Introduction: Lumbosacral radiculopathy (LR), also known as sciatica, is a common type of radiating neurologic pain involving burning, tingling, and numbness in the lower extremities. It has an estimated lifetime prevalence as high as 43%. Objectives: The objective of this randomized controlled trial was to evaluate the impact of virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) on patients with LR during the COVID-19 pandemic. Methods: Potentially eligible patients were identified using electronic health record queries and phone screenings. Participants were then randomized to MORE or treatment-as-usual (TAU) for 8 weeks, with pain intensity assessed daily. At baseline and follow-up visits, participants completed questionnaires assessing the primary outcome, disability, as well as quality of life, depression, mindful reinterpretation of pain, and trait mindfulness. Results: In our study, patients undergoing virtual delivery of MORE had greater improvements in daily pain intensity (P = 0.002) but not in disability (P = 0.09), depression (P = 0.26), or quality of life (P = 0.99 and P = 0.89, SF-12 physical and mental component scores, respectively), relative to TAU patients. In addition, patients in MORE experienced significantly greater increases in mindful reinterpretation of pain (P = 0.029) and trait mindfulness (P = 0.035). Conclusion: Among patients with lumbar radiculopathy, MORE significantly reduced daily pain intensity but did not decrease disability or depression symptoms. Given the long duration of symptoms in our sample, we hypothesize the discrepancy between changes in daily pain intensity and disability is due to fear avoidance behaviors common in patients with chronic pain. As the first trial of a mindfulness intervention in patients with LR, these findings should inform future integrative approaches to LR treatment, particularly when considering the increasing use of virtual interventions throughout the COVID-19 pandemic.

Background: Psoriasis often coexists with psychiatric disorders and decreased quality of life (QoL), with treatments commonly overlooking the psychological impact of the disease. Heart rate variability biofeedback (HRVB) may offer a mind–body solution by providing real-time feedback on autonomic functions, teaching individuals to manage stress via controlled breathing. Objective: To examine the impact of a 7-week HRVB protocol on skin severity (SS), QoL, and mental health (MH) in individuals with psoriasis and determine the sustainability of any outcomes post-intervention. Methods: A single-arm, proof-of-concept pre–post trial was conducted at Bastyr University Clinic in San Diego, CA. Five individuals were recruited, screened, and underwent a 7-week HRVB protocol. Assessments included SS through the Psoriasis Area and Severity Index (PASI-P and PASI-C), QoL via the Cardiff Dermatology Life Quality Index (DLQI), and MH using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Data collection points were baseline, post-protocol, and 1-month follow-up. Results: Notable improvements were observed between baseline and post-protocol for PASI-P, DLQI, and GAD-7. A significant change remained for GAD-7 between baseline and follow-up. No major differences were identified for PASI-C and PHQ-9 across any timeframe, and other scales remained consistent between post-protocol and follow-up. Conclusion: HRVB showed promise in enhancing perceived SS, QoL, and anxiety over 7 weeks. Further studies should expand participant numbers and diversify initial scores, comparing HRVB with a control group. Trial registration: ClinicalTrials.gov NCT05506644, retrospectively registered on 16 August 2022.

Purpose: Mental health (MH) crises in adolescence can derail development, possibly leading to poorer health outcomes in young adulthood. According to recent estimates, approximately half of US children have unmet MH need, with increased odds when uninsured or Hispanic. The aims of this study were to update estimates of MH services need and use in the US adolescent (12-17 years) and to reassess previously identified associations between insurance status, demographic characteristics, MH need and use, and unmet need, using data from the National Survey of Drug Use and Health (NSDUH; 2019).Methods: Adolescents aged 12-17 years were included from the NSDUH. Logistic regressions were performed to assess associations of race and insurance with outcomes of past-year major depressive episode (MDE) and unmet MH need. Adjustments were made for age, sex, and income.Results: Individuals of multiple races, females, and users of alcohol, marijuana, and illicit drugs had increased odds of MDE, while Black adolescents and the privately insured had decreased odds. Hispanic adolescents, people of multiple races, and users of alcohol and illicit drug had increased odds for unmet need.Discussion: We estimate that 15.8% of all US adolescents had an MDE and that 45.8% of these adolescents with MDE went without MH care in 2019. We found very limited support for asso-ciations of race and insurance status with past-year MDE or unmet MH need, although this may be due to the small number of uninsured adolescents sampled in 2019. Longitudinal data are needed to assess severity of MH needs and appropriateness of care.(c) 2022 Society for Adolescent Health and Medicine. All rights reserved.

The goal of this study is to identify a signature of bioenergetic and functional markers in the muscles of individuals with Parkinson’s disease (PD). Quantitative physiological properties of in vivo hand muscle (FDI, first dorsal interosseus) and leg muscle (TA, Tibialis Anterior) of older individuals with PD were compared to historical age/gender-matched controls (N = 30). Magnetic resonance spectroscopy and imaging (MRS) were used to assess in vivo mitochondrial and cell energetic dysfunction, including maximum mitochondrial ATP production (ATPmax), NAD concentrations linked to energy/stress pathways, and muscle size. Muscle function was measured via a single muscle fatigue test. TA ATPmax and NAD levels were significantly lower in the PD cohort compared to controls (ATPmax: 0.66 mM/s ± 0.03 vs. 0.76 ± 0.02; NAD: 0.75 mM ± 0.05 vs. 0.91 ± 0.04). Muscle endurance and specific force were also lower in both hand and leg muscles in the PD subjects. Exploratory analyses of mitochondrial markers and individual symptoms suggested that higher ATPmax was associated with a greater sense of motivation and engagement and less REM sleep behavior disorder (RBD). ATPmax was not associated with clinical severity or individual symptom(s), years since diagnosis, or quality of life. Results from this pilot study contribute to a growing body of evidence that PD is not a brain disease, but a systemic metabolic syndrome with disrupted cellular energetics and function in peripheral tissues. The significant impairment of both mitochondrial ATP production and resting metabolite levels in the TA muscles of the PD patients suggests that skeletal muscle mitochondrial function may be an important tool for mechanistic understanding and clinical application in PD patients. This study looked at individuals with mid-stage PD; future research should evaluate whether the observed metabolic perturbations in muscle dysfunction occur in the early stages of the disease and whether they have value as theragnostic biomarkers.

Abstract Background Psoriasis is a common psychocutaneous disorder, frequently associated with reduced quality of life (QoL) and psychiatric comorbidities, including anxiety and mood disorders. Although pharmacological interventions and phototherapy may provide effective, albeit temporary, relief in the skin, they frequently fail to address the psychological impact of the disease. Heart rate variability biofeedback (HRVB) is a specific mind-body therapy that provides real-time visual feedback on an individual’s autonomic functioning in order to modify their physiological stress response through diaphragmatic, paced breathing. Objective To explore the impact of a seven-week HRVB protocol on skin severity (SS), QoL, and mental health (MH) in individuals with psoriasis and to determine whether the effects, if any, can be maintained after the intervention has concluded. Methods This was a single-arm, proof-of-concept clinical case series conducted at Bastyr University Clinic in San Diego, California. Five participants were recruited through flyers and referrals and were screened for eligibility prior to undergoing a seven-week HRVB protocol. SS was assessed by both the participant and clinician using the Psoriasis Area and Severity Index (PASI-P and PASI-C), QoL was assessed using the Cardiff Dermatology Life Quality Index (DLQI), and MH was measured using the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). These outcomes were collected at baseline (T1), post-protocol (T2), and follow-up (T3) between June 2022 to December 2022. Results There were significant differences in scores between T1 and T2 for PASI-P, DLQI, and GAD-7. There was also a significant difference between T1 and T3 for GAD-7. PASI-C and PHQ-9 had no significant difference between any time points. All scales were non-significant for T2 and T3. PASI-P, PASI-C, DLQI, and PHQ-9 were non-significant between T1 to T3. Linear regressions for each participant showed a majority decreasing rate of change. Conclusion In this real-life setting, HRVB was associated with significant improvements in participant perception of SS, QoL, and anxiety over a seven-week period. Future studies should include a larger cohort with more variation in SS, QoL, and MH scores at T1 and compare the HRVB protocol against a control group. NCT05506644, retrospectively registered on 16 August 2022. Trial registration ClinicalTrials.gov

Abstract Background Psoriasis is a common psychocutaneous disorder, frequently associated with reduced quality of life (QoL) and psychiatric comorbidities, including anxiety and mood disorders. Although pharmacological interventions and phototherapy may provide effective, albeit temporary, relief in the skin, they frequently fail to address the psychological impact of the disease. Heart rate variability biofeedback (HRVB) is a specific mind-body therapy that provides real-time visual feedback on an individual’s autonomic functioning in order to modify their physiological stress response through diaphragmatic, paced breathing. Objective To explore the impact of a seven-week HRVB protocol on skin severity (SS), QoL, and mental health (MH) in individuals with psoriasis and to determine whether the effects, if any, can be maintained after the intervention has concluded. Methods This was a single-arm, proof-of-concept clinical case series conducted at Bastyr University Clinic in San Diego, California. Five participants were recruited through flyers and referrals and were screened for eligibility prior to undergoing a seven-week HRVB protocol. SS was assessed by both the participant and clinician using the Psoriasis Area and Severity Index (PASI-P and PASI-C), QoL was assessed using the Cardiff Dermatology Life Quality Index (DLQI), and MH was measured using the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). These outcomes were collected at baseline (T1), post-protocol (T2), and follow-up (T3) between June 2022 to December 2022. Results There were significant differences in scores between T1 and T2 for PASI-P, DLQI, and GAD-7. There was also a significant difference between T1 and T3 for GAD-7. PASI-C and PHQ-9 had no significant difference between any time points. All scales were non-significant for T2 and T3. PASI-P, PASI-C, DLQI, and PHQ-9 were non-significant between T1 to T3. Linear regressions for each participant showed a majority decreasing rate of change. Conclusion In this real-life setting, HRVB was associated with significant improvements in participant perception of SS, QoL, and anxiety over a seven-week period. Future studies should include a larger cohort with more variation in SS, QoL, and MH scores at T1 and compare the HRVB protocol against a control group. NCT05506644, retrospectively registered on 16 August 2022. Trial registration ClinicalTrials.gov

Background: It is estimated that half of the individuals with Parkinson’s disease (PD) use some form of over-the-counter vitamin, herbal supplement or nutraceutical. The goal of this study was to survey individuals with PD about their use of the nutraceuticals and evaluate the association of the nutraceutical with the severity of symptoms. Methods: Participants with self-reported idiopathic PD within the 2021 cohort (n = 1084) were included in a cross-sectional study to assess association of nutraceuticals with symptom severity via linear regression analysis. PD severity was measured using the patient-reported outcomes in PD, and supplement use reflected self-reported consistent use over the previous six months. All regression analyses adjusted for age, gender, income and years since diagnosis. The use of the term progression refers to PRO-PD scores adjusted for years since diagnosis. Results: The most frequently used supplements were vitamin D (71%), B12 (44%), vitamin C (38%) and fish oil (38%). None of the supplements being used were associated with statistically significant worse outcomes. Nutraceuticals associated with improved outcomes were Ginkgo biloba (GB), NAD+ or its precursors, 5-methyltetrahydrofolate, glutathione, mucuna, CoQ10, low dose lithium, curcumin, homocysteine factors, DHEA, coconut oil, vitamin C, and omega-3 fatty acids (fish oil). Conclusions: These data suggest that in a real-world setting, some over-the-counter supplements are associated with fewer patient-reported symptoms. Supplements with significant associations with fewer symptoms have biological plausibility and future clinical trials should be explored.

An enhanced understanding of Parkinson’s disease (PD) in recent years has led to the revelation that the motor symptoms by which we’ve been defining and describing PD are late-stage, downstream consequences of a degenerative process decades in the making. The objective outcome measures traditionally used in clinic and PD research rely heavily on motor symptoms and have been shown to lack sensitivity early in the disease. The Patient-Reported Outcomes in PD (PRO-PD) scale is an entirely subjective, patient-centered tool designed to be useful to patients, providers, and researchers as a remote patient monitoring system. The goal was to create a continuous outcome measure that does not require a clinic visit, is sensitive early in the disease, does not fluctuate throughout the day, captures severity of both motor and non-motor symptoms, and correlates with quality of life (QoL) and existing measures of severity. Two datasets were used with a total of 13,349 participants with PRO-PD scores. Data quality, feasibility, Cronbach’s alpha, and confirmatory factor analysis was conducted. Longitudinal analysis to determine change over time was completed. Response to change was evaluated by initiation of levodopa. The PRO-PD scale shows acceptable validity with a 95.1% completion rate, non-significant floor and ceiling effects, acceptable skew and kurtosis, Cronbach’s alpha of >0.75 for the total scale and subscales with acceptable unidimentionality (r between 0.37 and 0.84). Confirmatory factor analysis (CFI = 0.841, Tucker Lewis Index = 0.829, SRMSEA = 0.054) shows room for improvement for factors. Responsiveness has been shown by mean change per year in PRO-PD score of 38 (±14) and significant improvement in PRO-PD score with initiation of dopamine replacement therapy. These analyses suggest the PRO-PD is a feasible and valid tool for remote patient monitoring in PD.

The Mediterranean (MEDI) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets have been associated with a reduced risk of Parkinson’s disease (PD) diagnosis. However, studies evaluating whether these diets are associated with disease progression in those patients already diagnosed are lacking. The objective of this study was to evaluate whether MIND and MEDI scores were associated with improved patient-reported outcomes. Additionally, we sought to explore which questions on the MIND and MEDI scales were more strongly correlated with PD symptom severity. Data were obtained from the ongoing Modifiable Variables in Parkinsonism study, using patient-reported outcomes in Parkinson’s disease (PRO-PD) as the primary measure for symptom severity, and MIND and MEDI scales for diet score. After adjusting for age, gender, income, and years since diagnosis, for each 1-point increase in the MIND and MEDI scores, PRO-PD scores were 52.9 points lower (95%CI: −66.4, −39.4; p < 0.001) and 25.6 points lower (95%CI: −37.2, −14.0; p < 0.001), respectively (N = 1205). This study suggests MIND and MEDI scores are associated with fewer patient-reported symptoms over time, with each MIND point being twice as strong as a MEDI point in reducing symptom severity. Future dietary intervention trials should consider the MIND diet as a therapeutic strategy for improving long-term PD outcomes.

Introduction: Lumbosacral radiculopathy/radiculitis (LR) or “sciatica” is a commonly intractable sequelae of chronic low back pain (LBP), and challenges in the treatment of LR indicate that persistent pain may have both mechanical and neuropathic origins. Mindfulness-based interventions have been demonstrated to be effective tools in mitigating self-reported pain in LBP patients. This paper describes the protocol for a randomized controlled trial (RCT) evaluating the effects of the specific mindfulness-based intervention Mindfulness-Oriented Recovery Enhancement (MORE) on LR symptoms and sequelae, including mental health and physical function. Methods: Participants recruited from the Portland, OR area are screened before completing a baseline visit that includes a series of self-report questionnaires and surface electromyography (sEMG) of the lower extremity. Upon enrollment, participants are randomly assigned to the MORE (experimental) group or treatment as usual (control) group for 8 weeks. Self-reported assessments and sEMG studies are repeated after the intervention is complete for pre/post-intervention comparisons. The outcome measures evaluate self-reported pain, physical function, quality of life, depression symptoms, trait mindfulness, and reinterpretation of pain, with surface electromyography (sEMG) findings evaluating objective physical function in patients with LR. To our knowledge, this is the first trial to date using an objective measure, sEMG, to evaluate the effects of a mindfulness-based intervention on LR symptoms. Hypotheses: We hypothesize that MORE will be effective in improving self-reported pain, physical function, quality of life, depression symptoms, mindfulness, and reinterpretation of pain scores after 8 weeks of mindfulness training as compared to treatment as usual. Additionally, we hypothesize that individuals in the MORE group with abnormal sEMG findings at baseline will have improved sEMG findings at their 8-week follow-up visit.