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AimsFor most of us, visual imagery is a fundamental feature of day-to-day subjective experience. It is thought to play multiple cognitive roles.1 However, there is widespread variation in the subjective intensity of visual imagery, ranging from extreme vividness to complete absence. The term aphantasia was coined recently to describe the latter, which is usually lifelong. While rarer, cases of acquired aphantasia can provide mechanistic insight. Isolated cases have long been reported,2 with some attempts at theoretical synthesis.3 4 We give a preliminary description of 88 such cases identified from among ~14,000 people contacting us in the wake of publicity surrounding Aphantasia.MethodsCases were selected from individuals contacting us spontaneously reporting reduced or absent intensity of visual imagery. Contacts were asked to complete two measures of visual imagery, the Vividness of Visual Imagery Questionnaire (VVIQ) and Imagery Questionnaire (IQ).5 ResultsCases were divided into those in with a strong probability of a neurological cause (n=39), a psychological cause (n=20) and those about which we cannot yet be confident (n=29). Functional aphantasia appears likely to account for some of the cases in the third category. The commonest precipitating events were head injury (n=19), affective disorder (n=17) and stroke (n=13). Other causes included surgery (postoperative) (n=7), drugs (n=6), infectious or inflammatory disease (n=3), neurodegenerative disease (n=3), and seizure disorders (n=2). For subjects completing the VVIQ (n=29), the mean score was 20.1/80 (range 16-32,) indicating marked reduction of imagery vividness. Localizable lesions were predominantly right sided (n=6) and occurred in posterior cortical areas, particularly occipital and parietal, as well as two cases associated with damage to temporal cortex. Some cases reported other impairments, including impaired memory (n=12), prosopagnosia (n=5) and navigational difficulties (n=2). Of cases who reported on their dreams (n=28), around half had lost visual dreaming, a third had preserved visual dreaming and the remainder had visual dreaming of reduced intensity.ConclusionsTo our knowledge, this is the largest reported case series of acquired loss of visual imagery. Both neurological and psychological disorders can be responsible for acquired aphantasia. Our series includes cases of probable functional aphantasia. Further detailed analysis of these cases is required.References Pearson. Nat. Rev. Neurosci. 2019;20:624634. Zago, et al. Cognit. Neuropsychiatry 2011;16:481504. Farah. Cognition 1984;18:245272. Bartolomeo. Cortex 2002;38:357378. Zeman, et al. Cortex 2020;130:426440.

Background: For individuals with Lumber Disc Herniation (LDH), strategies for coping are crucial since they enhance daily living activities and reduce discomfort. Aim of study: To assess coping strategies among adult patients with LDH. Research design: A descriptive design was utilized in this study. Setting: This study was conducted at Neuro-Surgery Outpatient Clinic of Taif University Hospital, Saudi Arabia. Sample: A Convenient sample was used which included 151 adult patients with LDH. Tools of data collection: Four tools were used 1): A structured interviewing questionnaires to assess studied patients' socio-demographic characteristics, medical & family history and knowledge regarding LDH and coping strategies. II) The visual analog scale to assess pain intensity in studied patients with LDH. III) Coping strategy Questionnaires (CSQ) to assess coping strategies among studied patients with LDH. IV) Barthel Index of activity of daily living to assess dependency level of daily living activities in studied patients with LDH. Results: 35.1% of the studied patients aged from 35 to less than 45years, 97.4% of them had low back pain, 64.9%, affected in the L4&L5 vertebrae, 15.2% of the studied patients had good total knowledge level about LDH. 64.9% of the studied patients had moderate pain which affect duties performance, 76.8% of studied patients had independent level regarding activities of daily living and 64.9% of studied patients had moderate coping level regarding LDH. Conclusion: There was a highly statistically significant relation between level of coping of the studied patients and their dependency level in performing activities of daily of living. Recommendation: Develop and implement health education program to improve adult patients knowledge and practices regarding lumber disc herniation and coping strategies.

The aim of the current study is to know the social, psychological and health effects of divorce on children and adults, what are the problems resulting after divorce, especially children and adults, what are the effects of divorce on the psychology of children and adults. A questionnaire was created using the Google Drive program to design it, and then it was distributed to residents. The city ofMecca and Khamis Mushayt, where it was distributed via the social networking network (WhatsApp) in the amount of 750 questionnaires, and responses were obtained in 730 questionnaires, and they were analyzed, using frequency tables, and creating histotrophic drawings, and the results presented before you were obtained.it is concluded that,Divorce destroys the entire family, and it is psychologically and socially harmful to children and adults. Young people feel that their elders have abandoned them and have preferred their interests to the interests of others. Young children, parents must be wise and patient, and understand each other apart from the children, so that they do not fall victim to bad companions and other hateful things, and a healthy and sound environment must be created for them, so that they do not grow up psychologically shaken and so that their psychology and health do not deteriorate to the worst.

Background: The model of care is a fundamental framework that directs the provision of medical services and has a big impact on provider effectiveness and patient outcomes. Objective: the aim of this study is to evaluate the knowledge of staff (health workers and admin) about model of care working in Northern Border Health Cluster (N1C) of Saudi Arabia. Methods: This cross-sectional study was conducted in the Northern Border Health Cluster hospitals situated in the Northern border of Saudi Arabia. The questionnaire for the data collected was obtained from the previously published research. The questionnaire link was sent to all healthcare staff working at the N1C hospitals electronically until reach to the required sample size. Results: About 380 responded to the study’s survey.About45.3% of participants were agreed and 33.4% were Strongly agree that Model of Care will improve the quality of healthcare services the patient is receiving. About (42.9%) of participants were agreed and about (33.2%) were Strongly agree that that Model of Care will have a positive impact on their career. About (43.4%) of participants were agreed and about (34.5%) were Strongly agree to participate in the implementation of Model of Care There is statistically significant association between Job function (p-value < .001) and type of work facility (p- value .022) regarding their awareness about outcomes is Model of Care aiming to achieve. There is statistically significant association between gender (P-value .030), job function (P-value .002) and type of work facility ( P- value .039 )and confidence levels with staff sharing their to explain what the MoC is to a colleague or a friend. About (43.4%) of participants were agreed and about (31.6%) were Strongly agree to convince colleagues and friends of the benefits of Model of Care.Conclusion: In this study, each dimension gave an promising assessment of the MoC expertise of Northern Border Health Cluster (N1C) staff. The Northern Border Health Cluster (N1C) staff who participated in this study had good knowledge of MoC.

BackgroundThe number of private and online providers of STI tests is increasing in the Netherlands. The autonomy and accessibility of online self-testing may contribute to timely diagnosis, lower healthcare costs and shorter waiting lists at STI clinics. But ill-informed self-testing can also lead to underdiagnosis and insufficient partnermanagement of STIs. To improve linkage to high quality private testing providers the online advice application Advies.chat was launched in 2017. We assessed process indicators for the successful implementation of this online advice instrument in 2018.MethodsThe application generates tailored advices based on clinical guidelines. The questionnaire takes into account personal characteristics, sexual behaviour, sexual risks and symptoms. The advice refers to STI testing providers if testing is indicated and explains which specific STIs need to be tested for. All test advices refer to GP’s and the specific diagnostic tests offered by selected online testing providers. Key populations (MSM, sex workers and young people < 25 years) are also referred to STI clinics. Anonymous process data from the Advies.chat database were analysed.ResultsAdvies. chat was visited 337,736 times in 2018; 113,257 visitors started the questionnaire, 17,449 the chatbot. Visits increased on Sundays, peaked on Mondays and decreased during the week. The most indicated reason for using Advies.chat was the ‘possibility of being STI or HIV infected’ (75%). Around 60% finished the questionnaire, leading to 65,736 advices and 8,700 clicks to online self-test providers.ConclusionOnline self-management tools can play a keyrole in improving the quality of the growing online STI testing market. Advies.chat shows that online triage and tailored advice is feasible and increases traffic to quality testing providers. The contribution of Advies.chat to the estimated 430,000 consultations at GP’s and STI clinics in the Netherlands is sizable. Methods need to be developed to assess the impact of online self-management and self-testing on STI control.DisclosureNo significant relationships.

Introduction and objectivesPatients with pulmonary arteriovenous malformations (PAVMs) are at high risk of cerebral abscess with life-changing morbidity and mortality. These patients often concurrently have hereditary haemorrhagic telangiectasia (HHT). A recent study of patients with PAVMs/HHT at a single institution suggested several environmental associations with cerebral abscess, particularly dental care, higher iron intake, and long-haul flights.1 For example, 4/37 (10.8%) cerebral abscess patients reported their abscess occurred after long-distance travel.MethodsIn order to capture data on wider exposure of this population to such risk factors, an online questionnaire was developed using Survey Monkey. In total, 139 non-biassed questions gathered data online about an individual’s HHT and/or PAVM phenotype, and environmental factors of relevance to cerebral abscess and other study foci in our group. With ethical approval (16/LO/1909), participants were recruited following advertisement through global HHT support networks.ResultsThe survey opened on 31 st May 2017. Within 7 weeks, 449 patients with self-reported HHT had completed the questionnaire. The majority (≥60%) were North Americans, with Europeans constituting the second largest group. 229 (51%) had PAVMs, usually diagnosed in their twenties to fifties. 89/229 (38.9%) had been treated by PAVM embolization and 13 (5.7%) by surgery. 17 (7.42%) had experienced a cerebral abscess and 46 gave a family history of cerebral abscess. Preliminary analysis of long-distance travel data revealed most patients rarely travelled for ≥3 hours. 266 participants reported the number of flights they had taken in their lifetime of durations<4 hours, 4–8 hours and ≥8 hours. In total, an estimated 27,722 hours were flown giving a mean average of 122 hours, i.e., approximately 10 long-distance flights per lifetime.ConclusionsThis survey provides a large dataset from individuals with PAVMs/HHT, captured without a bias toward flight usage as in flight-specific surveys. The data suggest long-distance travel is less common than previously thought for the HHT population, which adds greater weight to the previously published association[1] between long-distance travel and cerebral abscess risk. This approach should enable the development of better tools to predict and reduce the risk of cerebral abscess for these patients.ReferenceBootheret al. Clin Infect Dis2017, Apr 19. doi:10.1093/cid/cix373

Despite a global recent interest in this matter, researchers have not developed, or validated scales focused on workplace bullying or destructive leadership in Chile. There are antecedents of workplace violence in the country, and the relationship with psychological distress is worldwide documented. The present study aimed to provide evidence of validity based on the internal structure and relationship with other variables of the Negative Acts Questionnaire-Revised (NAQ-R) and the Destructive Leadership Scale (CDLS). A survey was applied to a multi occupational sample of 1995 civil servants of the main metropolitan areas of Chile: Santiago, Valparaiso, and Concepcion. Responses were analyzed through exploratory and descriptive statistics, Confirmatory Factor Analysis for internal structure, and Logistic Regression for bindings with psychological distress as a criterion, adjusting on confounding variables. The CDLS scale obtained acceptable fit indices once one item was deleted (WLSχ2(64, N= 1847) = 642, p<.0,001; CMIN/df= 10.0; CFI= 0.966; GFI= 0.993; aGFI= 0.987; RMSEA = 0.070; 90% IC [0.065, 0.075] NNFI= 0.959), distinguishing between destructive (CR [composite reliability]= 0.81) and constructive leaderships (CR= 0.91). The NAQ-R showed properties that make it useful in the Chilean context as a unidimensional measure (WLSχ2(206, N= 1927) = 648, p<.0.001; CMIN/df= 3.1; CFI= 0.969; GFI= 0.994; aGFI= 0.990; RMSEA = 0.033; 90% IC [0.030, 0.036] NNFI= 0.965; CR= 0.98). A higher prevalence of Distress in the presence of bullying (PR [Prevalence ratio]=1.03, 95%IC [confidence intervals] 1.02, 1.04) or destructive leadership was found (PR= 1.09, 95%IC 1.06, 1.13). Studies may obtain prevalence by empirical classification methods.

Abstract Introduction: The circadian system coordinates internal events in a daily schedule to make sure that the body systems are synchronized to environmental time and internal cues. One important behavioral aspect of the circadian system is the chronotype. It is usually assessed through subjective questionnaires, being the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) one of the most used. It classifies individuals into three major categories: morning, evening and intermediate types. Recently, it has been hypothesized the existence of a fourth chronotype, the bimodal type, through an algorithm derived from the MEQ responses. Bimodals answer as morning-types in some questions, and as evening-types in others, resulting in an intermediate total score. To better characterize this phenotype, the present study aimed to detect and characterize the frequency of the bimodal chronotype in the EPISONO, a large population-based cohort, as well as to verify the association between bimodality and sleep parameters and genetic variation in the PER3 gene. Methods: A total of 1,042 participants completed a set of detailed sleep related questionnaires and underwent a polysomnography (PSG). An algorithm was used to classify bimodal individuals according to the number of morning-type/evening-type answers. Finally, genotyping of the variable number of tandem repeats (VNTR) polymorphism of the PER3 gene was performed by conventional polymerase chain reaction. Results: Of the 1,042 individuals who participated of the EPISONO, 857 had MEQ filled correctly. We found that 16% of our sample were bimodal types. We observed that bimodal individuals were significantly younger and had lower body mass index. The association between PER3 VNTR genotype or gender with bimodal chronotype were not significant. However, we found an association between bimodality and Epworth Sleepiness Scale (EES) and apnea-hypopnea index (AHI). Lastly, it was observed that the most significant predictors for bimodal chronotype were male gender, AHI and EES. Conclusion: In conclusion, the present work provides more evidence that the bimodal type might have to be considered when classifying chronotype and its association with young age and sleepiness may be due to the influence of social and environmental factors. Support (If Any): This work was supported by grants from AFIP, FAPESP and CNPq.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Lapidus procedure (LP) for hallux valgus (HV) requires an adequate control of first metatarsal (M1) sagittal alignment to avoid dorsiflexion. Otherwise, clinical and functional impairment, including transfer metatarsalgia may occur. This study aimed to evaluate the effects of pre- and postoperative measurements of M1 sagittal alignment on clinical and functional outcomes, and whether these variations would lead to transfer metatarsalgia or not. Methods: 29 patients (36 feet) with a mean follow-up of 20 months after LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. M1 sagittal alignment analysis was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Decrease of FMDA means that the M1 dorsiflected (Figure 1). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were assessed. Radiographic, clinical and functional measurements were compared. Intraclass Correlation Coefficients (ICC) were calculated for FMDA and MA. Linear regression was used to assess the association of Δ-FMDA and Δ-MA with clinical and functional questionnaires. Based on that, we assessed our sample at different cut-off points to evaluate whether a given Δ-FMDA and/or Δ-MA measurement was significantly related to the Δ-Questionnaires. Results: Pre- and postoperative ICC of FMDA was 0.90 and 0.91 and MA was 0.94 and 0.88, respectively. FMDA showed significant variation after the LP, but MA did not. IMA and HVA improved significantly. Significant clinical and functional improvement were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between ΔFMDA with Δ-PCS-12 and Δ-LEFS (p=.028 and p=.02, respectively), meaning that excessive dorsiflexion of M1 as measured by FMDA led to a decrease in PCS-12 and LEFS. We found that at the cut-off point of quartile 50%, in which our sample was divided equally, patients with Δ-FMDA below 3.2 degrees of dorsiflexion had significantly improved results on Δ-PCS-12 compared to those with greater values (p=.029) (Figure 2). Conclusion: The present study showed that excessive dorsiflexion of M1 led to decreased outcome scores as measured by PCS- 12 and LEFS. It supports that M1 dorsiflexion should be avoided after the LP. However, slight dorsal deviation can occur and, even so, satisfactory outcomes can be obtained. Further prospective and comparative studies with larger populations are required to evaluate the effects of M1 inclination on clinical and functional outcomes.