Journal of Psychosomatic Research

Background: Psychological health is an important aspect of health and well-being among adults with irritable bowel syndrome, yet the interrelationships among individual vulnerabilities, social experiences, perceived stress, and psychological health outcomes remain poorly understood. Objective: To characterize psychological health and examine direct and indirect associations of childhood adversity and adult attention-deficit/hyperactivity disorder-related symptoms within an adapted Stress Process Model. Design: Cross-sectional secondary analysis. Setting: The United States All of Us Research Program. Participants: 2,417 adults with electronic health record-documented irritable bowel syndrome and complete data on the primary analysis variables and covariates. Methods: Separate structural equation models examined childhood adversity and adult attention-deficit/hyperactivity disorder-related symptoms in relation to perceived stress, anxiety and depressive symptoms, and positive psychological well-being, with loneliness and perceived social support as psychosocial pathways. Models adjusted for sociodemographic and social-context factors. Results: The median age was 54.39 years; 80.7% were female and 84.4% were White. Moderate-to-high perceived stress was reported by 56.2%, at least moderate anxiety symptoms by 21.0%, and at least moderate depressive symptoms by 24.3%. Higher ACE-8 scores were associated with greater perceived stress, anxiety symptoms, and depressive symptoms and lower psychological well-being ({beta} = 0.063, 0.089, 0.116, and -0.100, respectively); corresponding associations for higher ASRS-6 scores were {beta} = 0.299, 0.355, 0.390, and -0.260. Loneliness-specific indirect associations were positive for perceived stress, anxiety, and depressive symptoms (ACE-8: {beta} = 0.023-0.034; ASRS-6: {beta} = 0.043-0.075) and negative for psychological well-being (ACE-8: {beta} = -0.039; ASRS-6: {beta} = -0.089; all p < .001). Social support-specific indirect associations were not significant in the ACE-8 model and were small and significant only for anxiety and depression in the ASRS-6 model ({beta} = 0.003-0.004). Conclusions: Psychological health among adults with irritable bowel syndrome was associated with interconnected individual and social factors within an adapted Stress Process Model. Childhood adversity and adult attention-deficit/hyperactivity disorder-related symptoms showed direct and indirect associations with psychological health, with loneliness emerging as the most consistent social factor. These findings support prospective investigation of individual vulnerabilities and social experiences in psychological health. The cross-sectional design does not establish temporal ordering or causal mediation.

Introduction: Neuroinflammation is a known pathophysiologic mechanism in multiple sclerosis and a proposed mechanism in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Positron Emission Tomography (PET) imaging of the translocator protein (TSPO) has been widely used to measure neuroinflammation, though second-generation ligands are highly sensitive to a single nucleotide polymorphism, rs6971, resulting in high, mixed, and low affinity binders. It is unknown whether this polymorphism is associated with neuroinflammatory disorders. Materials and Methods: Eighty-six total participant genotypes for TSPO binding affinity were identified through Sanger sequencing (30 fibromyalgia, 21 ME/CFS, 11 multiple sclerosis, and 24 healthy controls). Associations between patient group and genotype were assessed with Fishers Exact test. Associations between genotype and symptom severity from self-report questionnaires were assessed with Kruskal-Wallis tests. Results: In the present study individuals with fibromyalgia, (ME/CFS), or multiple sclerosis were more likely to have a mixed- or low-affinity genotypes compared to healthy controls. Presence of the low or mixed genotypes were also associated with greater self-reported fatigue severity and depressive symptoms. Discussion: These findings should be confirmed in larger samples but suggest functional consequences of rs6971 polymorphism that may be related to the pathophysiology of pain and fatigue illnesses.

Objective: Mindfulness is a robust predictor of mental health, yet the psychometric properties of the short-form Five Facet Mindfulness Questionnaire (FFMQ-15) have not been examined in Iranian populations. This study evaluated the psychometric properties, factor structure, and diagnostic utility of the FFMQ-15 among medical sciences students. Participants: A total of 348 students (178 females, 170 males) from Kermanshah University of Medical Sciences participated. Methods: Participants completed the FFMQ-15, Penn State Worry Questionnaire (PSWQ), Difficulties in Emotion Regulation Scale (DERS), and Emotion Regulation Questionnaire (ERQ). Data were analyzed using exploratory and confirmatory factor analyses, composite reliability, and ROC curve analysis. Results: Both EFA and CFA supported the five-factor model, revealing a culturally unique item loading pattern. The FFMQ-15 demonstrated strong convergent and discriminant validity. ROC analysis indicated acceptable diagnostic accuracy for distinguishing high- and low-worry groups (AUC = 0.72, 95% CI: 0.66-0.78). Conclusions: The FFMQ-15 demonstrated acceptable psychometric properties in Iranian medical students. The non-reactivity facet exhibited cultural variability, suggesting that cross-cultural adaptation is essential. The instrument shows promise for screening in high-stress educational settings.

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region of both women and men. Sexual dysfunction remains among the most debilitating and overlooked consequences of the disease, as available patient-reported outcome measures are either restricted to one sex or capture sexual health only partially. The aim of the present work is to validate the Qualisex questionnaire (in its the Italian version) in patients with LS and to evaluate its psychometric properties, factor structure, convergent, discriminant validity, and sex symmetry. Methods: A cross-sectional study was conducted on 211 patients (167 women, 44 men; mean age 52.9 years) with a confirmed diagnosis of LS. Participants completed the Italian Qualisex, Skindex-29, DASS-21, and sexual-health-specific scales, the Female Sexual Function Index (FSFI) for women, and the International Index of Erectile Function (IIEF) for men. Construct validity was assessed via Principal Component Analysis (PCA), and reliability via Cronbach's alpha. Convergent and discriminant validities were evaluated against standard psychometric batteries. Results: Item 2 was removed due to low communality (0.167). PCA on the remaining 9 items revealed a two-factor structure accounting for 72.5% of total variance: Component 1 (Sexual Functioning and Satisfaction, 59.89%) and Component 2 (Partner Devaluation, 12.66%). Internal consistency was high (alpha= 0.911 overall; alpha= 0.841 in women; alpha= 0.899 in men). Qualisex scores correlated strongly with Skindex-29 Social Functioning (r = 0.582) and Emotions (r = 0.531) subscales, as well as FSFI (r = -0.391) and IIEF (alpha= -0.566). Discriminant validity was supported by low-to-moderate correlations with DASS-21 domains (r < 0.38). While FSFI and IIEF showed significant negative correlations with age (p = 0.002), Qualisex remained age-independent across sexes (p > 0.05). Conclusion. The 9-item Italian Qualisex is a reliable, sex-symmetrical, and age-independent patient-reported outcome measure for assessing sexual health impairment in LS, successfully isolating disease-specific distress from physiological aging and general distress.

Financial well-being (FWB) encompasses objective and subjective financial status and may influence health. We developed and validated a parsimonious FWB index using data from 23,006 Health and Retirement Study (HRS) participants aged 50 years and older from 2006 to 2022. The FWB-5 Index was derived using correlated two-factor confirmatory factor analysis accounting for household clustering. Indicators included household wealth, household income-to-poverty ratio, monthly financial strain, satisfaction with one's financial situation, and perceived financial mastery. We assessed convergent and discriminant validity using the Consumer Financial Protection Bureau Financial Well-Being (CFPB-FWB) Scale and Satisfaction with Life Scale, respectively. Associations with pre-baseline socioeconomic factors and subsequent depressive symptoms and health conditions were examined to assess construct and predictive validity. Model fit indices supported the two-factor structure (robust comparative fit index = 0.99; robust root mean square error of approximation = 0.05). Correlations were stronger with the CFPB-FWB Scale (Spearman P = 0.80) than with life satisfaction (Spearman P = 0.43). Associations with socioeconomic factors and subsequent health outcomes were in the hypothesized directions. These findings support the FWB-5 Index as a parsimonious measure for examining financial well-being and its associations with health across HRS waves, including those predating the CFPB-FWB Scale.

Background: Girls are more likely than boys to experience psychological distress during adolescence. Drivers of this gender gap remain under-studied, despite its large impact on later life and outcomes, especially for women. Explanatory factors can be gendered in their prevalence (differential exposure) and/or in their impact (differential susceptibility). We developed a multi-domain framework of explanatory factors for distress and applied it in four low- and middle-income countries. Methods: We first proposed a framework of explanatory factors for psychological distress grouped into seven domains (biological, cognitive, psychological, behavioural, social, environmental and broader societal). We applied this framework to identify explanatory variables assessed in childhood and adolescence in the Young Lives longitudinal cohort studies in Ethiopia (N=908), India (N=952), Peru (N=634) and Vietnam (N=887). Distress symptoms at 18-19 years were measured with the Strengths and Difficulties Questionnaire Emotional Symptoms scale. Gendered prevalence of each explanatory factor was tested with Mann-Whitney tests, and gendered impact with country-specific linear regressions including a gender-by-factor interaction term. Exploratory boosted-tree machine-learning models, interpreted with SHAP values and permutation feature importance, examined the contribution of these factors to the gender gap in each country. Results: Distress was higher in girls than boys in every country, the gap ranging from 0.62 points in Ethiopia and Vietnam to 1.76 in India and 2.45 in Peru. Some explanatory factors were consistently gendered in prevalence (e.g. girls experienced greater role overload in each country), while others were gendered only in some countries (e.g. study amount was higher for girls in Peru and Vietnam, but not Ethiopia or India). Gendered impacts on distress displayed more variability across countries. For example, higher self-esteem was more protective for boys than girls in India, Peru and Vietnam, but more protective for girls in Ethiopia. The machine-learning models identified important predictors across all framework domains, though their salience varied by country. Conclusions: Our findings underscore the importance of considering multi-domain explanations for mental-health outcomes and observed inequalities in mental health. Large cross-country differences in the gender gap and in the prevalence and influence of explanatory factors caution against generalising drivers of mental-health outcomes and inequalities across contexts.

Objective: to estimate reconsultation risk and trajectories after a new episode of musculoskeletal pain in children and young people (CYP), and to determine routinely recorded prognostic factors associated with reconsultation. Design: Population based retrospective cohort study. Setting: Clinical Practice Research Datalink (CPRD) Aurum, 2005-2021. Participants: CYP aged 8-18 years consulting primary care for a new musculoskeletal pain episode (no musculoskeletal consultation in prior 12-months). Main Outcome Measures: Musculoskeletal pain reconsultation within 12-months, and 3-year musculoskeletal reconsultation trajectories derived using latent class growth analysis. Prognostic factors selected from a literature search and two-year symptom histories (sample prevalence >1%) were examined using regression models (conditional logistic; multinomial). Results: Among 313,830 CYP with >12 months' follow-up, 32% reconsulted for musculoskeletal pain within 12 months. Among 240,384 CYP with >3 years' follow-up, three trajectories were observed: single episode (62%), early reconsultation (18%), and persistent reconsultation (20%). Older age; female gender; hip, knee, multisite and back pain on index; previous headache; previous abdominal pain; and analgesic prescribing were associated with higher reconsultation risk. Asian or Black ethnicity, and residing in more deprived areas, were associated with lower recorded reconsultation. Conclusion: Most CYP had no further recorded consultation, but 38% followed early or persistent reconsultation trajectories. Routinely recorded prognostic factors, particularly index pain side and prior pain/symptom history, may differentiate groups who could benefit from proactive follow-up. Lower recorded reconsultation among Asian and Black individuals, and living in more deprived areas, should not imply lower need and warrants equity-sensitive monitoring of access, health-seeking, and coding.

Brief assessments reduce clinician and patient burden and increase utilization. Recently, five core depression symptoms (low mood, poor concentration, low self-worth, loss of interest, low energy) have been shown to be particularly sensitive to treatment effects in adults. How these core depressive symptom domains perform for screening or diagnostic purposes in youth is unknown. To address this question, we extracted five analogous symptom items from four widely used symptom assessment tools for children and adolescents (Child Behavior Checklist [CBCL], Youth Self Report [YSR], Parent General Behavior Inventory [P-GBI], and Adolescent General Behavior Inventory [A-GBI]) to create 5-item short forms. We evaluated their psychometric properties and diagnostic utility in a large (N=1185), racially diverse sample (48% Black youth) across community and academic outpatient mental health settings, with diagnoses established through LEAD consensus. All short forms correlated highly with full-length measures (r=.74-.92) and demonstrated comparable inter-item correlations (r =.19-.46). The short forms did not differ meaningfully from the full measures in correlations with psychiatric diagnoses, demographics, or diagnostic interviews. Area under the curve (AUC) values for identifying depression and any mood disorder diagnosis (determined by semi-structured diagnostic interviews) were fair to good (AUC=0.60-0.79), which were not worse than full measures, except for the P-GBI. The CBCL-5, YSR-5, P-GBI-5, and A-GBI-5 may be useful brief depression assessments in youth. How these five symptom domains perform as outcome measures in treatment deserves study.

PURPOSE: Women with metastatic breast cancer (MBC) are at risk of developing financial toxicity due to prolonged treatment. Resilience has been identified as a key protective factor associated with better quality of life among cancer populations. However, it is unknown if resilience is associated with financial toxicity. We sought to examine the relationship between resilience and financial toxicity among women with MBC and explore whether socioeconomic factors moderate this association. PATIENTS AND METHODS: Our sample included 209 women with MBC who completed self-reported questionnaires of the Resilience Scale Specific to Cancer (RS-SC) and the Comprehensive Score for Financial Toxicity (COST). Participants (n=2) with missing data were excluded from analysis. We conducted multiple linear regression to examine the association of resilience with financial toxicity. Interaction terms were used to test moderating effects of age (18-39, 40-64 and > =65 years), race, education, health insurance, household income and employment status. RESULTS: Of the sample, 56.5% were aged 40-64 years, 76.6% were White, and 79.9% had a college or master degree or above. Women reported moderately high resilience with mean RS-SC score of 34.49 (SD = 6.67), and moderate financial toxicity (mean COST score =21.01 [SD = 10.51]). Adjusting for covariates, higher resilience was linked to better financial well-being (b = 0.37, SE= 0.11, 95% CI [0.14, 0.59], P < 0.01). Age, education and health insurance moderated this relationship, with resilience more strongly associated with better financial well-being among those aged 40-64 years, with college/master degree or above and private insurance. Race, household income, and employment status did not moderate the association between resilience and financial toxicity. CONCLUSION: Women with MBC who reported higher resilience are more likely to experience better financial well-being, but the strength of this association varied by socioeconomic factors. Further research is needed to confirm these findings. Our results have important implications for incorporating resilience into financial toxicity interventions and tailoring such interventions based on individual socioeconomic characteristics.

Abstract Background: Insomnia is highly prevalent in major depressive disorder (MDD), yet the clinical and biological significance of dysfunctional beliefs and attitudes about sleep (DBAS) in MDD remains poorly understood. We examined whether distinct DBAS dimensions are associated with insomnia severity, depressive phenotypes, and neuroimmune-metabolic-oxidative (NIMETOX) biomarkers. Methods: DBAS-30 dimensions, clinical phenotypes, and NIMETOX biomarkers were assessed in 87 hospitalized patients with MDD and 31 healthy controls. Principal component analysis (PCA) was used to ascertain DBAS cognitive dimensions, and associations were examined using multivariable analyses. Results: Compared with controls, MDD patients showed lower scores on "perceived consequences of insomnia," "sleep-related worry and helplessness," and "medication-related beliefs," but higher "causal attributions to aging or biochemical imbalance" scores. A composite DBAS score reflecting these 4 MDD-associated cognitive dimensions was constructed, labeled DBAS dimensional index (DBAS-DI). This score was lower in MDD and inversely associated with Insomnia Severity Index (ISI) scores, overall MDD severity, physiosomatic symptoms, current suicidal ideation, and recurrence of illness. DBAS-DI and the expectations domain jointly explained 35.4% of the variance in ISI scores, with inverse and positive associations, respectively. The DBAS-DI score was inversely associated with indices of the acute-phase inflammatory response, oxidative stress, fecal branched-chain short-chain fatty acids (SCFAs) and positively associated with serum antioxidant capacity and protective SCFAs, such as acetate, propionate, and butyrate. Conclusions: DBAS abnormalities in MDD extend beyond insomnia-related cognitions and are associated with illness severity, suicidality, recurrence, and NIMETOX alterations. These findings suggest that dysfunctional sleep-related cognitions are embedded within broader immune-oxidative and gut microbial-metabolic processes that may contribute to the insomnia-depression interface.

Background: Pseudo-orthostatic tremor (psOT) is a rare form of tremor of the lower body, triggered by standing, at frequencies lower than 13 Hz. It is believed to be secondary to other neurological disorders in a large proportion of cases. Surface electromyography (sEMG) can identify its core characteristics and differentiate it from other similar disorders such as primary orthostatic tremor (POT) and orthostatic myoclonus (OM). Objectives: Our study aims to illustrate the clinical and neurophysiological features as well as the outcomes and final diagnoses of patients with psOT in a retrospective two-centre cohort. Methods: We retrospectively examined the available clinical and neurophysiological records of 35 consecutive patients with a diagnosis of psOT in the 2022-2026 period. Data on demographics, clinical characteristics, sEMG findings, pharmacological treatments, ancillary investigations and patient reported outcomes were collected. Results: 35 patients with psOT were identified, of which 6 (17%) displayed features consistent with a functional neurological disorder (FND). Among the 29 patients with organic psOT, 21 (72.4%) fulfilled the diagnostic criteria for essential tremor (ET), while an identifiable neurological cause was established in four (13.8%). sEMG findings differed between functional and organic psOT, with the latter often displaying features consistent with weight-bearing hyperkinesias. Conclusions: Our retrospective study suggests that psOT is most often associated with ET, while an identifiable neurological cause was found in a relatively small proportion of patients. We also describe functional psOT as a previously unrecognized clinical presentation of FND.

Autistic adults face considerable challenges in receiving adequate support, from both paid/formal (such as from disability services) and unpaid/informal (for example, from friends and family) sources. Having adequate support can lead to better health and well-being outcomes. However, most instruments designed to assess adequacy of support were not made specifically for/with autistic adults. This paper presents a psychometric validation of the AASPIRE Adequacy of Supports and Information Scale (AASIS), a community-informed adaptation of a previously developed instrument (the Quality of Care and Support scale; Lucas-Carrasco et al., 2011), designed to be relevant and accessible to autistic adults. We also used the AASIS to explore correlates of perceptions of support in a sample of 798 autistic adults. Our confirmatory factor analysis supported a two factor structure for the AASIS (factor one: Supports; factor two: Information). Further testing confirmed the instrument was invariant across several groups, including race/ethnicity, gender, intellectual disability, communication fluency, and self versus proxy-report. Regression analyses suggested that the way in which participants joined the study (i.e., through community advertisements or via established healthcare/disability services) impacted whether they viewed their support as adequate. Additionally, a higher number of adverse childhood events and greater experience of discrimination were related to worse perceptions of support adequacy across both factors. Our findings support the preliminary validity of the AASIS across a variety of autistic people, though further testing is warranted. Findings also point to the importance of addressing the needs of autistic people who are minoritized and/or who have complex trauma histories.

BACKGROUND: One in three adolescents with a concussion history report experiencing long-lasting somatic, sleep, emotional, and/or cognitive disturbances (persisting symptoms after concussion (PSaC)). Cognitive difficulties, such as attentional problems, are common symptoms and can interfere with ongoing development. Clinically, psychiatric symptoms also present in youth with PSaC. A concussion causes diffuse functional and microstructural alterations to neural networks. To develop targeted treatments for PSaC (e.g., neurostimulation), we need to understand how and where structural alterations and neural dysfunction intersect to cause long-lasting symptoms. OBJECTIVES: 1) Identify functional and microstructural properties in intrinsic connectivity networks, as well as neuropsychological outcomes, that differentiate adolescents with concussion with PSaC from those who do not have PSaC. 2) Determine whether neural activity within intrinsic connectivity networks mediates the relationship between network microstructure and specific neuropsychological features in adolescents with concussion. METHODS: CAMBY is a prospective study of adolescents aged 12 to 18 years with a history of concussion. Participants are allocated based on recovery status (PSaC vs. No-PSaC (recovered controls)). Advanced structural (magnetic resonance imaging; MRI) and functional (magnetoencephalography; MEG) neuroimaging and neuropsychological measures will be collected one month or more after concussion. Microstructural and functional features will be computed within intrinsic connectivity networks, then compared between PSaC and recovered control groups and related to symptom domains and neuropsychological profiles. IMPACT: This will be the first study to integrate MRI, MEG, and neuropsychology in adolescents with PSaC to identify disrupted networks underlying PSaC. This observational study is a necessary step towards future clinical trials that accurately target promising therapeutic neurostimulation protocols.

Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly PCOS) is associated with chronic low-grade inflammation. This study aimed to characterize the peripheral cytokine landscape in women with PMOS and identify cytokines associated with disease pathogenesis and phenotypic variation. Plasma concentrations of 48 cytokines were quantified using a multiplex bead-based assay in 102 women with PMOS and 114 healthy controls. We performed receiver operating characteristic (ROC) analysis, odds ratio estimation, correlation analysis, and network analyses to characterise cytokine alterations and identify phenotype-associated inflammatory signatures. Fourteen cytokines were significantly elevated in PMOS compared with healthy controls: IL-18, IL-1Ra, IL-12p70, IL-13, IL-16, MCP-1, MCP-3, CTACK, Eotaxin, RANTES, IP-10, M-CSF, HGF, and {beta}-NGF. ROC analysis identified IL-16, CTACK, and IP-10 as potential discriminators of phenotype A, whereas IL-18, M-CSF, and HGF demonstrated promising discriminatory performance for phenotype B. Odds ratio analysis identified 11 cytokines with odds ratios greater than 1, with IL-16 showing the strongest association with PMOS. Correlation analysis revealed 10 strongly correlated cytokine pairs (r [&ge;] 0.7) in the PMOS group, suggesting coordinated regulation of inflammatory mediators. Gene ontology and network analysis highlighted alterations in chemotaxis and immune cell migration pathways, implicating these processes in PMOS-associated immune dysregulation. These findings reveal a distinct peripheral inflammatory cytokine signature and phenotype-associated differences in PMOS. IL-16 emerged as a prominent candidate for further investigation, given its strong association with PMOS. Peripheral cytokine profiling may provide a minimally invasive approach to characterising immune alterations and identifying candidate biomarkers for disease characterisation and phenotype stratification.

Background: Although opioids are frequently prescribed for refractory chronic neuropathic pain, few data are available on baseline factors that may identify individuals more likely to respond and inform individually tailored practice. Methods: This was a post hoc, exploratory analysis of individual-level data from a placebo-controlled trial of methadone for chronic neuropathic pain (NCT05235191). Baseline clinical, psychological, psychophysical and radiological variables were tested for association with 30% or more pain reduction in the methadone group. The correlation between expectation of improvement and pain reduction was examined in both groups. Results: Of the 81 participants completing the 8-week follow-up, 28 (70%) on methadone and 14 (34.1%) on placebo achieved 30% or more pain reduction. In the methadone group, responders had higher baseline expectation of improvement (median 100 [80-100] vs. 55 [50-81]; p=0.004), which correlated moderately with percentage pain reduction (rs=0.508; p<0.001). Neither finding was observed in the placebo group (p=0.211 and p=0.161, respectively), although the correlation did not differ significantly between groups (p for interaction=0.728). Other clinical, sociodemographic, psychological and psychophysical variables were not associated with response. In the subsample with peripheral neuropathic pain and structural MRI (n=37), lower left precentral cortex volume was associated with response to methadone (p=0.041), and lower right paracentral volume with response to placebo (p=0.003). Conclusions: Baseline expectation may influence treatment outcomes, supporting its inclusion as a covariate to improve the precision of treatment effect estimates in trials, and its use in clinical practice to help tailor treatment to individual patients. These exploratory findings require confirmation in larger studies.

Glycemic control is key to prevention of complications of diabetes. Although eosinophils have been implicated in metabolic regulation, most human studies have been cross-sectional and have yielded inconsistent findings. We conducted a retrospective cohort study of adults with uncontrolled diabetes receiving primary care at Mass General Brigham. We evaluated the relationship between eosinophil count and HbA1c over one year, adjusting for demographic, socioeconomic, and clinical covariates. Among 21,447 patients included in the study, eosinophil count increased by a mean of 2.6 cells/L (SD 157.2 cells/L) and HbA1c decreased by a mean of 0.82% (SD 2.09%) during follow-up. Increases in eosinophil count were associated with reductions in HbA1c (parameter estimate -0.366 per 1,000 cells/L; 95% CI -0.526 to -0.206; P < 0.001), whereas baseline eosinophil count was not significantly associated with HbA1c changes. The association remained significant in a sensitivity analysis excluding systemic glucocorticoid users. Increases in eosinophil count were associated with improved glycemic control in adults with diabetes, whereas baseline eosinophil count was not. These findings extend prior cross-sectional observations and suggest that changes in eosinophils may represent a biomarker of glycemic improvement. Further prospective studies are needed to determine whether this relationship reflects underlying immune-metabolic mechanisms or treatment-related changes.

Abstract Background Health-related quality of life (HRQoL) is an important outcome in patients with chronic kidney disease (CKD) receiving kidney replacement therapy (KRT), but the relationship between comprehensive metabolic control and the Symptoms/Problems domain of kidney diseasespecific HRQoL remains uncertain. Objective To evaluate the association between composite metabolic control and the Symptoms/Problems domain of the Kidney Disease Quality of Life-36 (KDQOL-36) in patients with stage 5 CKD receiving KRT, and to explore the relationship between individual metabolic parameters and the continuous Symptoms/Problems score. Materials and Methods We conducted an observational, cross-sectional, analytical study of 177 adults receiving hemodialysis or peritoneal dialysis at a nephrology unit in Chihuahua, Mexico. Metabolic control included blood pressure, glycated hemoglobin (HbA1c), total cholesterol, and triglycerides. Adequate control was defined as achievement of at least three of four studydefined operational thresholds. The KDQOL-36 Symptoms/Problems score was analyze as a continuous variable and categorized as low, moderate, or high according to the study protocol. Group comparisons, Spearman correlations, Pearson chi-square tests, and ordinal logistic regression were performed. Results Adequate metabolic control was present in 106 patients (59.9%). No, statistically significant association was observed between achievement of at least three of four study-defined operational thresholds and Symptoms/Problems score category (x2=3.983; p=0.137; Cramers V=0.150). None of the individual metabolic parameters differed significantly across Symptoms/Problems score categories or showed significant correlations with the continuous score. In ordinal logistic regression, adequate metabolic control yielded an odds ratio of 1.81 (95% CI: 0.98-3.35; p=0.057) after adjustment for age, sex, time receiving KRT, and KRT modality. Conclusions No, statistically significant association was identified between the operational definition of metabolic control used in this study and the KDQOL-36 Symptoms/Problems domain in patients with stage 5 CKD receiving KRT. The findings support evaluating HRQoL multidimensionally and warrant confirmation in larger longitudinal studies. Categories: Family/General Practice, Internal Medicine, Nephrology Keywords: chronic kidney disease (ckd), hemodialysis, kdqol-36, kidney replacement therapy, metabolic control, peritoneal dialysis (pd)

Aims: To understand how users believe continuous glucose monitoring (CGM) changes their behaviour, which app features they credit, and whether endorsing more mechanisms of action (MoAs) is linked to reported diet and physical activity change. Methods: We surveyed 112 U.S. adults with type 1 or type 2 diabetes who had used a Dexcom or Abbott Libre CGM within 12 months. Participants rated 26 MoA statements mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model, identified contributing app features, and reported CGM-attributed diet and physical activity change. Logistic regression examined MoA count and COM-B domains as predictors of behaviour change. Results: Participants (mean age 54.5 years; 60.7% female) reported dietary (82.1%) and physical activity (46.4%) change and endorsed a median of 18 MoAs, most often relating to knowledge, skills and behavioural consequences. Real-time glucose and graphs were attributed to many MoAs. Each additional MoA was associated with higher odds of dietary (OR 1.27, 95% CI 1.15-1.44) and physical activity change (OR 1.27, 95% CI 1.16-1.43). Motivation made the strongest distinct contribution among COM-B domains. Conclusions: Users perceive CGM as engaging many behavioural mechanisms; endorsing more was linked to behaviour change. Motivation may be a key target for CGM-based behavioural support.

Objective To examine whether prospectively recorded maternal BMI in early pregnancy is associated with offspring multiple sclerosis (MS) risk, including childhood-onset and adult-onset MS. Design Nationwide population-based cohort study. Setting Swedish national health and demographic registers. Participants 1,524,863 singleton children born in Sweden from 1992 to 2007 and followed through 2025. Exposures Maternal BMI recorded at the first antenatal visit, categorised as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obesity ([&ge;]30.0), and also modelled continuously. Main outcome measures MS in offspring, identified as at least three ICD-10 G35 codes recorded on separate dates. Cox models estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) adjusting for confounders. Results During follow-up, 1539 offspring (0.1%) were diagnosed with MS at a median age of 24 years (interquartile range, 20-27 years). MS incidence rates by maternal BMI category were 0.37 per 10,000 person-years for both underweight, and normal weight, 0.42 for overweight, and 0.45 for obesity. Compared with normal weight women, maternal overweight and obesity were associated with higher hazards of offspring MS, with adjusted HRs of 1.20 (95% CI, 1.05 to 1.37) and 1.35 (95% CI, 1.11 to 1.64), respectively. Onset-specific analyses showed similar findings for adult-onset MS and less precise but directionally consistent estimates for paediatric-onset MS. Each 1-unit increase in maternal BMI was associated with a 3%, 4%, and 3% higher hazard of overall, paediatric-onset, and adult-onset offspring MS, respectively. Conclusions In this population-based cohort study, higher maternal BMI were associated with an increased rate of MS in offspring. The findings provide large-scale prospective evidence that maternal adiposity may be related to offspring MS risk and support further investigation of the prenatal metabolic environment in the early-life origins of MS.

Objective: To estimate how often remission of type 2 diabetes is recorded in routine care, how long it lasts, and what ends it, separating a return of hyperglycemia from a restart of treatment. Research design and methods: We studied 136,781 adults aged 18 years or older with laboratory confirmed type 2 diabetes in the Protege linked electronic health record (EHR) and claims database. The 96,817 adults with glucose-lowering treatment recorded at or before cohort entry formed the primary (previously treated) cohort; 39,964 adults with no treatment recorded at entry were analyzed in parallel. Remission required two HbA1c values <6.5%, 90 to 365 days apart, the first at least 3 months after all glucose-lowering drugs were discontinued, with no therapy recorded between them. After remission we followed glycemic relapse (HbA1c over 6.5%) and treatment restart (a new outpatient prescription or dispensed fill) separately, with death as a competing event (Aalen Johansen). Results: Remission was documented in 4.33% of previously treated adults cohort and 15.57% in the cohort of untreated adults at entry. Five-year cumulative incidence (Aalen Johansen) was 3.82% (95% CI 3.69 ;3.93) and 13.27% (12.90;13.59) in each cohort, respectively. Remission was less common with greater baseline treatment burden: exploratory adjusted 5-year incidence was 4.65% in adults with 1 glucose-lowering class with a treatment episode recorded at or before entry, 3.62% with two, 2.69% with three, and 2.02% with four or more such drugs.. The Median Kaplan Meier duration of first remission was 226 days (IQR 93 to 855) in previously treated adults and 371 days (166 to 1,027) in adults untreated at entry; 37.9% (treated cohort) and 23.1% (untreated cohort) of episodes had ended by 152 days. Among remission episodes that had ended, median duration was 159 days (71 to 362) and 265 days (129 to 565) for the treated and untreated at entry cohort, respectively. Within 5 years of remission in previously treated adults, the first event ending remission was glycemic relapse in 31.94%, treatment restart in 47.83%, and death in 4.65%.Treatment restart was about 1.5 times as common as glycemic relapse as the first event ending remission. A second remission followed within 5 years in 19.53% of previously treated and 24.10% of untreated remitters. Conclusions: Recorded remission was uncommon and short-lived, and it ended more often with a treatment restart than with a rise in HbA1c. Studies of remission in real-world data should report relapse and restart separately and state how they confirm remission and establish that treatment stopped.