative impact on the physical and mental health of healthcare workers worldwide. The aim of the paper is to measure the frequency of distress and wellbeing among general practitioners (GPs) in Austria during the pandemic and to identify key levers that could mitigate the risks of distress. MethodsData were collected as part of the international PRICOV-19 study. In Austria, 500 GPs were randomly selected for participation in a survey between December 2020 and July 2021. For analysis, all dependent and independent variables were described using descriptive statistical methods. Subgroup analyses were conducted using cross-tables and Fishers exact tests. A binary logistic regression model was also applied. Open text question was analysed via content analysis. ResultsIn total, 130 GPs completed the relevant questions for this analysis of the online survey. More than 40% of GPs felt burned out or stated that their work schedules did not leave enough time for personal/family life. Half of the GPs were found to be in distress, with 14.3% in (very) strong distress. More than 40% of the respondents thought that government support was insufficient for the proper functioning of their practice. Working in rural areas was a protective factor against distress, as were sport and exercise, particularly outdoor activity. Connecting with family and friends and adjustments to the work environment to reduce workload were shown to be important. DiscussionOur results show that GPs in Austria suffered from distress during the first two years of the pandemic. To protect GPs as our first-line healthcare workers in pandemic or high-stress situations, several factors are required for a functioning healthcare system: support of GPs regarding work-life balance, support in terms of collaboration between colleagues and the team and easy access to green outdoor spaces for sports and exercise. By identifying key factors that promote good mental health among GPs, healthcare organizations and policymakers can take targeted action to alleviate the negative impact of stress and burnout on this critical sector of the healthcare workforce.

BackgroundRising fear and panic among public during COVID19 pandemic increase concern regarding anxiety cases in Kuwait. Media capture our attention during this period looking for daily virus update lead to more fear. Our purpose of this study to examine the relationship between anxiety and media exposure among Kuwaiti during COVID19 outbreak Methodcross sectional study among Kuwaiti citizen between age23-55yrs old was conducted from April,21,2020 to May,15,2020 using online survey. Total of 1230 participants involve in the current study after exclusion criteria removed. Beside demographic data and media exposure anxiety was assessed using generalized anxiety disorder scale GAD-7, multivariable regression was used to identify the correlation between anxiety and media exposure Resultthe result show that there is positive correlation between media exposure and anxiety during COVID19 outbreak in Kuwait (p<.001), furthermore it revealed that there is significant relationship between the frequency of exposure and anxiety(<.001) Conclusionfrom this study we can understand that during COVID19 pandemic exposure to media can cause anxiety therefore measures should be taken by the governments to fight misinformation and physician should pay more attention to mental health disease during this period.

Burnout Syndrome (BOS), a pervasive occupational phenomenon stemming from unmanaged chronic workplace stress, leading to physical, psychological and cognitive impairment, represents a major challenge for preventive medicine. Indeed, the worldwide increasing incidence of BOS and the importance of its early management points to the unmet need for early BOS diagnosis. Whilst biomarkers of chronic stress have been explored with the description of the allostatic load, BOS lacks a consistent physiological signature, which would contribute to an early and comprehensive identification of persons at risk. This systematic review synthesizes current evidence on BOS-related biomarkers, aiming to identify potential physiological correlates. We conducted a comprehensive search of PubMed and EMBASE, yielding 111 studies evaluating 36 biomarkers in adult populations. Our analysis revealed inconsistent associations across most physiological systems, including the hypothalamic-pituitary-adrenal axis (e.g., cortisol, DHEA), immune system, cardiovascular parameters. While some biomarkers like HbA1c, blood glucose, or comorbidities like irritable bowel syndrome showed more consistent positive correlations with BOS, the overall findings are largely inconclusive. We conclude that the current biological evidence is insufficient for establishing a definitive BOS biosignature for routine clinical diagnosis. Future research should prioritize a more unified and comprehensive definition of BOS, potentially integrating emerging assessment tools to advance the objective identification and early intervention of burnout.

BackgroundGeneral Practitioners (GPs) play a key role in referring adolescents with depression and/or anxiety to mental health specialists and services, but their capacity to do so may be compromised by service wait times. It is unclear how GPs manage the mental healthcare of adolescents when the choice of treatment is not available. This study aimed to explore GPs self-reported referral practices to mental health specialists and services for adolescent depression and/or anxiety, as well as their perceived knowledge, acceptability, and impacts of the wait times for these. MethodsA cross-sectional online survey of 192 GPs in Australia who self-identified as treating adolescents (12 to 17 years old) with depression and/or anxiety. ResultsGPs most frequently referred adolescents with depression and/or anxiety to psychologists. However, the mean estimated wait time for psychologists was 57.26 days (SD: 47.91, Mdn: 45.0, range: 5-365), which was four times the proposed acceptable wait time (M: 14.66 days, SD: 8.70). Nearly all GPs (81.8%) had increased their level of care for adolescents due to long waits but had limited training in and knowledge of strategies for effective self-management. ConclusionsGPs in Australia lack information on the wait times for adolescent mental health specialists and services, despite frequent referrals. Greater knowledge of wait times, training in wait time approaches, and self-directed digital interventions may help to enhance the quality of primary care provided to adolescents.

ObjectiveTo develop and psychometrically evaluate an assessment of symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) MethodsAn initial symptom list was devised from the relevant literature with the patient and clinician advisory groups. An online survey with 85 symptom items in eight domains was completed by people with ME/CFS. Each item had two response structures (assessing symptom frequency and severity on five-point scales). Rasch analysis assessed each domain for unidimensionality, targeting, internal reliability, item fit and local dependency. ResultsSurvey data (n=721) indicated various item anomalies and inter-item dependencies, leading to item re-formatting or removal. The frequency and severity-based responses broadly replicated each other, and a four-point response format appeared more appropriate than a five-point response format. Following Rasch-based scale amendments, a revised version with a single four-point response format was re-administered to test the modifications. Validation data (n=354) showed the modified scale had an improved response structure and functionality across all domains, satisfying Rasch model assumptions. Additionally, domain-level super-items allowed for a summated total score along with sub-scales summarising neurological and autonomic symptoms, again satisfying Rasch model assumptions. ConclusionsThe Index of ME Symptoms (TIMES) and its associated sub-scales and domain scales are stable, valid assessments of symptoms in ME/CFS.

BackgroundAnxiety disorders are among the most prevalent mental health conditions globally, significantly impacting individuals quality of life and contributing to the global burden of disease. Cognitive Behavioral Therapy (CBT) is an evidence-based intervention, but traditional in-person therapy faces numerous barriers, including cost, access, stigma, and shortage of providers. ObjectiveThis review explores the growing field of digital CBT (dCBT) for anxiety disorders, summarizing recent findings on its clinical efficacy, accessibility, and future integration into healthcare systems. MethodsA structured search was conducted of studies published from 2017 to 2024 in PubMed, PsycINFO, and Scopus databases, focusing on randomized controlled trials (RCTs), meta-analyses, and large observational studies on dCBT for anxiety. ResultsMultiple RCTs and meta-analyses have demonstrated that dCBT is significantly effective in reducing generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and specific phobias, often with moderate-to-large effect sizes. Key advantages include scalability, anonymity, and cost-effectiveness. However, dropout rates and patient adherence remain concerns. ConclusionsDigital CBT is a viable alternative or supplement to in-person therapy for anxiety disorders. Further research is needed on personalizing interventions and optimizing engagement.

BackgroundSince the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. To explore the psychological distress and the psychological demand induced by COVID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal (PD) patients during the lockdown period. MethodsQuestionnaires were given to the dialysis patients in West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients trauma-related distress in response to COVID-19. Results232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00-19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms. HD patients had a significant higher IES score than PD patients (11.50 vs 8.00) (p<0.05). HD patients already got more psychological support from the medical staff. There was no significant difference on further demand of psychological support between the two groups. In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p<0.05). ConclusionsHD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.

ObjectiveTo evaluate the criterion-related and discriminant validity, test-retest reliability and minimal detectable difference of The Index of ME Symptoms (TIMES) in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) MethodsPeople with ME/CFS in the UK completed the TIMES online (n=1055). Rasch-transformed interval data and parametric statistics were used: Pearson correlations (with the ME severity scale); analysis of variance; intra-class correlations (ICC) and standard error of measurement of ICC measured criterion-related and discriminant validity, test-retest reliability and minimal detectable difference respectively. ResultsHighly significant (P<0.001) moderate (r=0.400-0.528) correlations were seen between the TIMES scales and severity of ME/CFS except the gastro-intestinal and immune systems scales (r= 0.315 and 0.302 P<0.001 respectively). Discriminant validity was demonstrated with significant differences in TIMES scores between all five levels of ME severity, except between levels 4 and 5 in some cases, which were underpowered due to the small group numbers. Test-retest reliability was excellent (ICC>0.7, p<0.001) except the cranial nerves and immune system scales which were good (ICC = 0.681 and 0.669, p<0.001) and minimal detectable difference was excellent (3.95-17.45%). ConclusionsThe Index of ME Symptoms (TIMES) scales are valid, reliable, sensitive assessments of symptoms in ME/CFS. They are freely available for use.

BackgroundAtypical haemolytic uremic syndrome (aHUS) is a rare life-threatening disease. Lifelong treatment with intravenous eculizumab every two/three weeks was recommended but evidence is emerging that patients can stop eculizumab and restart should they relapse. However, little is known about the opinions and needs of aHUS patients on withdrawal. ObjectiveWe aimed to understand the factors that impact on decisions to withdraw from treatment. MethodsWe analysed in-depth telephone interviews thematically using a constant comparative method. Interviewees included adults (8), and the parents of children (12), with aHUS approached to participate in an eculizumab withdrawal trial. ResultsThe onset of aHUS had been traumatic for most. Regarding eculizumab, withdrawal group participants talked of the disruptive treatment regime and side effects, the time off work/school and impact on taking holidays. Decisions to withdraw from eculizumab were driven by the wish to lead more normal lives and concerns about long-term treatment. Drivers for declining withdrawal focused on relapse and its perceived impact. After two years the withdrawal group had regained a semblance of normality, though fears about relapse remained and they were aware of the need for long-term follow-up. Participants had a greater sense of control over the necessary steps should they/their child relapse. ConclusionUnderstanding patient/parent experiences should guide discussions about eculizumab withdrawal. Support to alleviate fears in the early stages of withdrawal would be beneficial. Evidence from the main trial on successful withdrawal, and recovery time where eculizumab was reinstated may provide reassurance to those who are uncertain about withdrawal. Key findings and implicationsLifelong treatment can be burdensome for patients and families and have a substantial negative impact on their lives. This is particularly so when the onset of illness occurs, and treatment is commenced, in babies and young children. Long-term treatment can be disruptive to work and school, due to the fortnightly administration of eculizumab and the side effects experienced. There was a dislike for long-term medication particularly when there was uncertainty as to whether treatment was still warranted. The opportunity to consider treatment withdrawal was welcomed. Conversations between clinicians and patients/parents about withdrawal should be guided by an understanding of the experiences at onset and living on treatment, concerns and fears. Hearing parents and adults accounts of the positive impact of withdrawing from eculizumab may provide reassurance to others.

Background and hypothesisFinancial toxicity (FT) refers not only to the difficulty in affording medical care but also to the psychological distress and perceived financial burden it imposes. Although dialysis in Japan is extensively covered by public insurance, little is known about the prevalence of FT and its effects on medication adherence. This study aimed to assess the prevalence of FT and examine its association with medication adherence among patients undergoing haemodialysis in Japan. MethodsThis multicentre, cross-sectional study included Japanese adults undergoing in-centre haemodialysis at six facilities. FT was assessed using the Comprehensive Score for Financial Toxicity (COST), and medication adherence was assessed using the 12-item Adherence Starts with Knowledge (ASK-12) scale. The COST scores were compared with published data from Japanese patients with cancer and patients undergoing dialysis from other countries using unpaired t-tests. Associations between the COST and ASK-12 scores were analysed using multivariate general linear models. ResultsIn total, 455 participants were included in the analysis. The mean COST score was 22.0, and 68% of the participants experienced at least mild FT. FT severity was comparable to that of Japanese patients with cancer and significantly lower than that reported among patients undergoing dialysis in Brazil and China. Lower FT (i.e., higher COST scores) was associated with fewer medication adherence difficulties (per 1-point higher: {beta} = -0.19). This association was particularly evident in the inconvenience/forgetfulness and behaviour subdomains (per 1-point higher: {beta} = -0.06 and {beta} = -0.08, respectively). ConclusionsDespite generous public coverage, FT is common among Japanese patients undergoing haemodialysis and is associated with difficulties in medication adherence. The awareness of hidden financial distress and its integration into shared decision-making regarding prescriptions may help improve treatment adherence and patient outcomes. Key learning pointsO_ST_ABSWhat was knownC_ST_ABSO_LIAmong patients undergoing dialysis, medication adherence rates are generally < 70%. C_LIO_LI Financial toxicity is associated with poor medication adherence in oncology. C_LIO_LIHowever, among patients undergoing dialysis receiving publicly funded care, the prevalence of financial toxicity and its effects on medication adherence remain unclear. C_LI This study addsO_LIDespite Japans comprehensive public insurance system, approximately 70% of patients undergoing dialysis experience at least mild financial toxicity levels, comparable to those observed in Japanese patients with cancer. C_LIO_LILower financial toxicity was associated with better medication adherence, particularly in the inconvenience/forgetfulness and behaviour subdomains. C_LI Potential impactO_LIFinancial hardship can cause stress. Healthcare providers should build trust with their patients and foster open discussions on financial and social challenges. C_LIO_LIPractising shared decision-making is essential for prescribing medications that consider patients financial burden. C_LIO_LIProviding work-friendly dialysis schedules may support patients long-term financial independence. C_LI

ObjectiveTo evaluate the reliability and predictive utility of a time-efficient cognitive development chart that seeks to identify children and adolescents with high-risk for multiple outcomes such as mental health problems, substance use, and educational difficulties. MethodWe analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders (HRC), a longitudinal school-based study conducted from 2010-2011 to 2013-2014. Participants were 2,239 children and adolescents, 6 to 17 years of age, who completed the cognitive assessment at baseline. The task used to track cognitive development was the Two Choice Reaction Time task (<3 minutes of duration, computer-based), which assesses the accuracy and speed of perceptual decision-making. Mental health, substance use, and educational outcomes were assessed by validated standardized methods. Key variables were measured at baseline and 3-year follow-up. The predictive utility was assessed using static (deviations from the age-expected performance at baseline) and dynamic (deviations from the age-expected change in performance over time) indicators. ResultsThe reliability of the task parameter was high (intra-class correlation coefficient = 0.8). Static indicators of cognitive development significantly predicted concurrent mental, intellectual and educational difficulties, as well as incident and persistent educational difficulties and substance use in the 3-year follow-up. Dynamic indicators predicted persistent mental health problems. ConclusionPrimary-care and mental health professionals need a time-efficient tool for tracking deviations from age-expected cognitive development, which predicts multiple unwanted outcomes at the same time. If replicated, future results could support the generation of tools for tracking risk for mental health, substance use, and educational difficulties.

ObjectiveTo explore the relationship and identity of Health Care Worker stressors to a measure of perceived burnout and to a novel intervention tool. Participants and MethodsFrom July 2019 to June 2020, we surveyed Health Care Workers (HCW) pre and post COVID19 in an independent local community hospital for burnout with the Health Care Provider Wellness Assessment tool. Linear regression and means comparison were used to identify overall job demand and resource perception with burnout, unique stressor portraits by provider subtype and mean survey scores between those who did or did not voluntarily complete at least 14 days of a 28 day novel self-help intervention tool. ResultsRegarding the pre COVID-19 data, of 73 respondents, there was statistically significant (p<.01) correlation between overall job demands (directly) and resources (inversely) with burnout intensity. With respect to the HCW stressor characteristic analyses there was statistical significance (p<.05) between the mean frequency occurrence of the top 5 stressors identified by respondent subtype when compared to the mean occurrence of overall individual responses within the corresponding subtype. Finally, although limited by a low number of respondents, the intervention tool analysis suggested a therapeutic trend toward disruption of the stress-burnout relationship. Regarding the post COVID-19 data, 18 respondents did not show statistically significant characterizable stressor portraits (ie stressors were present but not patternable). ConclusionUnique stressor portraits were identified by HCW subtype which correlated with more intense burnout self-perception. Additionally, there was a trend toward self-help tool efficacy in mitigating burnout.