White matter integrity in hospitalized COVID-19 patients is not associated with short- and long-term clinical outcomes.

Objectives: SARS-CoV-2 infection is associated with a decline in functional outcomes; many patients experience persistent symptoms, while the underlying pathophysiology remains unclear. This study investigated white matter (WM) integrity on brain MRI in hospitalized COVID-19 patients and its associations with clinical outcomes, including long COVID. Materials and methods: We included hospitalized COVID-19 patients and controls from CORONavirus and Ischemic Stroke (CORONIS), an observational cohort study, who underwent MRI-DWI imaging at baseline shortly after discharge (<3 months after positive PCR) and 3 months after baseline scanning. We assessed WM integrity using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) and performed comparisons between groups and within patients. Clinical assessment was conducted at 3 and 12 months with functional outcomes such as modified Rankin Scale (mRS), Post-COVID-19 Functional Status scale (PCFS), Visual Analogue Scale (VAS), and long COVID, cognitive assessment was conducted by the Modified Telephone Interview for Cognitive Status (TICS-M), and the Hospital Anxiety and Depression Scale (HADS) was used to assess mood disorder. Associations between WM integrity and clinical outcomes were evaluated using logistic regression and linear regression. Results: A total of 49 patients (mean age 59.5 years) showed higher overall peak width of skeletonized mean diffusivity (PSMD) (p = 0.030) and lower neurite density index (NDI) in several WM regions compared with 25 controls at the baseline (p < 0.05; FWE-corrected) but did not remain statistically significant after adjusting for WM hyperintensities. Orientation dispersion index (ODI) increased after 3-month follow-up in several WM regions within patients (p < 0.05), which remained significant after correction for changes in WMH volume. Patients exhibited worse clinical outcomes compared with controls. Low NDI at baseline was associated with worse performance on the Post-COVID-19 Functional Status scale after 12 months (p = 0.018). Conclusion: After adjusting for WMH, hospitalized COVID-19 patients no longer exhibited lower WM integrity compared with controls. WM integrity was generally not associated with clinical assessments as measured shortly after discharge, suggesting that factors other than underlying WM integrity play a role in worse clinical outcomes or long COVID.

Prevalence and 3-month follow-up of cerebrovascular MRI markers in hospitalized COVID-19 patients: the CORONIS study.

PURPOSE: To investigate the prevalence of cerebrovascular MRI markers in unselected patients hospitalized for COVID-19 (Coronavirus disease 2019), we compared these with healthy controls without previous SARS-CoV-2 infection or hospitalization and subsequently, investigated longitudinal (incidental) lesions in patients after three months. METHODS: CORONIS (CORONavirus and Ischemic Stroke) was an observational cohort study in adult hospitalized patients for COVID-19 and controls without COVID-19, conducted between April 2021 and September 2022. Brain MRI was performed shortly after discharge and after 3 months. Outcomes included recent ischemic (DWI-positive) lesions, previous infarction, microbleeds, white matter hyperintensities (WMH) and intracerebral hemorrhage and were analysed with logistic regression to adjust for confounders. RESULTS: 125 patients with COVID-19 and 47 controls underwent brain MRI a median of 41.5 days after symptom onset. DWI-positive lesions were found in one patient (1%) and in one (2%) control, both clinically silent. WMH were more prevalent in patients (78%) than in controls (62%) (adjusted OR: 2.95 [95% CI: 1.07-8.57]), other cerebrovascular MRI markers did not differ. Prevalence of markers in ICU vs. non-ICU patients was similar. After three months, five patients (5%) had new cerebrovascular lesions, including DWI-positive lesions (1 patient, 1.0%), cerebral infarction (2 patients, 2.0%) and microbleeds (3 patients, 3.1%). CONCLUSION: Overall, we found no higher prevalence of cerebrovascular markers in unselected hospitalized COVID-19 patients compared to controls. The few incident DWI-lesions were most likely to be explained by risk-factors of small vessel disease. In the general hospitalized COVID-19 population, COVID-19 shows limited impact on cerebrovascular MRI markers shortly after hospitalization.

Heart-Stroke Team: A multidisciplinary assessment of patent foramen ovale-associated stroke.

INTRODUCTION: Patent foramen ovale (PFO) closure prevents recurrent ischemic stroke in selected patients with a cryptogenic stroke. Trial results tend to be generalized to daily practice, often extending original trial inclusion criteria. This may result in unnecessary closure without benefit, but with risk of complications. We therefore introduced a standardized and structured evaluation by an interdisciplinary Heart-Stroke Team (HST). Our aim was to investigate the proportion of actual PFO closure of all referred patients with a cryptogenic stroke, after evaluation by the HST. PATIENTS AND METHODS: We conducted a single-center, retrospective cohort study. Patients with an assumed cryptogenic ischemic stroke or transient ischemic attack (TIA) and a PFO who were referred for PFO closure were analyzed. As part of the HST approach, all patients underwent a standardized work-up, first to demonstrate the ischemic event on neuroimaging, second to evaluate all potential causes of stroke and finally, to assess the possible relation between the PFO and stroke. Outcome was the proportion of patients treated with PFO closure after referral. RESULTS: A total of 195 patients were included. In 124 patients (64%) PFO closure was advised. Fourty-two (22%) patients had a clear alternative cause of stroke and in 13 (7%) patients the initial stroke diagnosis could not be confirmed. CONCLUSION: After careful analysis of patients referred for PFO closure a relationship between the PFO and stroke could not be demonstrated in 32% of referrals, and 3% preferred best medical treatment over percutaneous closure. This stresses the need for a complete neurovascular work-up and multidisciplinary assessment.

Arts-based therapies, practices, and interventions in health.

This collection focuses on creative art therapies, practices, and interventions in health contexts as part of the Mind-body interventions series of BMC Complementary Medicine and Therapies. The collection highlights the emerging value of the arts in complementary medicine and contributes to the expanding knowledge and integration of mind-body interventions and creative art practices.

Gallium-68 labelled RGD PET/CT imaging of endothelial activation in COVID-19 patients.

In coronavirus disease 2019 (COVID-19), endothelial cells play a central role and an inadequate response is associated with vascular complications. PET imaging with gallium-68 labelled RGD-peptide (68Ga-RGD) targets αvß3 integrin expression which allows quantification of endothelial activation. In this single-center, prospective observational study, we included ten hospitalized patients with COVID-19 between October 2020 and January 2021. Patients underwent 68Ga-RGD PET/CT followed by iodine mapping of lung parenchyma. CT-based segmentation of lung parenchyma, carotid arteries and myocardium was used to quantify tracer uptake by calculating standardized uptake values (SUV). Five non-COVID-19 patients were used as reference. The study population was 68.5 (IQR 52.0-74.5) years old, with median oxygen need of 3 l/min (IQR 0.9-4.0). 68Ga-RGD uptake quantified as SUV ± SD was increased in lungs (0.99 ± 0.32 vs. 0.45 ± 0.18, p < 0.01) and myocardium (3.44 ± 1.59 vs. 0.65 ± 0.22, p < 0.01) of COVID-19 patients compared to reference but not in the carotid arteries. Iodine maps showed local variations in parenchymal perfusion but no correlation with SUV. In conclusion, using 68Ga-RGD PET/CT in COVID-19 patients admitted with respiratory symptoms, we demonstrated increased endothelial activation in the lung parenchyma and myocardium. Our findings indicate the involvement of increased and localized endothelial cell activation in the cardiopulmonary system in COVID-19 patients.Trail registration: NCT04596943.

A qualitative inquiry comparing mindfulness-based art therapy, mindfulness and neutral clay tasks as a proactive mental health solution for college students.

Objective: The purpose of this study was to examine how college students perceive and manage stress and anxiety in the university setting and explain their perceptions of the effects of MBAT, NCT, and MO on stress, anxiety, and general student functioning. Participants: 58 undergraduate college students participated in post-test interviews following their engagement in either mindfulness-based art therapy (MBAT), a neutral clay task (NCT) or mindfulness only (MO) interventions using a 5-week online format. Methods: Magnitude coding was used to describe participant's perspectives. Results: Many themes emerged including habitual creative practice, prioritizing time for the self, enjoyable/relaxing activity, learning new techniques, understanding of processing and developing self-insight. Themes in the NCT group were more surface level observations, whereas MBAT, and to a lesser extent, MO groups contained an element of deeper understanding and processing. Conclusions: These findings offer support for implementing online and accessible mental health strategies as a gateway to traditional therapies in college settings.

Prevalence, risk factors, and long-term outcomes of cerebral ischemia in hospitalized COVID-19 patients - study rationale and protocol of the CORONIS study: A multicentre prospective cohort study.

Background: COVID-19 is often complicated by thrombo-embolic events including ischemic stroke. The underlying mechanisms of COVID-19-associated ischemic stroke, the incidence and risk factors of silent cerebral ischemia, and the long-term functional outcome in these patients are currently unknown. Patients and methods: CORONavirus and Ischemic Stroke (CORONIS) is a multicentre prospective cohort study investigating the prevalence, risk factors and long-term incidence of (silent) cerebral ischemia, and the long-term functional outcome among patients with COVID-19. We aim to include 200 adult patients hospitalized with COVID-19 without symptomatic ischemic stroke to investigate the prevalence of silent cerebral ischemia compared with 60 (matched) controls with MRI. In addition, we will identify potential risk factors and/or causes of cerebral ischemia in COVID-19 patients with (n = 70) or without symptomatic stroke (n = 200) by means of blood sampling, cardiac workup and brain MRI. We will measure functional outcome and cognitive function after 3 and 12 months with standardized questionnaires in all patients with COVID-19. Finally, the long-term incidence of (new) silent cerebral ischemia in patients with COVID-19 will be assessed with follow up MRI (n = 120). Summary: The CORONIS study is designed to add further insight into the prevalence, long-term incidence and risk factors of cerebral ischemia, and the long-term functional outcome in hospitalized adult patients with COVID-19.

Long-term Risk of Bleeding and Ischemic Events After Ischemic Stroke or Transient Ischemic Attack in Young Adults.

BACKGROUND AND OBJECTIVES: Guidelines recommend antithrombotic medication as secondary prevention for patients with ischemic stroke or transient ischemic attack (TIA) at young age based on results from trials in older patients. We investigated the long-term risk of bleeding and ischemic events in young patients after ischemic stroke or TIA. METHODS: We included 30-day survivors of first-ever ischemic stroke or TIA aged 18-50 years from the Follow-Up of TIA and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, a prospective cohort study of stroke at young age. We obtained information on recurrent ischemia based on structured data collection from 1995 until 2014 as part of the FUTURE study follow-up, complemented with information on any bleeding and ischemic events by retrospective chart review from baseline until last medical consultation or June 2020. Primary outcome was any bleeding; secondary outcome any ischemic event during follow-up. Both were stratified for sex, age, etiology, and use of antithrombotic medication at discharge. Bleeding and ischemic events were classified according to location and bleeding events also by severity. RESULTS: We included 544 patients (56.1% women, median age of 42.2; interquartile range [IQR] 36.5-46.7 years) with a median follow-up of 9.6 (IQR 2.5-14.3) years. Ten-year cumulative risk of any bleeding event was 21.8% (95% CI 17.4-26.0) and 33.9% (95% CI 28.3-37.5) of any ischemic event. Risk of bleeding was higher in women with a cumulative risk of 28.2% (95% CI 21.6-34.3) vs 13.7% (95% CI 8.2-18.9) in men (p < 0.01), mainly because of gynecologic bleeds. Female sex (p < 0.001) and age between 40 and 49 years (p = 0.04) were independent predictors of bleeding. DISCUSSION: Young patients after ischemic stroke or TIA have a substantial long-term risk of both bleeding (especially women) and ischemic events. Future studies should investigate the effects of long-term antithrombotics in young patients, taking into account the risk of bleeding complications.

A qualitative inquiry comparing mindfulness-based art therapy versus neutral clay tasks as a proactive mental health solution for college students.

Objective: College students experience unprecedented levels of stress and anxiety, impacting their desire to perform well and live a balanced life. Mindfulness-based practices along with art therapy techniques have been demonstrated to improve psychological and physiological impacts of stress and anxiety among college students. Participants: 12 undergraduate college students participated in pre and post-test interviews following their engagement in either mindfulness-based art therapy (MBAT) or a neutral clay task (NCT) using a 5-week online format. Methods: Descriptive phenomenology and artful inquiry were used to elicit participants' perspectives. Results: Both MBAT and NCT elicited relaxing and calming effects, but MBAT provided more proactive and direct benefits, with participants reporting that they could identify and move through stressors. While NCT participants described their experience as fun or playful. Conclusions: These findings offer notable support for implementing online and accessible mental health strategies such as MBAT and NCT into college settings.

Mindfulness based art therapy study protocol to determine efficacy in reducing college stress and anxiety.

BACKGROUND: College students in Generation Z are among the most stressed of our time. Previous research suggests that current interventions on university campuses are primarily for students in crises, but supportive services like psychoeducation to introduce coping skills are scant. Interventions that take both financial and time pressures into account are needed to address the mental health challenges faced by students. This study is designed to determine the unique role of the arts as a proactive mental health strategy for college students. METHODS: A sample of college students in Generation Z (n = 120) will be recruited. Participants will be assigned to Arts-only, mindfulness-only, mindfulness-based art interventions or a non-intervention control group. These interventions will be delivered using a minimal contact, web-based approach. Participants will be screened for eligibility requirements prior to the inclusion in the Time 1 assessment though an online survey. Once enrolled, participants will complete the Time 1 assessment, followed by the intervention. Each assessment will consist of psychological and physiological measures. The MBAT, NCT and MO groups will complete a brief self-care task twice a week for 5 weeks. Upon completion of the assigned intervention, participants will complete a Time 2 assessment and participate in the Trier Social Stress Test. Six weeks post-intervention, participants will complete the final assessment to assess the longevity of effects of the intervention. DISCUSSION: This study will clarify the effects of Mindfulness-based Art Therapy on several biometric and physiological markers above and beyond isolated art therapy or mindfulness interventions. Qualitative data in the form of transcribed exit interviews will be analyzed to characterize the unique needs of Generation Z students, along with level of engagement, intervention acceptance and satisfaction. The results will identify the efficacy of a low-cost and easily accessible mental health intervention targeting college students experiencing stress and anxiety. Trial registration ClinicalTrials.gov, NCT04834765, 05/17/21. Retrospectively registered.

Therapeutic psychological and biological responses to mindfulness-based art therapy.

Stress and anxiety pose a threat to college students' academic performance as well as their long-term mental and physical health, but the time constraints of a rigorous academic schedule make it difficult to offer even brief mental health interventions. A convenience sample of full-time students at a public university was recruited for a 5-week study conducted mostly using an online platform. Participants were randomly assigned to a Mindfulness-Based Art Therapy (MBAT) intervention or a Neutral Clay Task (NCT). Anxiety, perceived stress, and salivary cortisol outcomes were measured. A total of n = 77 participants completed the study. The MBAT group experienced significant reductions in anxiety and perceived stress compared to the NCT group. Significant reductions in salivary cortisol were observed, but only time could be identified as a confounding variable. Art making alone is not enough to induce significant positive responses, but this study suggests MBAT can, and that an online intervention could offer feasible and accessible mental health services on college campuses. Further refinement of biological data collection and analysis is needed to determine what the mediating effects MBAT could have, if any, at the molecular level.

Identifying the evidence-base for art-based practices and their potential benefit for mental health recovery: a critical review.

PURPOSE: Art-based practices show promise as a beneficial solution for mental health services because they are in line with the whole person recovery framework currently being adopted, and have high acceptability with consumers. Nevertheless, incorporation of art-based approaches into mental health services has been impeded by claims of an insufficient evidence-base and ongoing debates about the most suitable research practices. This article addresses this gap in the literature by critically reviewing current research on the benefits of art-based practices in mental health rehabilitation settings. METHOD: A critical review of previous research was conducted identifying all quantitative, qualitative and mixed method studies that addressed art making and adult mental illness. Then a deductive/theoretical thematic analysis was conducted using Lal's framework for conceptualising mental health recovery. RESULTS: The identified areas where art-based practices were of key benefit included psychological and social recovery, particularly in the areas of self-discovery, self-expression, relationships and social identity. These findings in conjunction with the identified benefits to clinical, occupational and contextual recovery indicate that art-based practices play a substantial role in mental health recovery. To add weight to these claims, future research endeavours need to integrate the suggested recommendations detailed in this review. CONCLUSION: Recommendations are made to improve the quality of future research, including the need for well-designed mixed-method studies that integrate qualitative and quantitative research, whilst keeping in mind the values of mental heath recovery, would further validate this current evidence-base.

The lived experience of art making as a companion to the mental health recovery process.

PURPOSE: Art making is a common activity provided for consumers in mental health psychosocial rehabilitation services, yet there is little evidence available which examines its role in the recovery process. The current study inquires into mental health consumers' lived experiences of art making within psychosocial rehabilitation services and their views on how art making supports mental health recovery. METHOD: This research used qualitative in-depth interviews to explore the role of art making in the mental health recovery journey. The sample comprised 18 consumer participants who attended art-based programs in two psychosocial services in Victoria, Australia. The 60-90 min interviews were analysed using interpretative phenomenological analysis. RESULTS: A total of 11 major themes were identified and organised into three areas: qualities conducive to the art making context, how the art making process benefits mental health recovery, and how the image or art product benefits mental health recovery. The 11 themes are described and illustrated from participant interviews. Consumers described art making as a transformative activity which enabled them to take greater control of their lives, resulting in feeling stronger, more confident, and more capable of driving their journey of recovery. The art product also served valuable roles in supporting their recovery. CONCLUSIONS: Art making is a highly valued activity by consumers, who suggest that innovative and strengths-based methods, such as art making, can facilitate recovery and self-expression. A key challenge for the field is to determine how such methods can be better integrated into mental health service delivery.