ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Rev. edn Author, New York 2008
... The types of dementia diagnosed in the DEM participants are varied, including early-onset dementia, Alzheimer's Disease (AD), Dementia with Lewy bodies (DLB), Vascular Dementia (VaD), and Semantic Dementia (SD), with both mild and moderate severity stages. The dementia stages were determined according to the International Classification of Diseases (ICD-10) of the WHO [17] and the diagnostic criteria of dementia from the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V) [18]. Thorough clinical neuroimaging and neurological examinations, including MRI, blood test, health check, neuropsychological test, and the Thai version of Mini-Mental-Status examination (TMSE), were conducted by licensed clinical psychologists to evaluate the cognitive functions. ...
... 2) Relative Power: The obtained EEG signals were classified into four frequency bands of interest: delta (1-4 Hz), theta (4-8 Hz), alpha (8)(9)(10)(11)(12)(13), and beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Due to the muscle activity and artifacts, the gamma oscillation was excluded from our analysis [16], [31]. ...
... The overall outcome suggested that in order to classify the cognitive declination with the proposed tasks, the ideal number of trials was less than 20 trials (17 trials + 3 testing trials) to produce the optimal performance. The external and internal factors with the possibility to affect the performance could be related to tiredness, boredom, and drowsiness after a certain (8)(9)(10)(11)(12)(13), and Beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). * denotes the significance between a group-pair tested with the Wilcoxon Rank Sum Test at p < 0.01. ...
In the status quo, dementia is yet to be cured. Precise diagnosis prior to the onset of the symptoms can prevent the rapid progression of the emerging cognitive impairment. Recent progress has shown that Electroencephalography (EEG) is the promising and cost-effective test to facilitate the detection of neurocognitive disorders. However, most of the existing works have been using only resting-state EEG. The efficiencies of EEG signals from various cognitive tasks, for dementia classification, have yet to be thoroughly investigated. In this study, we designed four cognitive tasks that engage different cognitive performances: attention, working memory, and executive function. We investigated these tasks by using statistical analysis on both time and frequency domains of EEG signals from three classes of human subjects: Dementia (DEM), Mild Cognitive Impairment (MCI), and Normal Control (NC). We also further evaluated the classification performances of two features extraction methods: Principal Component Analysis (PCA) and Filter Bank Common Spatial Pattern (FBCSP). We found that the working memory related tasks yielded good performances for dementia recognition in both cases using PCA and FBCSP. Moreover, FBCSP with features combination from four tasks revealed the best sensitivity of 0.87 and the specificity of 0.80. To our best knowledge, this is the first work that concurrently investigated several cognitive tasks for dementia recognition using both statistical analysis and classification scores. Our results give essential information to design and aid in conducting further experimental tasks to early diagnose dementia patients.
... Almost 65,000 children and adolescents receive specialist mental health care yearly in Norway, with outpatient care being the dominant treatment option [22]. The latest numbers from 2021 show that most adolescents receiving specialist mental health care in Norway either had a mental or behavioural disorder, chapter F in the ICD-10 coding (57%) or had symptoms and signs involving cognition, perception, emotional state and behaviour, part of chapter R in the ICD-10 coding, (40%) [22,23]. ...
... The PHQ-8 consists of eight items, and participants were asked to indicate the extent to which certain symptoms had bothered them for the last two weeks using the following response options: "not at all", "several days", "more than half the days" and "nearly every day". The total score of the answers ranged from 0 to 24 and was categorised into four levels: minimal or mild depressive symptoms (0-9), moderate depressive symptoms [10][11][12][13][14], moderately severe depressive symptoms [15][16][17][18][19] and severe depressive symptoms [20][21][22][23][24]. ...
Introduction Adolescents in mental health care may benefit from using patient portals to access personalised
information about their health and treatment. While no studies have considered the interest in using patient
portals among adolescents in mental health care, factors such as patient activation, self-reported health, depressive
symptoms, diagnosis, healthcare utilisation, and eHealth literacy have been found to be associated with interest in
and use of patient portals in other patient groups. Therefore, the aim was to explore the associations between interest
in using patient portals and patient activation, self-reported health, depressive symptoms, diagnosis, healthcare
utilisation and eHealth literacy among adolescents in specialist mental health care.
Methods A cross-sectional study among adolescents between 12 and 18 years of age receiving or having received
treatment at four different specialist child and adolescent mental healthcare services across Norway. The adolescents´
answers to the questionnaire were linked to data on their healthcare utilisation and ICD-10 diagnoses from the
Norwegian Patient Registry. The data were analysed using descriptive statistics and bivariate tests.
Results The 53 adolescents who participated, had a mean age of 15 years and 68% of them identified as female.
Two out of three (64%) were interested in using patient portals. Most of the factors were not associated with interest
in using patient portals. However, adolescents with mental and behavioural disorders (F diagnoses, 75% interested)
were more interested in using patient portals compared to those with symptoms and signs involving cognition,
perception, emotional state, and behaviour (R diagnoses, 31% interested).
Conclusion Except for mental health diagnosis, this study did not ide
... Almost 65.000 children and adolescents receive specialist mental health care yearly in Norway, with outpatient care being the dominant treatment option (22). The latest numbers from 2021 show that most adolescents receiving specialist mental health care in Norway either had a mental or behavioural disorder, chapter F in the ICD-10 coding (57%) or had symptoms and signs involving cognition, perception, emotional state and behaviour, part of chapter R in the ICD-10 coding, (40%) (22,23). ...
... The PHQ-8 is an eight-item questionnaire where participants are asked how certain symptoms bothered them for the last two weeks with the following response options "not at all", "several days", "more than half the days" and "nearly every day". The sum of the answers can take a score between 0-24 which was categorized into four levels: minimal or mild depressive symptoms (0-9), moderate depressive symptoms (10)(11)(12)(13)(14), moderately severe depressive symptoms (15)(16)(17)(18)(19) and severe depressive symptoms (20)(21)(22)(23)(24). ...
Introduction:
Adolescents in mental healthcare may benefit from using patient portals to access personalized information about their health and treatment. While no studies consider the interest in using patient portals among adolescents in mental health care, some factors have been found to be associated with interest in and use of patient portals in other patient groups. The aim was therefore to explore the associations between interest in using patient portals and patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilization and eHealth literacy among adolescents in mental health care.
Methods
A cross-sectional study among adolescents between 12 and 18 years of age receiving or having received treatment at four different specialist child and adolescent mental healthcare services across Norway. The adolescents´ answers to the questionnaire were linked to data on their healthcare utilization and ICD-10 diagnoses from the Norwegian Patient Registry. Data were analysed with descriptive statistics and bivariate tests.
Results
The 53 adolescents who participated, had a mean age of 15 years and 68% of them identified as female. Two out of three (64%) were interested in using patient portals. Most of the factors were not associated with interest in using patient portals, but adolescents with mental and behavioural disorders (F diagnoses, 75% interested) were more interested in using patient portals than those with symptoms and signs involving cognition, perception, emotional state, and behaviour (R diagnoses, 31% interested).
Conclusion
Except for diagnosis, this study did not identify any specific factor that is likely to have an impact on patient portal interest among adolescents in specialist mental health care.
... One solution is to use electronic health records (EHR), with International Classification of Diseases (ICD) coded data on diagnoses, hospitalisations, procedures and deaths, alone or in combination with selected baseline survey data to enhance phenotyping of disease cases and controls [6]. While this approach is widely used, a lack of internationally agreed standards for selecting and combining ICD coded data for defining common diseases and their clinically following a project approval process by the UK Biobank. ...
... Hospital admission data in UKB is obtained from the Hospital Episode Statistics (HES) database, the Patient Episode Database for Wales (PEDW) database and the Scottish Morbidity Record-01 (SMR-01) in England, Wales, and Scotland, respectively. International Statistical Classification of Diseases and Health-Related Problems, 10th revision (ICD-10) classifications are used to record primary and secondary diagnoses (note that ICD-10 classifications in the UK are distinct from ICD-10 CM) [6]. Office of Population Censuses and Surveys Classification of Interventions and Procedures (OPCS) Version 4 classifications are used to record procedures, similar to the Current Procedural Terminology (CPT) advocated by the American Medical Association [17]. ...
Importance
A lack of internationally agreed standards for combining available data sources at scale risks inconsistent disease phenotyping limiting research reproducibility.
Objective
To develop and then evaluate if a rules-based algorithm can identify coronary artery disease (CAD) sub-phenotypes using electronic health records (EHR) and questionnaire data from UK Biobank (UKB).
Design
Case-control and cohort study.
Setting
Prospective cohort study of 502K individuals aged 40–69 years recruited between 2006–2010 into the UK Biobank with linked hospitalization and mortality data and genotyping.
Participants
We included all individuals for phenotyping into 6 predefined CAD phenotypes using hospital admission and procedure codes, mortality records and baseline survey data. Of these, 408,470 unrelated individuals of European descent had a polygenic risk score (PRS) for CAD estimated.
Exposure
CAD Phenotypes.
Main outcomes and measures
Association with baseline risk factors, mortality (n = 14,419 over 7.8 years median f/u), and a PRS for CAD.
Results
The algorithm classified individuals with CAD into prevalent MI (n = 4,900); incident MI (n = 4,621), prevalent CAD without MI (n = 10,910), incident CAD without MI (n = 8,668), prevalent self-reported MI (n = 2,754); prevalent self-reported CAD without MI (n = 5,623), yielding 37,476 individuals with any type of CAD. Risk factors were similar across the six CAD phenotypes, except for fewer men in the self-reported CAD without MI group (46.7% v 70.1% for the overall group). In age- and sex- adjusted survival analyses, mortality was highest following incident MI (HR 6.66, 95% CI 6.07–7.31) and lowest for prevalent self-reported CAD without MI at baseline (HR 1.31, 95% CI 1.15–1.50) compared to disease-free controls. There were similar graded associations across the six phenotypes per SD increase in PRS, with the strongest association for prevalent MI (OR 1.50, 95% CI 1.46–1.55) and the weakest for prevalent self-reported CAD without MI (OR 1.08, 95% CI 1.05–1.12). The algorithm is available in the open phenotype HDR UK phenotype library (https://portal.caliberresearch.org/).
Conclusions
An algorithmic, EHR-based approach distinguished six phenotypes of CAD with distinct survival and PRS associations, supporting adoption of open approaches to help standardize CAD phenotyping and its wider potential value for reproducible research in other conditions.
... Healthcare professionals need to analyse data in the healthcare domain, which comes from multiple sources, for example, admission records, diagnosis reports, laboratory test results, and treatment procedures from various departments and clinics. Although there exist several healthcare ontologies, for example, ICD-10 [13] and SNOMED-CT [1], there needs to be a uniform framework for data analysis in the healthcare domain. ...
Healthcare processes need to be streamlined to offer better healthcare services. Data analysis can be crucial in reducing costs, optimizing processes, and analyzing treatment effectiveness. However, data analysis in healthcare is complex due to the variety and complexity of patient data. This paper proposes a multi-dimensional comparative analysis method that offers healthcare professionals a lens to delve into healthcare datasets from various perspectives. The paper discusses the importance of comparative analysis in healthcare illustrated by two examples on how we can understand the pattern of comorbidity and how we can analyze the effectiveness of internet delivered psychological interventions. The paper presents a multi-dimensional comparative analysis framework covering various use cases in analysing healthcare data. The framework allows healthcare professionals to compare and contrast healthcare data across multiple dimensions, including clinical dimensions such as diagnosis, outcome measures, time dimension, patient dimensions (engagement, involvement), cost dimension, and other relevant factors. This approach offers a more insightful understanding of healthcare data and facilitates informed decision-making in healthcare practices.
... Common data standards and interoperability frameworks are necessary to facilitate better care coordination and enhance data sharing for research purposes. Even though there exist several healthcare ontologies, e.g., ICD-10 [82] and SNOMED-CT [29], the healthcare dataset often consists of unstructured data. Image processing and Natural Language Processing (NLP) may play an important role in extracting structured information from unstructured information. ...
This paper overviews the challenges of using artificial intelligence (AI) methods when building healthcare systems, as discussed at the AIsola Conference in 2023. It focuses on the topics (i) medical data, (ii) decision support, (iii) software engineering for AI-based health systems , (iv) regulatory affairs as well as (v) privacy-preserving machine learning and highlights the importance and challenges involved when utilizing AI in healthcare systems.
... The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) includes a section on caffeine use disorder, which is similar to the caffeine dependence syndrome in the ICD-10 (tenth revision of the International Classification of Diseases) [19,20]. The DSM-5 criteria overlap significantly with other substance use disorders. ...
A 51-year-old female, with no previous history of psychosis, presented to the Emergency Department with an acute psychotic episode in the context of excess caffeine consumption. Caffeine is an adenosine antagonist. An antagonist of adenosine can lead to the release of dopamine into the synaptic cleft, which can induce psychotic symptoms in vulnerable individuals. The patient had consumed caffeine in the form of up to eight energy drinks daily. She experienced persecutory delusions alongside auditory and visual hallucinations. She did not have a history of psychotic disorder but did have a history of generalized anxiety disorder. Upon cessation of caffeine, her symptoms resolved within five days. She remained caffeine-free and symptom-free 18 months later when reviewed in the community. This case highlights the potential psychiatric consequences of excessive caffeine consumption and identifies the need to screen for excessive consumption of caffeine in individuals presenting with new psychotic symptoms or worsening of pre-existing psychotic symptoms.
... CAD was defined according to the WHO International Classification of Diseases (ICD) as ICD-9 410 to 412, or ICD-10 I21 to I24 and I25.2. [8] LTVA risk was defined as LTVA mortality or admission to hospital with a LTVA diagnosis 6-months before or after the CAD diagnosis. The available information included collections of 10-seconds I-lead ECGs recorded at rest, health electronic records and follow-up data for each subject considered in the study. ...
Coronary Artery Disease (CAD) is a leading cause of life-threatening ventricular arrhythmias (LTVAs). This study aimed to identify distinct clusters of CAD individuals based on QRS morphology using a 3-nearest neighbors clustering algorithm. Cluster 1, characterized by the lowest QRS amplitudes and widest QRS complexes, was strongly associated with LTVA risk.
... In [51], we introduced the idea of using a new approach, called model-based slicing, that utilizes ontologies and dimensional models to access the data required for improved data analysis. This approach exploits the use of structured information available in the healthcare industry such as standard ontologies (e.g., ICD (International Classification of Disease)-10 [44], designed to provide diagnostic codes for classifying diseases, and SNOMED-CT [8] which provides a comprehensive terminology for clinical health) as well as organizational frameworks within hospitals and other relevant hierarchies. In [50], we discussed community detection methods which, together with filtering techniques based on dimensional modeling and ontologies, built on the work of [51] to allow us to obtain "contextual insights" from event log data using what we called "contextual process mining". ...
The volume and diversity of healthcare data available using modern technology offers great potential for improving health services delivery. Giving clinicians and health system administrators the ability to easily investigate and analyze data from various perspectives can promote evidence-based decision-making. Current analysis approaches often result in process models where essential relations are difficult to depict and/or discern. Moreover, it is not easy to change the level of detail in order to accommodate user requirements by allowing them to analyze data from various perspectives or capture temporal aspects of the data. Further, inherent differences between patients and the vast variety of healthcare settings, even for one patient, make process mining extremely difficult. In this paper, we first discuss community detection methods which, together with filtering techniques based on dimensional modeling and ontologies, allow us to obtain "contextual" insights from event log data using what we call "contextual process mining". Then, to capture time-dependent relations in patient data, we propose a linear temporal logic-based language, LTL-EOT, which can be used to express both time and order-dependent conditions. The LTL-EOT formulas are used to filter the event log data to find those patients who satisfy the conditions, thus capturing "temporal" insights in event log data. Both the investigations using community detection methods and those using the temporal logic methods are validated learning approaches: the first allows the user to experiment with the level of abstraction, while the second allows the user to experiment with the temporal logic formulas. This approach can give healthcare professionals insights into patterns of admission, diagnosis, and treatment among patients, which, in turn, lead to the overall goal of this research, which is improved resource management, scheduling, and other aspects of health services delivery. In a simple case study, we show this approach leads to an improved understanding of healthcare processes among comorbid patients.
... In [7] we introduced the idea of using a new approach, called model based slicing, that utilizes ontologies and dimensional models to access the data required for improved data analysis. This approach exploits the use of structured information available in the healthcare industry such as standard ontologies (e.g., ICD (International Classification of Disease)-10 [8], designed to provide diagnostic codes for classifying diseases, and SNOMED-CT [9] which provides a comprehensive terminology for clinical health) as well as hospital organizational and other relevant hierarchies. ...
The volume and diversity of healthcare information available through the use of modern technology offers great potential for improving health services delivery. Giving healthcare practitioners and health system administrators the ability to investigate and analyse data from various perspectives can promote evidence-based decision making. Current analysis approaches often result in models where essential relations are difficult to depict and/or discern. Further it is not easy to dynamically change the level of detail in order to accommodate user requirements and allow users to analyse data from various perspectives. We outline an approach involving filtering and abstraction of event logs using ontologies, dimensional modeling and cluster analysis so healthcare professionals may access the information they need. Our approach enhances existing process mining techniques by incorporating data mining techniques for dividing patient records into closely related groups, and results in contextual process mining.
... (16) DR was determined according to the International Classification of Diseases, Tenth Revision Codes in E113, presented in medical records. (17) BMI was calculated as body weight in kilograms divided by height in meters squared. The pulse pressure (PP) was calculated as the difference of SBP and DBP levels. ...
Background: Diabetic retinopathy (DR) is one of the ocular complications among patients with type 2 diabetes (T2D) in both developed and developing countries. At present, epidemiological data of DR and the risk factors among patients with T2D especially in Thai community hospitals have been limited. Methods: A retrospective cohort study was conducted between January 1, 2013 and December 31, 2020 to determine the incidence and risk factors of DR among patients with T2D visiting Tha Wung Hospital, Lop Buri Province, central Thailand. DR was determined according to the International Classification of Diseases, Tenth Revision codes in E113 presented in medical records. Multivariate Cox regression analysis was performed to obtain the adjusted hazard ratios (HR) and 95% confidence interval (CI) of the factors related to DR. Results: A total of 2007 patients with T2D were enrolled in the present study. During the study period, participants (5.3%) had a diagnosis of DR; the incidence rate was 0.9 per 100 person-years (95% CI; 0.7-1.1). The independent risk factors for DR included HbA1c ≥8% (adjusted hazard ratio (AHR) = 4.7, 95% CI; 2.5-8.7), urine albumin 3+ (AHR = 2.4, 95% CI; 1.1-5.3), urine albumin 4+ (AHR = 20.3, 95% CI; 2.7-150.9), and a longer distance between residential area (AHR= 1.3, 95% CI; 1.2-1.4). Conclusion: Patients with T2D should be encouraged to reach their glycemic control indicated by HbA1c level. Additionally, effective health interventions should be conducted to contribute appropriate access to diabetic care for patients residing in remote areas.
This paper focuses on a single case of ayahuasca-assisted grief therapy for the prevention of complicated grief, conducted within a clinical trial. The participant, a woman in her thirties who lost her father to cancer, completed a 9-session process of Meaning Reconstruction Therapy (MRT) organised around two ayahuasca sessions. Following each psychedelic experience, she also completed a psychedelic integration session. The case study investigates the effect of the intervention, the observed changes in the participant, and the potential processes of change which may account for this improvement. The analysis relies on a qualitative narrative approach to examine the content of each therapy session, as well as on the psychometric measures completed at baseline, post-treatment, and at the three-month follow-up. These results are linked to emerging theories in the field, with a particular focus on the role of meaning reconstruction, psychological flexibility, and a continuing bond with the deceased.
Introduction
Perforation represents the most critical manifestation of complicated diverticulitis. In 2008, it was estimated that about 2,000 cases of perforated diverticulitis (PD) were diagnosed in the United Kingdom (UK). Management of PD is evolving with considerable variation in approaches between hospitals and countries with an increased trend towards a conservative approach.
Objective
Our aim is to provide a comprehensive overview of the management strategies and treatment outcomes for PD, with a particular focus on the influence of abscess size and the presence of distant air (DA) on the success of conservative management.
Methods
Data from 112 patients admitted with PD to a single district hospital in the UK between 2013 and 2018 were retrospectively analysed. CT scan reports and images were examined to assess the size and number of abscesses, as well as the presence of DA. Failed initial management was defined as the need for an alternative therapeutic option after 48 hours during the index admission or readmission within 12 weeks. Follow-up data were also reviewed to evaluate the need for elective resection and stoma reversal.
Result
In this cohort of 112 patients with PD, a variety of treatment strategies were employed. Antibiotic therapy alone was successful in 46 patients (41%). Radiological management was successful in only six patients (5%). Surgical washout was required in 12 cases (11%), while resection was performed in 40 cases (36%). Best supportive care was provided to eight patients (7%) who were considered unfit for invasive interventions. The success rate was higher in cases with smaller abscesses and no DA (p <0.05). Specifically, 30 out of 45 patients (66.6%) with abscesses less than 4 cm and no DA were managed successfully with conservative treatment, whereas the success rate dropped to 14 out of 30 patients (47%) when DA was present (p<0.05). For abscesses larger than 4 cm, the success rate was seven out of 20 patients (35%) without DA and significantly lower at two out of 20 patients (10%) with DA (p=0.01). The data also show a shift towards increased conservative management over the six-year period, with a steady reduction in the number of surgical interventions. However, 12 patients (19%) were readmitted with complicated diverticulitis after the initial non-resectional management.
Conclusion
We observed a shift towards more conservative, non-operative management of acute complicated diverticulitis with perforation over the six-year period, likely influenced by advancements in diagnostic and interventional radiology, antibiotic therapy, and minimally invasive techniques. Our data also stress that cases of PD with distant extraluminal air or larger abscesses are less suited to conservative treatment, often necessitating traditional surgical interventions. Long-term follow-up showed a moderate rate of readmissions after non-resectional management, and while stoma reversal was successful in a proportion of patients, many either opted to live with the stoma or were deemed unsuitable for reversal. A larger, multicentre prospective study would likely provide more robust data on this subject.
In recent years, Internet Addiction Disorder (IAD) has become a major mental health concern among
adolescents, with detrimental effects on social relationships, academic performance, and emotional wellbeing.
The focus of mindfulness-based interventions (MBIs) on improving self-awareness, emotional
regulation, and cognitive flexibility has drawn interest in MBIs as possible therapeutic approaches for
treating IAD. The purpose of this narrative review is to investigate how mindfulness interventions affect
teenagers who are experiencing IAD. The review summarizes research findings from multiple studies that
look at how well MBIs work to promote healthier online behavior, improve mental health outcomes, and cut
down on excessive internet use. According to recent research, adolescents who engage in mindfulness
practices are better able to control their compulsive internet usage habits, resist impulsive impulses, and
spend less time on the internet. Furthermore, mindfulness practices like breathing exercises, body scanning,
and meditation may help reduce stress, anxiety, and depression, which are the common comorbidities linked
to IAD. The review ends by emphasizing the necessity of more research on the long-term impacts of MBIs on
IAD, the incorporation of mindfulness into school-based initiatives, and the significance of developing
interventions that are specific to the developmental needs of teenagers. All things considered, mindfulness
intervention seems like a promising strategy for reducing Internet addiction disorder, but more thorough
research is needed to determine its effectiveness and suitability for use in a range of adolescent populations.
Single-word phonological tests are widely used for detecting children at risk for Speech Sound Disorders (SSDs). However, specific conceptual and operational criteria should be evaluated to ensure that these assessments are valid and reliable and can serve as diagnostic tools. The current study aimed to investigate the validity and reliability of the screener of a phonological Greek instrument, named the Phonological Assessment for Greek (PAel) comparing the phonological performance of typically developing (TD) children and children with SSDs, aged 4 to 6 years. The participants were 20 TD children and 40 children with SSDs. All participants completed the screener of PAel, the 70-word list of the standardised Test of Phonetic and Phonological Development (TPPD), and a language test, namely the Action Picture Test. Participants who scored below the 25th percentile on the language test were excluded. Phonological analysis revealed that PAel has high content validity. The participants who had received a diagnosis of SSDs presented restricted consonant and cluster inventories and significantly lower whole-word match levels in comparison to their TD peers. The overall Spearman's correlation coefficients between PAel and TPPD were 0.611 for TD children (p < 0.001) and 0.875 for children with SSDs (p < 0.001), indicating good criterion validity. The tool demonstrated strong test-retest reliability and inter-rater reliability with Spearman values exceeding 0.85, and Intra-class correlation coefficients over 0.90. Overall, the results suggest that PAel has satisfactory reliability and validity and can be used as an assessment tool to detect children at risk for SSDs.
High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N1 = 201; N2 = 254) using structural equation bi-factor models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception.
We reviewed 141 epidemiological surveys of autism conducted in 37 countries since 1966. Prevalence has significantly increased over time; in 31 recent surveys performed in high-income countries on school-aged samples, the median prevalence was 1.14%. Male/female ratio (median 4.1:1) was stable over time. Methodological progresses and remaining challenges in designing and executing surveys are discussed, including the effects on prevalence of variable case definitions, case ascertainment through mainstream school surveys, innovative approaches to screen school samples more efficiently, cross-cultural variation in phenotypic expression and developing surveillance programs.
Background
The immune system has a central role in preventing carcinogenesis. Alteration of systemic immune cell levels may increase cancer risk. However, the extent to which common genetic variation influences blood traits and cancer risk remains largely undetermined. Here, we identify pleiotropic variants and predict their underlying molecular and cellular alterations.
Methods
Multivariate Cox regression was used to evaluate associations between blood traits and cancer diagnosis in cases in the UK Biobank. Shared genetic variants were identified from the summary statistics of the genome-wide association studies of 27 blood traits and 27 cancer types and subtypes, applying the conditional/conjunctional false-discovery rate approach. Analysis of genomic positions, expression quantitative trait loci, enhancers, regulatory marks, functionally defined gene sets, and bulk- and single-cell expression profiles predicted the biological impact of pleiotropic variants. Plasma small RNAs were sequenced to assess association with cancer diagnosis.
Results
The study identified 4093 common genetic variants, involving 1248 gene loci, that contributed to blood–cancer pleiotropism. Genomic hotspots of pleiotropism include chromosomal regions 5p15-TERT and 6p21-HLA. Genes whose products are involved in regulating telomere length are found to be enriched in pleiotropic variants. Pleiotropic gene candidates are frequently linked to transcriptional programs that regulate hematopoiesis and define progenitor cell states of immune system development. Perturbation of the myeloid lineage is indicated by pleiotropic associations with defined master regulators and cell alterations. Eosinophil count is inversely associated with cancer risk. A high frequency of pleiotropic associations is also centered on the regulation of small noncoding Y-RNAs. Predicted pleiotropic Y-RNAs show specific regulatory marks and are overabundant in the normal tissue and blood of cancer patients. Analysis of plasma small RNAs in women who developed breast cancer indicates there is an overabundance of Y-RNA preceding neoplasm diagnosis.
Conclusions
This study reveals extensive pleiotropism between blood traits and cancer risk. Pleiotropism is linked to factors and processes involved in hematopoietic development and immune system function, including components of the major histocompatibility complexes, and regulators of telomere length and myeloid lineage. Deregulation of Y-RNAs is also associated with pleiotropism. Overexpression of these elements might indicate increased cancer risk.
An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries. We aimed to report cancer profiles and trends among young adults in China. Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults (ages 20–49 years) in China in 2017, and an age-period-cohort model was employed to estimate the average annual percent change (AAPC) in incidence and mortality from 2000 to 2017. All 25 cancer types were grouped into obesity- or overweight-associated cancers (12 cancer types) and additional cancers (13 cancer types). In 2017, there were 681,178 new cases and 214,591 cancer deaths among young adults in China. Among young adults, the most common cancers were thyroid, breast, cervical, liver, lung, and colorectal cancer, and the leading causes of cancer deaths were liver, lung, cervical, stomach, breast, and colorectal cancer. From 2000 to 2017, the cancer incidence increased for all cancers combined among young adults, with the highest AAPC (1.46%) for adults aged 20–24 years, while cancer mortality decreased, with the highest AAPC (−1.63%) for those aged 35–39 years. In conclusion, the cancer incidence in China has increased among young adults, while cancer mortality has decreased for nearly all ages. Cancer control measures, such as obesity control and appropriate screening, may contribute to reducing the increasing cancer burden among young adults.
The volume and diversity of healthcare data available using modern technology offers great potential for improving health services delivery. Giving clinicians and health system administrators the ability to easily investigate and analyze data from various perspectives can promote evidence-based decision-making. Current analysis approaches often result in process models where essential relations are difficult to depict and/or discern. Moreover, it is not easy to change the level of detail in order to accommodate user requirements by allowing them to analyze data from various perspectives or capture temporal aspects of the data. Further, inherent differences between patients and the vast variety of healthcare settings, even for one patient, make process mining extremely difficult. In this paper, we first discuss community detection methods which, together with filtering techniques based on dimensional modeling and ontologies, allow us to obtain “contextual” insights from event log data using what we call “contextual process mining”. Then, to capture time-dependent relations in patient data, we propose a linear temporal logic-based language, (: Event-Ontology-Time Linear Temporal Logic), which can be used to express both time and order-dependent conditions. The formulas are used to filter the event log data to find those patients who satisfy the conditions, thus capturing “temporal” insights in event log data. Both the investigations using community detection methods and those using the temporal logic methods are validated learning approaches: the first allows the user to experiment with the level of abstraction, while the second allows the user to experiment with the temporal logic formulas. This approach can give healthcare professionals insights into patterns of admission, diagnosis, and treatment among patients, which, in turn, lead to the overall goal of this research, which is improved resource management, scheduling, and other aspects of health services delivery. In a simple case study, we show this approach leads to an improved understanding of healthcare processes among comorbid patients.
Mental sağlık, kognitif ve emosyonel iyilik halini ifade eder. Daha somut olarak ise kişinin nasıl düşündüğünü, hissettiğini ve davrandığını ifade etmektedir. Mental sağlık günlük hayatı, ilişkileri, hayattan zevk alma yeteneğini ve hatta fiziksel sağlığı bile etkileyebilmektedir. Mental sağlık, yaşam aktiviteleri ile dayanıklılığa ulaşma çabaları arasında bir denge bulmayı içerir. Dünya Sağlık Örgütü’ne (WHO) (1) göre mental sağlık, ‘kişinin kendi yeteneklerini fark ettiği, hayatın normal stresleriyle başa
çıkabildiği, üretken ve verimli çalışabildiği ve kendi topluluğuna katkıda bulunabildiği durumdur’. Mental sağlık sadece bir ruhsal bozukluğun olup olmaması değildir. Mental sağlık problemleri ile mental sağlık bozuklukları arasında ayrım yapmak önemlidir. Mental sağlığı problemi, günlük yaşamın bir parçası olan ve duygusal ve/veya sosyal yeteneklere müdahale eden olumsuz bir zihinsel deneyimdir. Mental bozukluğu olan kişilerin ise yeteneklerinde giderek artan bir dengesizlik vardır. Mental bozukluk, bireyin bilişinde, duygu düzenlemesinde veya davranışında klinik açıdan önemli bir rahatsızlık ile karakterize edilen bir sendrom olarak tanımlanır. Zihinsel işleyişin altında yatan psikolojik, biyolojik veya gelişimsel süreçte yaygın veya ciddi bir işlev bozukluğunu yansıtır. Her dört kişiden biri hayatının belirli bir noktasında bir ruh sağlığı bozukluğuyla karşı karşıya
kalabilmektedir. Mental sağlık bozukluğu, dünya çapında engelliliğin dördüncü en önemli nedenidir. Depresyon ise bu mental sağlık bozukluklarının başında gelen problemlerden
biridir (2, 3).
Background: Children with disabilities are at heightened risk of violence compared to their non-disabled peers. However, extant research suffers from several limitations, focusing on child abuse and one or few types of disability, ignoring conventional violent crimes.
Objective: The aim was to assess 10 disabilities and to examine whether different disabilities vary in their risk of criminal victimization.
Method: Using the Danish Psychiatric Case Register, the Criminal Register, and other population-based registers, we included nine birth cohorts (n = 570,351) and followed them until 18 years of age. We compared children exposed to violence with non-exposed children. We estimated odds ratios (ORs) for the disabilities and adjusted the ORs for several risk factors.
Results: We identified 12,830 cases of reported violence (2.25% of the population) towards children and adolescents. Children with disabilities were overrepresented, as were boys and ethnic minorities. After controlling for risk factors, four disabilities had heightened risk for criminal violence: attention-deficit hyperactivity disorder (ADHD), brain injury, speech, and physical disabilities. When we compared risk factors controlling for the various disabilities, parental history of violence, family break-up, out-of-home placement, and parental unemployment contributed especially to the violence, while parental alcohol/drug abuse was no longer a predictor. Having several disabilities increased the risk of violence.
Conclusions: Criminal victimization of children and adolescents with specific disabilities was common. However, compared to the previous decade, a considerable reduction of one-third has taken place. Four risk factors contributed particularly to the risk of violence; therefore, precautions should be taken to further reduce the violence.
Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place.
Background:
While cigarette smoking is the leading cause of lung cancer, the majority of smokers do not develop the disease over their lifetime. The inter-individual differences in risk among smokers may in part be due to variations in exposure to smoking-related toxicants.
Methods:
Using data from a subcohort of 2,309 current smokers at the time of urine collection from the Multiethnic Cohort Study, we prospectively evaluated the association of ten urinary biomarkers of smoking-related toxicants (total nicotine equivalents [TNE], a ratio of total trans-3'-hydroxycotinine [3-HCOT]/cotinine [a phenotypic measure of CYP2A6 enzymatic activity], 4-(methylnitrosamino)-1-3-(pyridyl)-1-butanol [NNAL], S-phenylmercapturic acid [SPMA], 3-hydroxypropyl mercapturic acid [3-HPMA], phenanthrene tetraol [PheT], 3-hydroxyphenanthrene [PheOH], the ratio of PheT/PheOH, cadmium (Cd), and (Z)-7-(1R,2R,3R,5S)-3,5-dihydroxy-2-[(E,3S)-3-hydroxyoct-1-enyl]cyclopenyl]hept-5-enoic acid [8-iso-PGF2α]) with lung cancer risk (n=140 incident lung cancer cases over an average of 13.4 years of follow-up). Lung cancer risk was estimated using Cox proportional hazards models.
Results:
After adjusting for decade of birth, sex, race/ethnicity, body mass index, self-reported pack-years, creatinine, and urinary TNE (a biomarker of internal smoking dose), a one standard deviation increase in log total 3-HCOT/cotinine (HR=1.33, 95% CI:1.06-1.66), 3-HPMA (HR=1.41, 95% CI:1.07-1.85), and Cd (HR=1.45, 95% CI: 1.18-1.79) were each associated with increased lung cancer risk.
Conclusion:
Our study demonstrates that urinary total 3-HCOT/cotinine, 3-HPMA, and Cd are positively associated with lung cancer risk. These findings warrant replication and consideration as potential biomarkers for smoking-related lung cancer risk.
Impact:
These biomarkers may provide additional information on lung cancer risk that is not captured by self-reported smoking history or TNE.
This study examined the roles of drug use disorder, neurotic health symptoms, and pathological smartphone use in COVID-19 lockdown–related stress. A sample of 288 young adults were purposively recruited. Data were collected using four standardized measures with robust psychometric properties: Cannabis Abuse Screening Test (CAST), the Smartphone Addiction Scale, COVID Stress Scale, and a Neuroticism subscale of the Big Five Inventory. The participants’ ages ranged from 17 to 34 years, with a mean age of 24.09 (SD = 3.81) years. The hierarchical regression confirmed the hypotheses and results were consistent with expectations, F(3, 284) = 4.79, p < .05, such that 4.8% of the variance in COVID-19 lockdown stress was a result of the joint function of drug use disorder, neurotic health symptoms, and pathological smartphone use. Drug use disorder contributed to COVID-19 lockdown stress independently, whereas when merged with neuroticism, it did not predict outcome variable independently; the same was true for pathological smartphone use when entered into the third model. The preventive and control advocacy is a harm-reduction approach. Further empirical investigations of other predictors of COVID-19 lockdown stress, with a goal of initiating telebehavioral health interventions targeted at identifying and treating people with mental health needs—especially in times of global pandemic or movement restrictions—are recommended.
This study aimed to build on the relationship of well-established self-report and behavioral assessments to the latent constructs positive (PVS) and negative valence systems (NVS), cognitive systems (CS), and social processes (SP) of the Research Domain Criteria (RDoC) framework in a large transnosological population which cuts across DSM/ICD-10 disorder criteria categories. One thousand four hundred and thirty one participants (42.1% suffering from anxiety/fear-related, 18.2% from depressive, 7.9% from schizophrenia spectrum, 7.5% from bipolar, 3.4% from autism spectrum, 2.2% from other disorders, 18.4% healthy controls, and 0.2% with no diagnosis specified) recruited in studies within the German research network for mental disorders for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) were examined with a Mini-RDoC-Assessment including behavioral and self-report measures. The respective data was analyzed with confirmatory factor analysis (CFA) to delineate the underlying latent RDoC-structure. A revised four-factor model reflecting the core domains positive and negative valence systems as well as cognitive systems and social processes showed a good fit across this sample and showed significantly better fit compared to a one factor solution. The connections between the domains PVS, NVS and SP could be substantiated, indicating a universal latent structure spanning across known nosological entities. This study is the first to give an impression on the latent structure and intercorrelations between four core Research Domain Criteria in a transnosological sample. We emphasize the possibility of using already existing and well validated self-report and behavioral measurements to capture aspects of the latent structure informed by the RDoC matrix.
This study measured visual attention (fixation count, dwell time) during two real-life social stress tasks using mobile eye-tracking glasses in children (9–13 years) diagnosed with social anxiety disorder (SAD; n = 25) and a healthy control group (HC; n = 30). The influence of state anxiety on attention allocation and negative self-evaluation biases regarding gaze behavior were also examined. Compared to the HC group, children with SAD showed visual avoidance (i.e., fewer fixations) of the faces of interaction partners during the second social stress task. While visual avoidance in HC children decreased with declining state anxiety from the first to the second social stress task, no such effect was found in children with SAD. A negative self-evaluation bias regarding gaze behavior in children with SAD was not found. In sum, measuring visual attention during real-life social situations may help enhance our understanding of social attention in childhood SAD.
Purpose
This study explores whether the quality of parent–child interaction is associated with language abilities cross-sectionally and longitudinally up to preschool-age among children with developmental language disorder (DLD).
Method
Participants were 97 monolingual children with DLD and their parents from the Helsinki Longitudinal SLI study, HelSLI (baseline, age in years;months, M = 4;3, SD = 0;10), of which 71 pairs were followed longitudinally (age in years;months, M = 6;6, SD = 0;5). Video recordings from three play sessions were scored for child, parent, and dyadic behavior using Erickson's sensitivity scale protocol and mutually responsive orientation at baseline. Children's expressive and receptive language and language reasoning ability were assessed at baseline, and expressive and receptive language were assessed at follow-up.
Results
At baseline, engaged child behavior, parent's supportive guidance, and fluent and attuned dyadic behavior were associated with better receptive language ability, and engaged child behavior and dyadic synchrony were positively associated with language reasoning ability in 3- to 6-year-olds. The child's positive engagement and fluent and attuned dyadic behavior at baseline were associated with better expressive and receptive language abilities at follow-up in 6- to 7-year-olds, respectively.
Conclusions
Fluent and attuned dyadic behavior is associated with better receptive language ability in preschool-age children. Parent behavior alone was not associated with language ability. A connected and mutually attuned parent–child relationship could be a protective factor for language development for children with DLD.
Objective:
Previous studies have shown positive treatment outcomes of e-mental health applications targeting depression. However, few applications provide personalized features. The aim of the present study is to ask for the user experience and acceptance of patients with depression and healthy adults, who tested the self-management app Self-administered Psycho Therapy SystemS over a period of 5 days. The results serve as a source for evidence-based recommendations for developers and clinicians.
Methods:
A total of 110 participants (41 patients and 69 healthy controls) tested the app Self-administered Psycho Therapy SystemS over a period of 5 days and completed evaluation sheets developed for the purpose of this study. Quantitative measures were asked with 5-point Likert-scaled items (range: -2 to + 2) for the perceived quality of the programme and its components, its practicality (both referred to as user experience) and its acceptance. Student's t-tests and Pearson correlations were calculated for group comparisons and associations, respectively. Open text fields were analysed by applying a qualitative structuring content analysis.
Results:
The perceived quality of the total programme was rated with M = 0.96 (SD = 0.82), the practicality was M = 0.84 (SD = 0.08) and the acceptance was M = 0.25 (SD = 1.04). Patients rated perceived quality of the total programme and acceptance higher than healthy adults, while there was no difference in practicality. Acceptance was associated with increased depression scores (r = 0.33, p = .01), higher scores of perceived quality of the total programme (r = 0.48, p< .001) and of practicality (r = 0.45, p < .001). Feedback of both groups regarding usability, therapeutic content and personalization revealed a strong wish for guidance and insights into mood progress, opportunities for choice of interventions and features of customization for individualized treatment.
Conclusions:
Patients with depression accepted the app Self-administered Psycho Therapy SystemS more than healthy adults and gave higher ratings in quality. User experience of all users shows a need for features of guidance, choice and personalization that clinicians and developers of future apps should pay attention to.
Objective
To describe health burden and health service utilization from the prenatal period to 1 year postpartum among women with births covered by Texas Medicaid, focusing on the major contributors to maternal mortality after 60 days postpartum in Texas.
Methods
We analyzed diagnoses and health service utilization during the prenatal, early postpartum (5–60 days postpartum), and late postpartum (> 60 days to 1 year postpartum) periods, using administrative medical claims data for women ages 18–44 years with a Medicaid-paid delivery in 2017 residing in selected regions in Texas (n = 49,302).
Results
Overall, 12.6% and 17.5% of women had diagnoses of cardiovascular/coronary conditions and substance use disorder, respectively. Mental health conditions affected 30% of women, with anxiety (47.1%) and depression (34.3%) accounting for the greatest proportion of diagnosed mental health conditions. The prevalence of these conditions was higher during the late (19.4%) versus early (9.9%) postpartum period. About 47.8% of women had other chronic health conditions, including obesity, diabetes mellitus, and hypertension. Among women with the selected health conditions, utilization of any health services was higher during the prenatal period compared to early and late postpartum periods (e.g., any mental health service utilization: prenatal period (57.4%) versus early postpartum (26.9%) and late postpartum (25.5%) periods). However, among women with the selected health conditions, there was a high utilization of emergency room services during the late postpartum period [e.g., emergency room service utilization among those with mental health conditions: prenatal period (35.6%); postpartum period: early (5.5%) and late (30.1%)].
Conclusions for Practice
Increasing access to the full range of recommended services during the prenatal period through 1 year postpartum has potential to help improve vulnerable women’s birth outcomes.
Purpose
Mental health problems and substance misuse are common among the mothers of children who experience court-mandated placement into care in England, yet there is limited research characterising these health needs to inform evidence-based policy. In this descriptive study, we aimed to generate evidence about the type, severity, and timing of mental health and substance misuse needs among women involved in public family law proceedings concerning child placement into care (‘care proceedings’).
Methods
This is a retrospective, matched cohort study using linked family court and mental health service records for 2137 (66%) of the 3226 women involved in care proceedings between 2007 and 2019 in the South London and Maudsley NHS Mental Health Trust (SLaM) catchment area. We compared mental health service use and risk of dying with 17,096 female-matched controls who accessed SLaM between 2007 and 2019, aged 16–55 years, and were not involved in care proceedings.
Results
Most women (79%) were known to SLaM before care proceedings began. Women had higher rates of schizophrenia spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%). They were more likely to have a SLaM inpatient admission (27% vs 14%) or to be sectioned (19% vs 8%). Women had a 2.15 (95% CI 1.68–2.74) times greater hazard of dying, compared to matched controls, adjusted for age.
Conclusion
Women involved in care proceedings experience a particularly high burden of severe and complex mental health and substance misuse need. Women’s increased risk of mortality following proceedings highlights that interventions responding to maternal mental health and substance misuse within family courts should offer continued, long-term support.
Background
Little is known about the relationship between social determinants of health (SDH) and medication adherence among Medicaid beneficiaries with hypertension.
Methods
We conducted a posthoc subgroup analysis of 3044 adult Medicaid beneficiaries who enrolled in a parent prospective cohort study and had a diagnosis of hypertension based on their Medicaid claims during a 24-month period before study enrollment. We calculated the proportion of days covered by at least one antihypertensive medication during the first 12 months after study enrollment using the prescription claims data. We measured numerous SDH at the time of study enrollment and we categorized our hypertension cohort into 4 social risk groups based on their response profiles to the SDH variables. We compared the mean proportion of days covered by the different levels of the SDH factors. We modeled the odds of being covered by an antihypertensive medication daily throughout the follow-up period by social risk group, adjusted for age, sex, and disease severity using a generalized linear model.
Results
The nonrandom sample was predominately Black (93%), female (62%) and had completed high school (77%). The mean proportion of days covered varied significantly by different SDH, such as food insecurity (49%–56%), length of time living at present place (47%–57%), smoking status (50%–56%), etc. Social risk group was a significant predictor of medication adherence. Participants in the 2 groups with the most social risks were 36% (adjusted odds ratio=0.64 [95% CI, 0.53–0.78]) and 20% (adjusted odds ratio=0.80 [95% CI, 0.70–0.93]) less adherent to their hypertension therapy compared with participants in the group with the fewest social risks.
Conclusions
Social risks are associated with lower antihypertensive medication adherence in the Medicaid population.
Background
A quarter of people with Intellectual Disability (ID) in the UK have epilepsy compared to 0.6% in the general population and die much younger. Epilepsy is associated with two - fifths of all deaths with related polypharmacy and multimorbidity. Epilepsy research on this population has been poor. This study describes real-world clinical and risk characteristics of a large cohort across England and Wales.
Methods
A retrospective multi-centre cohort study was conducted. Information on seizure characteristics, ID severity, relevant co-morbidities, psychotropic and antiseizure drugs (ASDs), SUDEP and other risk factors was collected across a year.
Results
Of 904 adults across 10 centres (male:female, 1.5:1), 320 (35%) had mild ID and 584 (65%) moderate-profound (M/P) ID. The mean age was 39.9 years (SD 15.0). Seizures were more frequent in M/P ID (p<0.001). Over 50% had physical health co-morbidities, more in mild ID (p<0.01). A third had psychiatric co-morbidity and a fifth had an underlying genetic disorder. Autism Spectrum Disorder was seen in over a third (37%). Participants were on median two ASDs and overall, five medications. Over quarter were on anti-psychotics. Over 90% had an epilepsy review in the past year but 25% did not have
an epilepsy care plan, particularly those with mild ID (p<0.001). Only 61% had a documented discussion of SUDEP, again less likely with mild ID or their care stakeholders (p<0.001).
Conclusions
Significant levels of multi-morbidity, polypharmacy and a lack of systemised approach to treatment and risk exist. Addressing these concerns is essential to reduce premature mortality.
Se os avanços sociais, econômicos e tecnológicos do Brasil nas últimas seis décadas lograram significativas mudanças no quadro epidemiológico do país e as doenças infecciosas e parasitárias não figuram mais entre as principais causas de morbimortalidade, por que esse grupo de doenças ainda merece destaque para o debate?
Nesse caso, pontuamos que os ganhos sociais e econômicos vistos no Brasil não foram atravessados pela construção de uma política de equidade racial, inclusive na saúde, que pudesse institucionalizar ações voltadas a mitigar as desigualdades as quais marcam o país. O bônus não foi distribuído para todos. Na última década, no Brasil, a redução da pobreza tem beneficiado mais a população branca do que a negra. O resultado é que, apesar de compor a maioria do contingente populacional brasileiro, entre a população negra há maior prevalência de doenças infecciosas e parasitárias negligenciadas, a exemplo da síndrome da imunodeficiência adquirida (AIDS), da Tuberculose, da Leishmaniose visceral e da Doença de Chagas.
Purpose
Prior research on the psychological consequences of skin diseases has focused on assessing mental comorbidities. The aim of this study was to investigate subjective well-being in a large sample of individuals affected by psoriasis, a chronic inflammatory skin disease, and to explore the associations with depression and disease-related parameters such as disease severity.
Methods
A cross-sectional online survey was conducted from March to June 2019. The link to the questionnaire was shared on websites and Facebook pages of psoriasis patient organizations and campaigns. Participants filled in validated scales measuring subjective well-being—operationalized as positive affect (PA), negative affect (NA) and satisfaction with life (SWL); and depression.
Results
The data of 722 participants were analyzed. Exploratory factor analysis supported the differentiation of PA, NA, SWL, and depression as four different constructs. The respondents reported lower levels of PA than healthy individuals and judged themselves to be less happy and were less satisfied with their lives than the general population (except age group 65 + years). 40.3% of respondents were screened positive for depression. More severe psoriasis was associated with lower affective well-being and a higher risk for depression.
Conclusion
The results of this study empirically supported the differentiation of subjective well-being and depression as different constructs in individuals with psoriasis, and underline the large mental burden of the disease which goes beyond a higher risk for depression. Measures of well-being should thus be incorporated in both research and clinical practice in patients with psoriasis in order to achieve a more comprehensive picture of the mental burden of this disease.
Background
Little is known about the healthcare needs of the increasing number of undocumented migrants in Europe. We aimed to gain knowledge about undocumented migrants´ use of a free healthcare clinic including an outreach program in Denmark.
Methods
We conducted a retrospective cohort study of all patients registered in the database at the AmiAmi healthcare clinic in Fredericia, Denmark, January 1st 2006 - July 30th 2019.
Results
In all, 579 patients from 47 different countries were included, of which 525 (90.7%) were cis-women (= assigned female sex at birth and identifies as female). They had a total of 3135 consultations (median 3, IQR 2–6), and 19% used the clinic over a period of >2 years. In all, 820 consultations (26%) were done as part of the outreach program, and the number of outreach contacts increased significantly over the study period (p<0.001). Of 738 tests for sexually transmitted infections (STIs), 76 (13.1%) patients were found positive for one or several STIs. Transgender women & cross-dressing men had significantly higher risk of STIs (25.8% vs. 10.3%, p=0.007) compared with cis-women. Of 94 patients referred to the public healthcare system, the majority (n=64) were referred to the department of gynecology during pregnancy or for induced abortion. 52 patients (9.0%) reported being submitted to abuse or violence while in Denmark, and another 24 (4.1%) were registered as victims of human trafficking.
Conclusions
Our results highlight the multifaceted healthcare needs of undocumented migrants, with an increasing use of healthcare services over the study period. It underlines the importance of outreach programs to reach this patient group at their place of work or stay. Finally, it emphasizes that transgender female and cross-dressing male sex-workers are an especially vulnerable group with higher risk of HIV and other STIs compared with cis-women.
The SPARK cohort was established to facilitate recruitment in studies of large numbers of participants with autism spectrum disorder (ASD). Online registration requires participants to have received a lifetime professional diagnosis by health or school providers although diagnoses are not independently verified. This study was set to examine the validity of self- and caregiver-reported autism diagnoses. Electronic medical records (EMR) of 254 SPARK participants (77.6% male, age 10.7 years) were abstracted. Using two different methods, confirmation of ASD diagnosis in EMRs was obtained in 98.8% of cases. Core clinical features recorded in EMRs were typical of autism samples and showed very good agreement with SPARK cohort data, providing further evidence of the validity of clinical information in the SPARK database.
Objective
Medically treated opioid overdoses identify a population at high risk of subsequent mortality and need for treatment. This study reports on medically treated opioid overdose trends in a state with rapid fentanyl spread.
Methods
We conducted stratified trend analysis of medically treated overdose due to heroin, synthetic opioids, methadone, or other natural opioids among New Jersey Medicaid beneficiaries aged 12–64 years (2014–2019); evaluated associations with demographics and co-occurring conditions; and examined trends in fentanyl penetration in suspected heroin seizures from New Jersey State Police data.
Results
Overdose risk more than tripled from 2014 to 2019, from 120.5 to 426.8 per 100,000 person-years, respectively. Increases primarily involved heroin and synthetic opioids and were associated with co-occurring alcohol and other non–opioid drug disorders, major depressive disorder, and hepatitis C. Concurrent changes in the drug exposure environment (2015–2019) included an increase in fentanyl penetration (proportion of suspected heroin seizures that included fentanyls) from 2% to 80%, and a decrease in the proportion of Medicaid beneficiaries who received opioid analgesic prescriptions from 23% to 13%.
Conclusion
Results document a rapid increase in overdose risk among individuals with opioid use disorder in an environment in which fentanyl is highly prevalent, and highlight the need for intensified services and engagement of non–treatment seekers, and integrated models to address multiple co-occurring conditions and risk factors.
Primary care systems are a cornerstone of universally accessible health care. The planning, analysis, and adaptation of primary care systems is a highly non-trivial problem due to the systems’ inherent complexity, unforeseen future events, and scarcity of data. To support the search for solutions, this paper introduces the hybrid agent-based simulation model SiM-Care. SiM-Care models and tracks the micro-interactions of patients and primary care physicians on an individual level. At the same time, it models the progression of time via the discrete-event paradigm. Thereby, it enables modelers to analyze multiple key indicators such as patient waiting times and physician utilization to assess and compare primary care systems. Moreover, SiM-Care can evaluate changes in the infrastructure, patient behavior, and service design. To showcase SiM-Care and its validation through expert input and empirical data, we present a case study for a primary care system in Germany. Specifically, we study the immanent implications of demographic change on rural primary care and investigate the effects of an aging population and a decrease in the number of physicians, as well as their combined effects.
Purpose
This study aimed to identify the association between health-related physical indicators—sarcopenia-related factors, physical fitness, independence in activities of daily living (ADL) and habitual physical activity—and self-rated quality of life (QoL) in people with neurocognitive disorder (NCD).
Methods
This cross-sectional study included 115 participants (78.22 ± 7.48 years; 74.8% female) clinically diagnosed with NCD. Self-rated QoL was evaluated using The Quality of Life-Alzheimer’s Disease (QoL-AD). Dual energy X-ray Absorptiometry, handgrip strength, Short Physical Performance Battery, and the 6-m Walk test were used to assess sarcopenia-related factors. Senior Fitness Test and One Leg Balance test, Barthel Index, Baecke Modified Habitual Physical Activity Questionnaire were used to determine physical fitness, independence in ADL and physical activity, respectively. Regressions analyses were performed to examine associations between these variables and QoL-AD.
Results
Data from univariable linear regression analysis revealed that self-rated QoL was associated with sarcopenia-related factors (lower body function, handgrip strength, gait speed, and appendicular skeletal muscle mass index—ASMI), physical fitness (upper-and-lower-body strength, agility/dynamic balance, cardiorespiratory fitness and body mass index), habitual physical activity and independence in ADL. Results from multivariable regression analysis showed that ASMI (B = 1.846, 95% CI 0.165–3.527, p = 0.032) and lower body function (B = 0.756, 95% CI 0.269–1.242, p = 0.003) were positively associated with self-rated QoL. These variables explained 20.1% of the variability seen in self-rated QoL, controlling for age, sex, marital status and education.
Conclusion
Sarcopenia-related factors, namely lower body function and ASMI, should be acknowledged in future research studies as critical health-related indicators associated with QoL in people with NCD.
Trial registration
ClinicalTrials.gov—identifier number NCT04095962.
Purpose
Autism-specific characteristics have been associated with internet criminal activities. Internet and non-internet offenders differ on a series of demographic, psychological and offending variables. However, the clinical and criminal presentation of individuals with autism spectrum disorder (ASD) in forensic secure care settings has been underexplored. This paper aims to explore the profiles of internet offenders with ASD admitted to a secure psychiatric unit.
Design/methodology/approach
This study provides the results of a service evaluation of individuals with ASD. The demographic, clinical and criminal characteristics of a small sample of internet offenders with ASD admitted to secure care are described and discussed.
Findings
Internet offenders present in secure care with high rates of comorbid disorders, histories of violence and traumatic experiences, mood disorders and difficulties with relationships. Of the 24 internet offenders discussed, 18 of them committed an offence of a sexual nature involving children.
Originality/value
This paper highlights the potential risks for individuals with ASD in using the internet and the possible difficulties associated with detecting this because of rapid advancements in technology.
Objective
To investigate, by systematically reviewing the literature, if the attention-deficit/hyperactivity disorder ADHD polygenic risk score (PRS) associates with ADHD and related traits in independent clinical and population samples.
Method
Pubmed, Embase and PsychoInfo were systematically searched, alongside study bibliographies. Quality assessments were conducted, and a best-evidence synthesis was applied. Studies were excluded when 1) predictor was not based on the latest ADHD genome-wide association study; 2) PRS was not based on genome-wide results; 3) study was a review. Initially, 197 studies were retrieved [dd. Feb 22nd 2020]; a second search [dd June 3rd 2020] retrieved a further 49 studies; from both searches, 57 studies were eligible and 44 studies met inclusion criteria.
Results
Included studies were published in the last three years. Over 80% of the studies were rated excellent based on a standardized quality assessment. Evidence of associations between ADHD PRS and the following categories was strong: ADHD, ADHD traits, brain structure, education, externalizing behaviors, neuropsychological constructs, physical health and socio-economic status. Evidence for associations with addiction, autism and mental health are mixed and were, so far, inconclusive. Odds ratios for PRS associating with ADHD ranged from 1.22-1.76; variance explained in dimensional assessments of ADHD traits was 0.7%-3.3%.
Conclusion
A new wave of high quality research using the ADHD PRS has emerged. Eventually, symptoms may be partly identified based on PRS, but the current ADHD PRS is useful for research purposes only. This review shows the ADHD PRS is robust and reliable, associating not just ADHD but many outcomes and challenges known to be linked to ADHD.
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset condition that may continue into adulthood. When assessing adult patients, clinicians usually rely on retrospective reports of childhood symptoms to evaluate the age-of-onset criterion. Since inaccurate symptom recall may impede the diagnosis and treatment of ADHD, knowledge about the factors influencing retrospective reports is needed. This longitudinal study investigated (a) the accuracy of retrospective symptom ratings by adult participants with a childhood diagnosis of ADHD (self-ratings) and parents or significant others (proxy ratings), and (b) the influence of current ADHD symptom severity and ADHD-associated impairments on retrospective symptom ratings. Participants (N = 55) were members of the Cologne Adaptive Multimodal Treatment (CAMT) study who had been referred and treated for ADHD in childhood and were reassessed in adulthood (average age 27 years). Participants’ retrospective self-ratings were substantially lower than, and did not correlate with, parents’ ADHD symptom ratings provided at study entry, while retrospective symptom ratings provided by proxy respondents correlated moderately with parents’ childhood ratings. In addition, participants were more likely to underreport childhood symptoms (79%) and more frequently denied the presence of three or more childhood symptoms (17%) compared to proxy respondents (65% underreporting, 10% false-negative recall). Proxy respondents’ symptom recall was best predicted by childhood ADHD, while participants’ symptom recall was best predicted by current ADHD symptom severity. ADHD-associated impairments were not correlated with symptom recall after controlling for childhood ADHD. Together, these findings suggest a recall bias in adult patients and question the validity of retrospective reports, even in clinical samples.
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