Pandemic Grief Reaction and Intolerance of Uncertainty on the Cognitive-Behavioral Model of COVID-Related Hypochondriasis Among Firefighters.

OBJECTIVE: This study aimed to explore the feasibility of cognitive-behavioral model hypochondriasis regarding coronavirus disease-2019 (COVID-19) among firefighters. In addition, we examined the possible role of their grief reaction and intolerance of uncertainty in the model of COVID-related hypochondriasis. METHODS: An anonymous online survey was done on October 27-28, 2022, among firefighters who witnessed people's death. Demographic characteristics were collected, and their psychological states were assessed using rating scales such as the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Fear of COVID-19 Scale (FCV-19S), Pandemic Grief Scale (PGS), and Intolerance of Uncertainty Scale-12 (IUS-12). RESULTS: Their OCS score was expected by the CRBS (ß=0.30, p<0.001), FCV-19S (ß=0.10, p<0.001), PGS (ß=0.29, p<0.001), and IUS12 (ß=0.04, p=0.024) (F=134.5, p<0.001). The COVID-related cognitive-behavioral model of hypochondriasis was feasible among firefighters who witnessed people's death. Their pandemic grief reaction and intolerance of uncertainty directly influenced their preoccupation with coronavirus, and viral anxiety and coronavirus reassurance-seeking behavior mediated the relationship. CONCLUSION: Firefighters' viral anxiety and coronavirus reassurance-seeking behavior mediated the influence of pandemic grief reaction or intolerance of uncertainty on the preoccupation with coronavirus.

The Risk of Neuropsychiatric Adverse Events With Use of Leukotriene Receptor Antagonists in Patients With Asthma: Analysis of Korea's National Health Insurance Sharing Service Database.

BACKGROUND: Montelukast, a selective leukotriene receptor antagonist, is a commonly prescribed allergy medication but its potential association with neuropsychiatric adverse events is concerning. OBJECTIVE: To analyze Korea's National Health Insurance System claims records to identify the risk of neuropsychiatric adverse events in patients with asthma treated with montelukast. METHODS: This retrospective population-based study analyzed the National Health Insurance claims records of the entire Korean population between 2008 and 2015. We compared the risk of neuropsychiatric adverse events among patients with asthma using inhaled corticosteroids and/or long-acting ß2-agonists with montelukast or pranlukast and those not using leukotriene receptor antagonists (control group). RESULTS: There was no increased risk of the composite outcome of all measured neuropsychiatric adverse events in patients with asthma who were prescribed montelukast or pranlukast compared with those who were not. However, montelukast use was associated with an increased risk of hallucinations (inverse probability treatment weighting hazard ratio, 1.45; 95% CI, 1.07-1.96) and attention problems (inverse probability treatment weighting hazard ratio, 1.24; 95% CI, 1.01-1.52). Significant negative hazards for disorientation, anxiety, stress reactions, and somatic symptoms were observed in the montelukast group. When grouped by sex, the risk of hallucinations and attention problems was higher in men prescribed montelukast compared with the controls. CONCLUSIONS: We did not observe an increase in all neuropsychiatric adverse events in the leukotriene receptor antagonist-treated group; however, an increased risk of hallucinations and attention problems was observed in those taking montelukast, regardless of the medication administration period.

High removal efficiency of industrial toxic compounds through stable catalytic reactivity in water treatment system.

We identified optimal conditions for the disposal of high concentration of organic contaminants within a short time using a hybrid advanced oxidation process (AOP) combining various oxidizing agents. Plasma-treated water (PTW) containing many active species, that play dominant roles in the degradation of organic substances like hydroxyl radicals, atomic oxygen, ozone, and hydrogen peroxide, was used in this study as a strategy to improve degradation performance without the use of expensive chemical reagents like hydrogen peroxide. In particular, the optimal decomposition conditions using PTW, which were combined with 10 mg/h ozone, 2 g/L iron oxide, and 4 W UV light, demonstrated excellent removal abilities of a high concentration of reactive black 5 (RB5; 100 mg/L, >99%, [k] = 4.15 h-1) and tetracycline (TC; 10 mg/L, >96.5%, [k] = 3.35 h-1) for 25 min, approximately 1.5 times higher than that without PTW (RB5; 100 mg/L, 94%, [k] = 2.80 h-1). These results confirmed that the production of strong reactive hydroxyl radicals from the decomposition process, as well as various reactive species included in PTW efficiently attacked pollutant substances, resulting in a higher removal rate. This suggests that a water treatment system with this optimal condition based on complex AOP systems using PTW could be useful in critical environmental and biomedical applications.

Development of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Work-related Stress and Anxiety in Healthcare Workers in Response to Viral Epidemics.

BACKGROUND: The coronavirus disease 2019, or COVID-19, has had a major psychological impact on healthcare workers. However, very few scales are available to specifically assess work-related stress and anxiety in healthcare workers responding to a viral epidemic. This study developed a new assessment tool, the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) and aimed to validate it among healthcare workers directly affected by COVID-19 in Korea. METHODS: A total of 1,019 healthcare workers responded through anonymous questionnaires during April 20-30, 2020. Exploratory factor analysis (EFA) was conducted to explore the construct validity, and the reliability was assessed using internal consistency measures of Cronbach's alpha coefficients. Receiver operating characteristic analysis was conducted to define the most appropriate cut-off point of SAVE-9 using the Generalized Anxiety Disorder-7 scale (GAD-7; ≥ 5). Second, Spearman's rank correlation coefficient was used to establish convergent validity for the SAVE-9 questionnaire with GAD-7 and the Patient Health Questionnaire-9. RESULTS: The nine-item scale had satisfactory internal consistency (Cronbach's α = 0.795). It adopted a two-factor structure: 1) anxiety regarding viral epidemics and 2) work-related stress associated with viral epidemics. A cut-off score of 22 for the SAVE-9 ascertained levels of stress and anxiety in response to a viral epidemic in healthcare workers that warranted clinical attention. Correlations between the SAVE-9 and the other scales were statistically significant (P < 0.05). CONCLUSION: The results suggest that the SAVE-9 is a useful, reliable, and valid tool to evaluate stress and anxiety responses in healthcare workers during viral epidemics.

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea.

BACKGROUND: The healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcare-associated infection during the early spread of COVID-19. METHODS: A real-time online survey was conducted between April 14-18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout Inventory-General Survey scale, and the Stress and Anxiety to Viral Epidemics-9. RESULTS: The HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73; P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07-1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31-2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21-2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09-2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression. CONCLUSION: The present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.

High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study.

BACKGROUND: The COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics. OBJECTIVE: We investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic. METHODS: Respondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers' depression as outcome variables. RESULTS: Among 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression. CONCLUSIONS: Psychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores.

The Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) Scale: A New Instrument for Assessing the Anxiety Response of General Population to the Viral Epidemic During the COVID-19 Pandemic.

The general population has reported experiencing anxiety due to the COVID-19 pandemic. This study explored the validity and utility of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for measuring the anxiety response of the general population to the viral epidemic. About 1,009 respondents participated in an online survey. Of these, 501 (49.7%) participants were rated as having at least a mild degree of anxiety response to the viral epidemic (SAVE-6 score ≥ 15), while 90 (8.9%) and 69 (6.8%) participants were rated as having moderate degree of depression and anxiety, respectively. The SAVE-6 scale showed a good internal consistency (Cronbach's alpha = 0.815). Parallel analysis suggested a one-factor structure for the measure. The SAVE-6 scale was found to be a reliable, valid, and useful brief measure that can be applied to the general population.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era.

OBJECTIVE: We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. METHODS: We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. RESULTS: Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers. CONCLUSION: Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Risk Perception, Unhealthy Behavior, and Anxiety Due to Viral Epidemic Among Healthcare Workers: The Relationships With Depressive and Insomnia Symptoms During COVID-19.

We aimed to investigate the relationship between mental health problems and unhealthy behaviors among healthcare workers in response to the COVID-19 pandemic. Using an online survey, we collected data on healthcare workers' perception regarding COVID-19 exposure in a work unit. Workers' depression, insomnia, and anxiety symptoms were assessed using the Patient Health Questionnaire-9, Insomnia Severity Index, and Generalized Anxiety Disorder-7 scale, respectively. Work-related stress and anxiety in response to the viral epidemic were measured using the Stress and Anxiety to Viral Epidemic-9 (SAVE-9) scale. We found that work-related stress and anxiety in response to the viral epidemic was associated with female sex, perception of the workplace as being dangerous, and depressive symptoms. Unhealthy behaviors, such as smoking and drinking as coping behaviors during the pandemic, were associated with male sex, young age, depression, and insomnia. During the COVID-19 pandemic, it is necessary to closely observe the patterns of work-related stress and anxiety reactions among healthcare workers to reduce their burnout.

Application of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) and Coronavirus Anxiety Scale (CAS) to Measure Anxiety in Cancer Patient in Response to COVID-19.

This study investigated the usefulness of the six-item Stress and Anxiety to Viral Epidemics (SAVE-6) scale and the Coronavirus Anxiety Scale (CAS) as tools to assess anxiety related to coronavirus disease (COVID-19) in cancer patients. A total of 221 patients with cancer responded to an anonymous online questionnaire between 15 July and 15 August 2020. The functional impairment of the patients was assessed using the Work and Social Adjustment Scale (WSAS), and the SAVE-6 and CAS were also applied. Among these 221 cancer patients, 110 (49.8%) had SAVE-6 scores ≥ 15 and 21 (9.5%) had CAS scores ≥ 5. Within the study population, 104 (47.1%) and 29 (13.1%) patients had WSAS scores ≥ 11 (moderate to severe functional impairment) and ≥ 21 (severe functional impairment), respectively. The correlations between the SAVE-6 and WSAS (p < 0.001) and CAS (p < 0.001) scores were statistically significant. The cut-off for the SAVE-6 was 15 points, while that for the WSAS was 11. Our results suggested that the SAVE-6 and CAS could be used to evaluate moderate and severe degrees of functional impairment related to mental health, respectively, in cancer patients during viral epidemics.

Increased prevalence of depression in South Korea from 2002 to 2013.

South Korea has one of the highest suicide rates among countries. However, the prevalence of depression in South Korea has been reported to be much lower than in other countries. The current study aims to estimate the prevalence of major depressive disorder using a large representative sample of the South Korean population. The prevalence of depression in a sampled population of one million individuals increased from 2.8% in 2002 to 5.3% in 2013; it was found to increase with the age of the population, and was higher in females than in males for most age groups. A Cox's proportional hazard model showed that suicide risk was significantly higher in people with depression (hazard ratio [HR] 3.79, 95% CI 3.14-4.58) than those without depression. It was also significantly higher in older people (HR 1.52, 95% CI 1.36-1.70) than in younger people, and in males (HR 2.45, 95% CI 2.02-2.96) than in females. Furthermore, higher income groups were at lower suicide risk as compared to lower income groups (HR 0.88, 95% CI 0.80-0.95). This study using the large representative sample data provided evidence that increased prevalence of depression contributed to the increased risk of suicide in South Korea during the recent decade.

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.

Prism Adaptation Deficits in Schizophrenia.

Recent clinical and neurobehavioral evidence suggests cerebellar dysfunction in schizophrenia (SZ). We used the prism adaptation motor task (PAT) to probe specific cerebellar circuits in the disorder. PAT requires cerebellum-dependent motor adaptation, perceptual remapping, and strategic control. A failure to engage in early corrective processes may indicate impairment within either the cerebellum or regions contributing to strategic components, such as the parietal lobe, while an inability to develop and retain a visuomotor shift with time strongly suggests cerebellar impairment. Thirty-one individuals with SZ and 31 individuals without a history of psychological disorders completed PAT. Subjects reached to a target before, during, and following prism exposure, while their movements were recorded using motion-sensing technology. The SZ group performed worse on conditions consisting of adaptation, post-adaptation, aftereffects, and reorientation, thereby demonstrating a failure to adapt to the same degree as healthy controls. SZ performance remained impaired even with visual feedback and did not differ from controls at baseline, suggesting the observed deficit is specific to adaptation. Results indicate that sensorimotor adaptation is impaired in SZ and implicate disturbances in cerebellar circuits.

Quality of Life in Patients with Papillary Thyroid Microcarcinoma Managed by Active Surveillance or Lobectomy: A Cross-Sectional Study.

Background: Active surveillance (AS) is recommended as an alternative to immediate surgery in patients with papillary thyroid microcarcinoma (PTMC), but the impact of AS on quality of life has not been reported. The aim of this study was to compare quality-of-life parameters in patients with PTMC under AS versus those who underwent lobectomy (LB). Methods: In this cross-sectional study, patients with PTMC were prospectively enrolled between June 2016 and October 2017. All patients completed three questionnaires: the 12-item short-form health survey, thyroid cancer-specific quality of life, and fear of progression. The results were compared after adjusting for age, sex, and serum thyrotropin levels. Results: The AS group comprised 43 patients, and the LB group comprised 148 patients. According to the 12-item short-form health survey questionnaire, the score for role limitations due to emotional problems showed a significant negative association between the groups (coefficient [coef]: -7.71 [confidence interval (CI) -15.26 to -0.16], p = 0.045). The thyroid cancer-specific quality of life questionnaire also showed statistically significant differences between the groups with respect to three scores: neuromuscular problems (coef: 4.99 [CI 0.63-10.62], p = 0.020), throat/mouth problems (coef: 5.28 [CI 0.18-10.38], p = 0.043), and scar problems (coef: 9.34 [CI 4.38-14.29], p < 0.001), suggesting a higher level of complaint in the LB group than in the AS group. No significant differences in fear of progression scores were seen between the two groups. Conclusions: Patients with PTMC underwent LB experienced more health-related problems than those managed by AS. These findings support the role of AS as a reasonable management option for patients with PTMC.

Aberrant structural-functional coupling in adult cannabis users.

Cellular studies indicate that endocannabinoid type-1 retrograde signaling plays a major role in synaptic plasticity. Disruption of these processes by delta-9-tetrahydrocannabinol (THC) could produce alterations either in structural and functional brain connectivity or in their association in cannabis (CB) users. Graph theoretic structural and functional networks were generated with diffusion tensor imaging and resting-state functional imaging in 37 current CB users and 31 healthy non-users. The primary outcome measures were coupling between structural and functional connectivity, global network characteristics, association between the coupling and network properties, and measures of rich-club organization. Structural-functional (SC-FC) coupling was globally preserved showing a positive association in current CB users. However, the users had disrupted associations between SC-FC coupling and network topological characteristics, most perturbed for shorter connections implying region-specific disruption by CB use. Rich-club analysis revealed impaired SC-FC coupling in the hippocampus and caudate of users. This study provides evidence of the abnormal SC-FC association in CB users. The effect was predominant in shorter connections of the brain network, suggesting that the impact of CB use or predispositional factors may be most apparent in local interconnections. Notably, the hippocampus and caudate specifically showed aberrant structural and functional coupling. These structures have high CB1 receptor density and may also be associated with changes in learning and habit formation that occur with chronic cannabis use.

Untangling the relatedness among correlations, Part II: Inter-subject correlation group analysis through linear mixed-effects modeling.

It has been argued that naturalistic conditions in FMRI studies provide a useful paradigm for investigating perception and cognition through a synchronization measure, inter-subject correlation (ISC). However, one analytical stumbling block has been the fact that the ISC values associated with each single subject are not independent, and our previous paper (Chen et al., 2016) used simulations and analyses of real data to show that the methodologies adopted in the literature do not have the proper control for false positives. In the same paper, we proposed nonparametric subject-wise bootstrapping and permutation testing techniques for one and two groups, respectively, which account for the correlation structure, and these greatly outperformed the prior methods in controlling the false positive rate (FPR); that is, subject-wise bootstrapping (SWB) worked relatively well for both cases with one and two groups, and subject-wise permutation (SWP) testing was virtually ideal for group comparisons. Here we seek to explicate and adopt a parametric approach through linear mixed-effects (LME) modeling for studying the ISC values, building on the previous correlation framework, with the benefit that the LME platform offers wider adaptability, more powerful interpretations, and quality control checking capability than nonparametric methods. We describe both theoretical and practical issues involved in the modeling and the manner in which LME with crossed random effects (CRE) modeling is applied. A data-doubling step further allows us to conveniently track the subject index, and achieve easy implementations. We pit the LME approach against the best nonparametric methods, and find that the LME framework achieves proper control for false positives. The new LME methodologies are shown to be both efficient and robust, and they will be publicly available in AFNI (http://afni.nimh.nih.gov).

Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients.

BACKGROUND: Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. OBJECTIVE: In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. METHODS: We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. RESULTS: With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. CONCLUSIONS: Our results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients.

Hyperglycemia Reduces Efficiency of Brain Networks in Subjects with Type 2 Diabetes.

Previous research has shown that the brain is an important target of diabetic complications. Since brain regions are interconnected to form a large-scale neural network, we investigated whether severe hyperglycemia affects the topology of the brain network in people with type 2 diabetes. Twenty middle-aged (average age: 54 years) individuals with poorly controlled diabetes (HbA1c: 8.9-14.6%, 74-136 mmol/mol) and 20 age-, sex-, and education-matched healthy volunteers were recruited. Graph theoretic network analysis was performed with axonal fiber tractography and tract-based spatial statistics (TBSS) using diffusion tensor imaging. Associations between the blood glucose level and white matter network characteristics were investigated. Individuals with diabetes had lower white matter network efficiency (P<0.001) and longer white matter path length (P<0.05) compared to healthy individuals. Higher HbA1c was associated with lower network efficiency (r = -0.53, P = 0.001) and longer network path length (r = 0.40, P<0.05). A disruption in local microstructural integrity was found in the multiple white matter regions and associated with higher HbA1c and fasting plasma glucose levels (corrected P<0.05). Poorer glycemic control is associated with lower efficiency and longer connection paths of the global brain network in individuals with diabetes. Chronic hyperglycemia in people with diabetes may disrupt the brain's topological integration, and lead to mental slowing and cognitive impairment.

Untangling the relatedness among correlations, part I: Nonparametric approaches to inter-subject correlation analysis at the group level.

FMRI data acquisition under naturalistic and continuous stimuli (e.g., watching a video or listening to music) has become popular recently due to the fact that it entails less manipulation and more realistic/complex contexts involved in the task, compared to the conventional task-based experimental designs. The synchronization or response similarities among subjects are typically measured through inter-subject correlation (ISC) between any pair of subjects. At the group level, summarizing the collection of ISC values is complicated by their intercorrelations, which necessarily lead to the violation of independence assumed in typical parametric approaches such as Student's t-test. Nonparametric methods, such as bootstrapping and permutation testing, have previously been adopted for testing purposes by resampling the time series of each subject, but the quantitative validity of these specific approaches in terms of controllability of false positive rate (FPR) has never been explored before. Here we survey the methods of ISC group analysis that have been employed in the literature, and discuss the issues involved in those methods. We then propose less computationally intensive nonparametric methods that can be performed at the group level (for both one- and two-sample analyses), as compared to the popular method of circularly shifting the EPI time series at the individual level. As part of the new approaches, subject-wise (SW) resampling is adopted instead of element-wise (EW) resampling, so that exchangeability and independence assumptions are satisfied, and the patterned correlation structure among the ISC values can be more accurately captured. We examine the FPR controllability and power achievement of all the methods through simulations, as well as their performance when applied to a real experimental dataset.

Diminished Quality of Life and Increased Brain Functional Connectivity in Patients with Hypothyroidism After Total Thyroidectomy.

BACKGROUND: Acute hypothyroidism induced by thyroid hormone withdrawal (THW) in patients with thyroid cancer after total thyroidectomy can affect mood and quality of life (QoL). While loss or dysregulation of thyroid hormone (TH) has these well-known behavioral consequences, the effects of TH alterations on brain function are not well understood. Resting state functional connectivity (FC) measured by functional magnetic resonance imaging (fMRI) allows non-invasive evaluation of human brain function. This study therefore examined whether THW affects resting state FC and whether changes in FC correlate with the mood or QoL of the patients with THW status. METHODS: Twenty-one patients who had undergone total thyroidectomy for thyroid cancer were recruited. Resting state fMRI scanning of the brain, thyroid function tests, and administration of the 12-Item Short Form Health Survey (SF-12) and the Patient Health Questionnaire-9 (PHQ-9) were performed before and after two weeks of THW. Regional homogeneity (ReHo), one of the measures of resting state FC, was calculated, and each voxel was compared between before and after THW in 19 patients. The ReHo values were extracted from the regions of interest showing within-group differences in ReHo values after THW, and correlations of ReHo values with thyrotropin (TSH) levels, total score of the PHQ-9, and composite scores of the SF-12 were statistically evaluated. RESULTS: Higher ReHo was observed after THW in the brain cortical regions across primary motor and sensory, visual, and association cortices. Among the regions, the ReHo values in the bilateral pre- and postcentral gyri, bilateral middle occipito-temporal cortices, the left precuneus, and the left lingual gyrus showed positive correlations with serum TSH levels after THW. Higher ReHo values in the bilateral pre- and postcentral gyri, the left middle temporo-occipital cortices, and the left ligual gyrus correlated with the lower mental component summary score from the SF-12, while higher ReHo values in the bilateral pre- and postcentral gyri correlated with higher total scores in the PHQ-9. CONCLUSIONS: Local brain FC is increased in the acute hypothyroid state. Higher FC correlates with a poorer mental QoL and increased depression in the hypothyroid state.