Within the mild traumatic brain injury (mTBI) population, there is heterogeneity both in symptom presentation and recovery patterns. Components of the fear-avoidance model (FAM) may be useful in understanding this heterogeneity. This longitudinal study aimed to identify latent trajectory classes of postconcussion symptoms (PCS) and evaluate how these classes differ on components of the FAM, following mTBI compared with controls. Participants included 185 patients with mTBI and 180 patients with orthopedic injury. PCS, catastrophizing, activity avoidance, somatic focus, depression, participation restrictions and satisfaction were measured 2 weeks, 3, 6, and 12 months post-injury. Multivariate latent class growth analysis identified classes of participants with similar longitudinal trajectories on three variables: cognitive, emotion, and somatic symptoms. Demographic and injury characteristics were used to predict class membership. Class membership was used to predict FAM outcomes. In the mTBI group, Class 1 (C1, 5.9%) had very high maintained symptoms. Class 2 (C2, 20.5%) had high decreasing symptoms. Class 3 (C3, 19.5%) had moderate decreasing symptoms. Class 4 (C4, 54%) experienced low decreasing symptoms. Belonging to class 1 or 2 predicted worse outcomes, including higher catastrophizing, activity avoidance, depression, and participation dissatisfaction. In the control group, two classes were found. Findings highlight the heterogeneity within the mTBI population and the universal disabling impact of person-related behavioral characteristics across medical conditions. Persistent symptoms management and education after mTBI should target those with higher emotion and somatic symptoms, catastrophizing, and depression at 2 weeks post-injury. Interventions targeting catastrophizing, avoidance behaviors, and emotional health may assist in recovery.

Persistent breast cancer treatment-related pain affects up to 40% of patients, decreasing their quality of life (QoL). While current research typically utilizes correlation and regression analysis to identify biopsychosocial phenotypes contributing to this pain, this study employs cluster analysis to identify qualitatively different phenotypes based on somatosensory and psychosocial characteristics both before and one week post-breast cancer surgery. Further, it investigates how these phenotypes are related to pain intensity one year post-surgery and examines the evolution of phenotype membership from pre- to post-surgery. Somatosensory and psychosocial functioning was evaluated pre- and post-surgery in 184 women undergoing unilateral breast cancer surgery. Eight different quantitative sensory testing (QST) methods including mechanical detection and pain thresholds, pressure pain thresholds, thermal detection and pain thresholds, and conditioned pain modulation were performed at the surgical area (trunk, arm, major pectoral muscle) and a distant location (quadriceps muscle). Psychosocial functioning was assessed using the Central Sensitization Inventory, Pain Catastrophizing Scale, Depression Anxiety Stress Scale-21, and the McGill Quality of Life Questionnaire. Pain intensity was evaluated one year post-breast cancer surgery using the Visual Analogue Scale. Latent class analysis identified five distinct phenotypes before and post-surgery, characterized by differences in mechanical and pain thresholds alongside psychosocial factors. Moreover, higher psychosocial distress and lower QoL correlated with elevated pain intensity one year post-surgery. These findings underscore the importance of addressing breast cancer patients' mental health perioperatively. Therefore, future research should explore whether psychological interventions perioperatively can reduce long-term pain intensity. PERSPECTIVE: This secondary analysis, utilizing cluster analysis, reveals five distinct phenotype based on somatosensory and psychosocial characteristics both before and post-breast cancer surgery. Higher psychosocial distress and lower quality of life correlated with elevated pain intensity one year post-surgery, emphasizing the need to address patients' mental health perioperatively. TRIAL REGISTRATION: clinicaltrials.gov (NCT03351075).

Sensory processing (SP) difficulties, such as heightened sensitivity to sensory input, have been linked to prolonged recovery and persistent post-concussive symptoms in adults following mild traumatic brain injury (mTBI). However, research on SP across different sensory inputs after pediatric mTBI is limited. This study examined SP patterns in children and adolescents aged 6-17 years with mTBI at 2 weeks and 6 months post-injury. Caregivers of children aged 6-11 years (n = 120) completed the Short Sensory Profile - Dutch version (SSP-NL), while adolescents aged 12-17 years (n = 121) completed the Adolescent/Adult Sensory Profile - Dutch version (AASP-NL), and scores were compared to normative data. Multilevel latent class growth analysis (MLCGA) identified four SP classes in children: (1) taste and smell sensitivity, (2) general hypersensitivity, (3) general hyposensitivity, and (4) under responsiveness with auditory filtering issues. Class 2 showed lower Child and Adolescent Scale of Participation (CASP) scores. SP changes over time were limited, with persistent issues (of hyper- and hyposensitivity) at 6 months. For adolescents, two classes were found: (1) avoidant and passive, and (2) mild, with Class 1 showing lower CASP scores. Class 2 exhibited reductions in poor registration, sensory sensitivity, and sensation avoidance over time. These findings highlight inter-individual differences in SP after pediatric mTBI, with subgroups differing in how they affect activities and participation. Early identification of SP issues may help tailor more effective interventions.

Background:Preliminary research indicates that psychedelics may hold promise as analgesic agents. This study investigated the potential analgesic effects of lysergic acid diethylamide (LSD) microdosing on pain tolerance and subjective pain perception in healthy participants. Methods:Utilizing a randomised, placebo-controlled design, participants received 15 μg of LSD or placebo over four administrations. Pain tolerance was assessed using the Cold Pressor Task (CPT), along with subjective ratings of painfulness, unpleasantness, and stress. Results:No analgesic effects of LSD were found on any of these measures in the whole sample. LSD increased blood pressure and subjective ratings of drug experience on administration days. Blood pressure was positively correlated to pain tolerance in the LSD group, whereas subjective drug experience was not. To explore whether the absence of analgesic effects of LSD could be explained by ceiling effects observed in CPT performance, post-hoc analyses were conducted in a smaller subsample of individuals that did not show ceiling effects at baseline. This post-hoc analysis suggested that LSD increased pain tolerance and reduced unpleasantness, but only after the first dose. Conclusions:Overall, the present study provided no evidence for analgesic effects of 15 µg LSD. Post-hoc analyses only revealed a marginal analgesic effect of LSD in a subsample of participants. The dose used in this study may be below the threshold dose that is needed to produce a solid and consistent analgesic effect. Future research with larger, appropriately selected samples and higher doses is recommended to further elucidate LSD's analgesic effects and its application in clinical settings.

Visuospatial neglect is a common and debilitating condition following unilateral stroke, significantly impacting cognitive functioning and daily life. There is an urgent need for effective treatments that can provide clinically relevant and sustained benefits. In addition to traditional stroke treatment, non-invasive brain stimulation, such as transcranial alternating current stimulation, shows promise as a complementary approach to enhance stroke recovery. In the current study, we aimed to evaluate the additive effects of multi-session transcranial alternating current stimulation at alpha frequency when combined with visual scanning training in chronic stroke patients with visuospatial neglect. In this double-blind randomized controlled trial, we compared the effects of active transcranial alternating current stimulation at alpha frequency to sham (placebo) transcranial alternating current stimulation, both combined with visual scanning training. Both groups received eighteen 40-minute training sessions over a 6-week period. A total of 22 chronic visuospatial neglect patients participated in the study (active group n = 12, sham group n = 10). The median age was 61.0 years, with a median time since stroke of 36.1 months. We assessed the patients at six time-points: at baseline, after the first, ninth and eighteenth training sessions, as well as 1 week and 3 months following the completion of the combined neuromodulation intervention. The primary outcome measure was the change in performance on a visual search task, specifically the star cancellation task. Secondary outcomes included performance on a visual detection task, two line bisection tasks and three tasks evaluating visuospatial neglect in daily living. We found significantly improved visual search (primary outcome) and visual detection performance in the neglected side in the active transcranial alternating current stimulation group, compared to the sham transcranial alternating current stimulation group. We did not observe stimulation effects on line bisection performance nor in daily living. Time effects were observed on all but one outcome measures. Multi-session transcranial alternating current stimulation combined with visual scanning training may be a more effective treatment for chronic visuospatial neglect than visual scanning training alone. These findings provide valuable insights into novel strategies for stroke recovery, even long after the injury, with the aim of enhancing cognitive rehabilitation outcomes and improving the overall quality of life for individuals affected by this condition. Trial registration: ClinicalTrials.gov; registration number: NCT05466487; https://clinicaltrials.gov/ct2/show/NCT05466487.

OBJECTIVE:Fatigue is a common symptom following acquired brain injury although the severity and course differs for many individuals. This longitudinal study aimed to identify latent trajectory classes of fatigue and associated outcomes following mild brain injury.METHODS:204 adults with mild traumatic brain injury (159; 78%) or minor stroke (45; 22%) were assessed 4 times over 1 year. Subjective measures of fatigue, anxiety, depression, cognitive complaints and societal participation were collected. Multivariate Latent Class Growth Analysis identified classes of participants with similar longitudinal patterns. Demographic and injury characteristics were used to predict class membership.RESULTS:Analysis revealed four classes. Class 1 (53%) had mild, decreasing fatigue with no other problems. Class 2 (29%) experienced high persistent fatigue, moderate cognitive complaints and societal participation problems. Class 3 (11%) had high persistent fatigue with anxiety, depression, cognitive complaints and participation problems. Class 4 (7%) experienced decreasing fatigue with anxiety and depression but no cognitive or participation problems. Women and older individuals were more likely to be in class 2.CONCLUSION:Half the participants had a favourable outcome while the remaining classes were characterised by persistent fatigue with cognitive complaints (class 2), decreasing fatigue with mood problems (class 4) or fatigue with both cognitive and mood problems (class 3). Fatigue treatment should target combinations of problems in such individual trajectories after mild brain injury.

Objective: This study aimed to investigate (1) the prevalence of self-reported sensory hypersensitivity (noise [NS] and light [LS]) over 1 year after mild traumatic brain injury (mTBI) in adults and (2) the impact of NS and LS measured 2 weeks after injury on long-term outcomes 12 months postinjury, while controlling for postconcussion symptoms. Setting: Participants were recruited from 6 hospitals in the south of the Netherlands and were tested 4 times (2 weeks, 3 months, 6 months, and 12 months postinjury), using self-report questionnaires. Participants: In total, 186 mTBI participants (diagnosed using WHO [World Health Organization]/EFNS [European Federation of Neurological Societies] criteria at the neurology/emergency department) and 181 participants with a minor orthopedic injury in their extremities (control group). Design: An observational, longitudinal, multicenter cohort study. Main Measures: NS and LS items (Rivermead Post-Concussion Symptoms Questionnaire) were used as main outcome variables to determine sensory hypersensitivity symptoms. Additional outcomes included anxiety, depression, health-related quality of life (HRQoL), and life satisfaction. Results: There was an elevated prevalence of NS and LS between 2 weeks and 3 months after injury in the mTBI group compared with controls. Approximately 3% of mTBI patients had persistent hypersensitivity symptoms during the whole course of the study. At 12 months postinjury, the mTBI and control groups did not differ in the prevalence of persistent hypersensitivity symptoms. There was no evidence of a predictive value of hypersensitivity within 2 weeks postinjury on anxiety, depression, HRQoL, or life satisfaction, 12 months later after controlling for postconcussion symptoms. Conclusions: These results not only confirm the presence of hypersensitivity symptoms after mTBI in the subacute stage but also provide assurance about the small size of the group that experiences persistent symptoms. Furthermore, there was no evidence that early NS and LS are uniquely associated with long-term emotional and quality-of-life outcomes, over and above general levels of postconcussion symptoms.

In this paper, we present E-ReMI, a new method for studying two-way interaction in row by column (i.e., two-mode) data. E-ReMI is based on a probabilistic two-mode clustering model that yields a two-mode partition of the data with maximal interaction between row and column clusters. The proposed model extends REMAXINT by allowing for unequal cluster sizes for the row clusters, thus introducing more flexibility in the model. In the manuscript, we use a conditional classification likelihood approach to derive the maximum likelihood estimates of the model parameters. We further introduce a test statistic for testing the null hypothesis of no interaction, discuss its properties and propose an algorithm to obtain its distribution under this null hypothesis. Free software to apply the methods described in this paper is developed in the R language. We assess the performance of the new method and compare it with competing methodologies through a simulation study. Finally, we present an application of the methodology using data from a study of person by situation interaction.

This research documents the prevalence rate and demographic risk factors for sexual assault among undergraduate and graduate students enrolled at a Dutch university. The present study used a sample of N = 2,887 students who filled in responses to a campus climate survey about students' experiences with sexual assault and diverse demographic variables. Results showed that approximately one in four students (25.3%) experience non-consensual sexual touching, and almost one in ten are raped (9.2%). Next, to examine the effects of demographic factors and their interactions on sexual assault, the dataset was divided randomly into two subsamples. Exploratory multiple regression analyses were conducted on the first subsample and confirmatory multiple regression analyses on the second. Variables that increased odds for unwanted sexual touching, rape, and any type of sexual assault were gender; being a member of a student or a study association; having a disability; and being in a relationship (in this context, "any type of sexual assault" refers to any incident that included unwanted touching, attempted rape, or rape). LGBQ+ sexual orientation was significant for any kind of sexual assault and for rape; and being a member of a sport association was significant for any kind of sexual assault and for sexual touching.

Research on emotional labour has primarily focused on two emotional labour strategies that employees may use when confronted with organizational display rules: deep acting and surface acting. Initial evidence suggests that these two strategies do not fully cover the range of strategies that employees engage in when responding to display rules in interactions with customers. Yet, a systematic overview of the full range of such strategies is missing. Across two studies, we used a bottom-up approach to develop a taxonomy of strategies used in response to display rules. In Study 1, we conducted interviews in the Netherlands and in Turkey to collect a comprehensive list of employee-generated strategy statements. We found that deep and surface acting only partially accounted for the strategy statements (Netherlands: 47.6%; Turkey: 53.3%). In Study 2, we asked a new sample of participants to sort the strategy statements into categories based on their similarity. Hierarchical cluster analysis showed that employees engage in deep and surface acting in response to display rule requirements. However, employees also engage in additional strategies: changing customers' cognitions or affect, solution-oriented, waiting, and avoidance strategies. These results reveal that employees rely on a wide range of strategies to deal with display rules.

Due to the rapid changes in today’s business world, leaders need to, more than ever, adequately and flexibly react to new and changing demands in the workplace. An instrument that captures adaptive leadership behavior is still missing, however. This study describes the development and validation of a concise and timely new leadership instrument, the Adaptive Leadership Behavior Scale (ALBS). Based on a thorough literature review, we developed 27 items as an initial item pool. We tested this set of items with leaders and followers in a pilot study to assess its relevancy and comprehensibility. In Study 1, a field study with 201 employees, we explored the internal structure of the initial item pool with a Principal Component Analysis (PCA). Based on the factor loadings resulting from a second PCA, we reduced the item pool, resulting in a 15-item scale for which we then assessed convergent and divergent validity. In Study 2, a field study with 311 employees, we replicated the findings of Study 1 and assessed additional convergent and divergent validity as well as the model fit with a Confirmatory Factor Analysis (CFA). In Study 3, a multi-source field study with 155 leader-follower dyads we replicated the CFA and additionally assessed criterion-related validity. Results show that the ALBS is a concise and valid instrument for assessing adaptive leadership behavior, thereby building the grounds to extend our understanding of antecedents, mechanisms and consequences of leadership in dynamic environments.

We conducted a field study at a music festival to examine effects of naturally occurring sleep deficits and substance intoxication on false memory formation and susceptibility to suggestion, using two paradigms. In a misinformation task, sleep restriction was associated with increased levels of susceptibility to suggestion and false alarms to nonsuggestive questions for a virtual reality eyewitness scenario. Use of tetrahydrocannabinol and amphetamines was also related to increased false alarms to nonsuggestive questions, indicating that such questions might be sensitive to use of those drugs. In an implantation paradigm, neither sleep restriction, substances, nor exposure to fake social media content increased the likelihood of falsely believing or recollecting a purportedly experienced festival event. However, some people came to falsely believe (13%, n = 30) or falsely remember (6%, n = 14) the false suggested event. Findings indicate that some established lab effects can also be observed in a less controlled environment.

We present a novel method, REMAXINT, that captures the gist of two-way interaction in row by column (i.e., two-mode) data, with one observation per cell. REMAXINTis a probabilistic two-mode clustering model that yields two-mode partitions with maximal interaction between row and column clusters. For estimation of the parameters of REMAXINT, we maximize a conditional classification likelihood in which the random row (or column) main effects are conditioned out. For testing the null hypothesis of no interaction between row and column clusters, we propose a max - F test statistic and discuss its properties. We develop a Monte Carlo approach to obtain its sampling distribution under the null hypothesis. We evaluate the performance of the method through simulation studies. Specifically, for selected values of data size and (true) numbers of clusters, we obtain critical values of the max - F statistic, determine empirical Type I error rate of the proposed inferential procedure and study its power to reject the null hypothesis. Next, we show that the novel method is useful in a variety of applications by presenting two empirical case studies and end with some concluding remarks.

Introduction: This study is one of the first to examine the association between relationship and sexual variables as approached from a dyadic perspective in Saudi Arabian couples. Theoretical models assign an important role to relationship factors in women's sexuality. Aim: We examined the role of sexual and relationship satisfaction relative to sexual desire in explaining sexual function in a sample of clinical versus nonclinical couples. Methods: This is a cross-sectional, observational study in a sample of 50 heterosexual couples with sexual problems and 50 control couples without problems (N 1/4 100 couples; 200 men and women). Main Outcome Measure: All participants completed an Arabic version of measures of relationship satisfaction, sexual satisfaction, sexual desire, sexual distress, and sexual function. Results: Results showed that in the clinical group, sexual function of women was predicted by their own and their partner?s level of sexual satisfaction, and their own level of solitary and dyadic sexual desire. Men?s sexual function was predicted by their own sexual satisfaction and their partner?s relationship satisfaction. In the control group, the sexual function of women was predicted only by their level of sexual satisfaction. In men, sexual function was predicted by their own sexual satisfaction and their level of dyadic sexual desire. Conclusion: These results suggest that sexual desire rather than relationship satisfaction plays an important role in women's sexual dysfunction. Being the most consistent determinant of male and female sexual functioning, sexual satisfaction is an important target of intervention in Arabian couples. Copyright (C) 2020, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.

Injury/illness sensitivity (IS) is conceptualized as a fundamental fear that underlies fear-related psychopathology and chronic health conditions, including chronic pain. The current study examines the internal consistency, test–retest reliability, and factor structure of the Dutch version of the injury/illness sensitivity index-revised (ISI-R). In addition, we aimed to further validate the ISI-R by studying convergent and divergent validity. Participants (N = 255) were recruited in a Dutch community sample to complete an online questionnaire battery including the ISI-R and several validation measures. Four weeks later, 117 participants completed the ISI-R a second time. The ISI-R showed good internal consistency and test–retest reliability. Confirmatory factor analysis confirmed two correlated factors in the ISI-R: Fear of Injury and Fear of Illness. The measure’s validity was supported by strong correlations between the ISI-R and well-established pain and physical health-related anxiety measures, moderate correlations with measures that reflect general negative emotionality (e.g. anxiety, depression), and weak correlations with fear constructs that do not entail a direct link to a health threat. These results indicate the appropriateness of working with the Dutch ISI-R and its two subscales as a reliable and valid measure of fear of physical harm, Fear of Illness and Fear of Injury.

Genital pain is a social experience that needs to be studied as a dyadic interaction between partners. The present study relied on a sample of 42 heterosexual couples to examine the level of congruence between both partners' ratings of pain and sexual arousal in response to experimentally induced vaginal pressure that served as a simulation of vaginal sensations during penetration. We also inferred the men's ability to estimate their partner's level of pain and sexual arousal. Because the relationship has shown to influence pain estimations, we considered the moderating role of perceived partner responsiveness and relationship satisfaction. We found higher disagreement in pain ratings when vaginal pressure was induced in the context of a sexual film compared to a neutral film, with men overestimating the level of pain in women. Also sexual arousal ratings diverged between partners, with men underestimating their partners' level of sexual arousal during the induction of vaginal pressure, regardless of whether they were watching a sexual or neutral film. Importantly, the level of congruence between actual and estimated ratings of pain and sexual arousal depended on how relationally satisfied men and women were and how validated and supported women felt by their male partner. These results make an important contribution to the growing literature on the social determinants of sexual pain experiences.

PURPOSE:This study aimed to elucidate whether muscle activity (in terms of glucose uptake) between the legs can be considered symmetrical during walking. Furthermore, we aimed to determine whether the [18F]-fluorodeoxyglucose was distributed heterogeneously throughout each muscle, and if so, whether areas of high uptake would be clustered.METHODS:Ten healthy participants walked on a treadmill at self-selected comfortable walking speed for a total of 90 minutes, 60 minutes before and 30 minutes after intravenous injection of 50 MBq [18F]-fluorodeoxyglucose. Thereafter, a positron emission tomography/computed tomography scan of the lower limb was acquired. Three-dimensional muscle contours of 78 (= 39x2) muscles of the left and right lower limb were semi-automatically determined from magnetic resonance imaging scans. After non-rigid registration, those muscle contours were used to extract [18F]-fluorodeoxyglucose uptake from the positron emission tomography scans.RESULTS:Large asymmetries were observed in the lower leg muscles (e.g. median absolute asymmetry index of 42% in the gastrocnemius medialis) and in the gluteus minimus (30% asymmetry) and gluteus medius (15% asymmetry), whereas the uptake in the thighs was relatively symmetrical between the limbs (<6% asymmetry). These were not related to limb-dominance nor to inter-limb differences in muscle volume. The [18F]-fluorodeoxyglucose distribution was not distributed normally; most voxels had a relatively low standardized uptake value, and a minority of voxels had a relatively high standardized uptake value. The voxels with higher [18F]-fluorodeoxyglucose uptake were distributed heterogeneously; they were clustered in virtually all muscles.CONCLUSION:The findings in this study challenge the common assumption of symmetry in muscle activity between the limbs in healthy subjects. The clustering of voxels with high uptake suggests that even in this prolonged repetitive task, different spatial regions of muscles contribute differently to walking than others.

After students drop out of school, their alcohol use may vary according to the reason for dropping out. In this paper, out of school youth (OSY) are those between 13–20 years old, have not completed their schooling, and have not enrolled in secondary or high school for the current academic year. OSY are at heightened risk of alcohol use. This study examined the relationship between reasons for leaving school and alcohol use, taking into account gender differences. Survey data from 4222 OSY (mean age = 17.4 years, SD = 1.9; males = 59.4%) were analysed using ordinal regression. Leaving school for “not having enough money to pay for school fees” was associated with more alcohol consumption, among females living specifically in rural areas of Gauteng. However, in urban areas of Kwazulu Natal and Mpumalanga, females who left school for the same reason as their rural counterparts were less likely to consume alcohol in the past month. Males were more likely to consume higher levels of alcohol if they reported leaving school due to making someone pregnant, but only when they resided in peri-urban areas. Understanding the relationship between reasons for leaving school and alcohol use may give us insight into the profile of school dropouts at risk for alcohol use. This information is useful for intervention development across the school, home and community.

Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing. Trial Registration NTR3652, http://www.trialregister.nl.