Category: Nevin Manimala

Orbit. 2023 Nov 30:1-6. doi: 10.1080/01676830.2023.2286380. Online ahead of print.

ABSTRACT

PURPOSE: Merkel cell carcinoma of the eyelid (MCCE) is a rare yet aggressive neuroendocrine tumour associated with significant morbidity and mortality. This study aimed to investigate survival trends and demographic factors related to MCCE, 2000-2019, using the Surveillance, Epidemiology, and End Results (SEER) Program.

METHODS: Cases were analysed by demographic parameters, disease properties, and survival. Statistical analyses were performed via a dedicated computerized software package.

RESULTS: A total 349 cases of MCCE were identified, accounting for 2% of all MCC cases in the United States during that time. Of note, the incidence of MCCE remained stable over the study period (p = .35). Female patients accounted for 56% of the cases, and males for 44%. White patients accounted for 90.8% of the the cases, and Black patients for 2.9%. MCCE incidence increased with age, with the majority of patients age 85+ (p < .05). Incidence was greatest in metropolitan areas and among those with median incomes >$75,000/year. Income correlated with likelihood of MCCE diagnosis (p < .05). Analysis of 5-year survival data showed 20% of the patients died due to MCCE within 5 years of diagnosis. Of these, the majority died within one year of diagnosis.

CONCLUSIONS: Consistent with previous reports, most patients were white, female, and age 85+.Incidence correlated with metropolitan environments and median income. While most patients did not die from MCCE, majority of recorded deaths occurred within one year of diagnosis.

PMID:38032687 | DOI:10.1080/01676830.2023.2286380

Cardiovasc J Afr. 2023 Nov 22;34:1-4. doi: 10.5830/CVJA-2023-056. Online ahead of print.

ABSTRACT

We aimed to explore the predictive values of stress hyperglycaemia (SHG) and glycosylated haemoglobin (HbA_1c) levels on admission for long-term recovery of cardiac function in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PPCI). A total of 210 AMI patients were randomly selected. The levels of SHG and HbA_1c were measured on admission, and all patients were treated with PPCI and followed up for one year. According to the recovery status of cardiac function during follow up, the patients were divided into a good recovery group and a poor recovery group. At one year after treatment, there were statistically significant differences in the levels of SHG (6.75 ± 0.69 vs 7.81 ± 0.92 mmol/l) and HbA_1c (5.13 ± 0.25 vs 5.91 ± 0.39%) between the good and poor recovery groups (p < 0.05). The levels of SHG and HbA_1c were associated with long-term recovery of cardiac function (p < 0.05). The receiver operating characteristic curves were plotted, and the area under the curves of SHG and HbA_1c for predicting the long-term recovery of cardiac function were > 0.70. The levels of SHG and HbA_1c were closely associated with longterm recovery of cardiac function after PPCI in AMI patients, displaying high predictive values.

PMID:38032685 | DOI:10.5830/CVJA-2023-056

Psychol Serv. 2023 Nov 30. doi: 10.1037/ser0000824. Online ahead of print.

ABSTRACT

The posttraumatic stress disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5; Weathers et al., 2013) is a well-validated self-report instrument intended to assess provisional diagnostic status and symptom severity of PTSD. With the recent release of the Department of Veterans Affairs measurement-based care initiative, the PCL-5 is now required to be used by VA-based PTSD Specialty Clinics to track and monitor patient progress in treatment. With the rise of telehealth modalities in response to the COVID pandemic, clinicians have turned to remote, asynchronous assessment (i.e., assessments completed without the provider present through remote platforms) as a means to provide best care to virtual patients and reduce time burden on providers. We review the psychometric properties of the PCL-5 along with relevant criticisms of the measure to provide recommendations for its optimal use through remote, asynchronous means. We also explore considerations for using remote, asynchronous assessment to assist with measurement-based care more broadly. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38032650 | DOI:10.1037/ser0000824

JAMA Netw Open. 2023 Nov 1;6(11):e2344136. doi: 10.1001/jamanetworkopen.2023.44136.

ABSTRACT

IMPORTANCE: There is an urgent unmet need for a treatment addressing the core symptoms and associated maladaptive symptoms of autism spectrum disorder (ASD), especially in preschool populations.

OBJECTIVES: To evaluate whether treatment of children with ASD aged 3 to 6 years treated with high-protease pancreatic therapy produces long- and short-term improvements in autism-associated maladaptive behaviors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study at 32 sites across the US used a double-blind parallel group, delayed-start design comprising a 2-week blinded placebo run-in, and a double-blind, randomized, placebo-controlled segment (12 weeks). Children were recruited into the study in 2015, with data collection continuing until 2021. The analyses were completed from June 2021 to February 2022.

INTERVENTIONS: All participants were randomly assigned to receive either 900 mg high-protease pancreatic replacement therapy or placebo with food 3 times a day for 12 weeks, followed by all receiving 900 mg high-protease pancreatic replacement therapy for 24 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was the irritability/agitation subscale of the Aberrant Behavior Checklist (ABC-I). All potential participants were screened using the Social Communication Questionnaire (SCQ) with diagnosis confirmed by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) for ASD and the Autism Diagnostic Inventory-Revised (ADI-R). Outcomes were measured at the conclusion of the 12-week double-blind segment and at the conclusion of the 24-week open-label segment (total 36 weeks).

RESULTS: A total of 190 participants (150 male [79%]), aged 3 to 6 (mean [SD] age, 4.5 [0.8]) years were randomized. Mixed model for repeated measures analysis performed on ABC-I demonstrated statistically significant differences of -2.49 (95% CI, -4.66 to -0.32; Cohen d = 0.364; P = .03) at the 12-week timepoint and -3.07 (95% CI, -5.81 to -0.33; Cohen d = 0.516; P = .03) at 36-week timepoint. No convergence was noted. Our high-protease pancreatic replacement (CM-AT) was well tolerated with no emergent safety concerns or related serious adverse events noted.

CONCLUSIONS AND RELEVANCE: This cohort study of preschool children sustained cumulative reduction in the maladaptive behavior of irritability in autism. This delayed-start analysis, used to demonstrate disease and condition modification, may prove to be an important tool to evaluate treatments for ASD.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02410902 and NCT02649959.

PMID:38032645 | DOI:10.1001/jamanetworkopen.2023.44136

JAMA Netw Open. 2023 Nov 1;6(11):e2344469. doi: 10.1001/jamanetworkopen.2023.44469.

ABSTRACT

IMPORTANCE: Good-quality parent-infant interactions have protective effects on infant socio-emotional and behavioral development. These interactions are especially critical for very preterm infants at risk of vulnerabilities related to immaturity. Skin-to-skin contact (SSC) has been found to improve mother-preterm infant interaction behaviors, but few studies exist regarding its benefits when initiated immediately after birth.

OBJECTIVE: To determine the effect of immediate SSC at birth for very preterm infants on mother-infant interaction quality at 4 months of corrected age.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis used data from the Immediate Parent-Infant Skin-to-Skin Study (IPISTOSS), a randomized clinical trial conducted between April 1, 2018, and June 30, 2021, at 3 neonatal units in Sweden and Norway. Participants included very preterm infants (28-33 gestational weeks of age) and their parents. Four-month follow-up was concluded in December 2021. Data analyses were performed on March 16 and September 18, 2023.

INTERVENTION: Infants were allocated to standard incubator care or SSC with either parent initiated at birth and continued throughout the first 6 hours after birth.

MAIN OUTCOMES AND MEASURES: The primary outcome was mother-infant interaction quality as measured with the Parent-Child Early Relational Assessment (PCERA), based on video recordings of a 5-minute free-play situation with mother-infant dyads at 4 months of corrected age. A multilevel regression analysis was performed.

RESULTS: This analysis included 71 infants (31 twins [44%]) and 56 mothers. Infants had a mean (SD) gestational age of 31 weeks 3 (1.3) days, and more than half were male (42 [59%]); mothers had a mean (SD) age of 32 (4.9) years. There were 37 infants allocated to standard care and 34 to SSC with either parent after birth. During the first 6 hours after birth, fathers provided more SSC than mothers, with a median (IQR) of 3.25 (2.25-4.5) and 0.75 (0-2.5) hours, respectively. A statistically significant difference in 1 of 5 PCERA subscales (subscale 3: infant positive affect, communicative and social skills) was observed, with higher-quality mother-infant interaction in the SSC group at 4 months (Cohen d = 0.67 [95% CI, 0.17 to 1.17]; P = .01). This effect remained significant when adjusting for primiparity, child sex, and observation setting.

CONCLUSIONS AND RELEVANCE: In this study of the effect of immediate parent-infant SSC after very preterm birth, SSC was beneficial for the mother-infant relationship. These findings suggest that immediate SSC should be supported in the clinical setting.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03521310.

PMID:38032643 | DOI:10.1001/jamanetworkopen.2023.44469

JAMA Netw Open. 2023 Nov 1;6(11):e2345138. doi: 10.1001/jamanetworkopen.2023.45138.

ABSTRACT

IMPORTANCE: Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple, low-cost, and well-tolerated option, but further studies are needed to establish its efficacy and safety.

OBJECTIVE: To estimate the efficacy and safety of auricular acupuncture as a treatment for depression.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at 4 university research centers in Brazil, from March to July 2023. Eligible patients were adults aged 18 to 50 years whose score on the Patient Health Questionnaire-9 (PHQ-9) indicated moderate depression (score 10-14) or moderately severe depression (score 15-19). Exclusion criteria included previous application of AA, risk of suicidal ideation, or severe depression (PHQ-9 score >20). An intent-to-treat analysis and modified intent-to-treat analysis were conducted.

INTERVENTION: Participants were randomized into 2 treatment groups, which included specific AA (SA) and nonspecific AA (NSA). Both groups received 12 sessions of AA with semipermanent needles with daily stimulation twice a week over 6 weeks and were followed-up for 3 months. All participants continued with their usual care for ethical reasons. The SA group’s treatment protocol consisted of 6 acupuncture points on the auricular pavilion chosen according to the diagnosis of depression by traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver, and kidney). The NSA group’s acupuncture points were the external ear, the cheek and face area, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm which areas had neuroreactive points.

MAIN OUTCOMES AND MEASURES: The primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months. Secondary outcomes included depression recovery at 4 and 6 weeks; depression remission (PHQ-9 score < 5) at 4 weeks, 6 weeks, and 3 months); and adverse events.

RESULTS: A total of 304 participants were screened, and 74 participants (62 women [84%]; median [IQR] age, 29 [23-27] years) were included in the intention-to-treat analysis, with 37 participants randomized to each group (SA and NSA). A total of 47 participants (64%) were followed-up through 3 months. The results showed no statistically significant difference in depressive recovery between the groups at 3 months (14 of 24 participants in the SA group [58%] vs 10 of 23 participants in the NSA group [43%]; risk ratio [RR], 1.34; 95% CI, 0.76-2.45; P = .38). The proportions of depression recovery and remission at 4 and 6 weeks based on the PHQ-9 were higher in the SA group (except for depression recovery at 6 weeks) with no statistically significant differences. However, a statistically significant difference was observed in symptom remission at 3 months (11 of 24 participants in the SA group [46%] vs 3 of 23 participants in the NSA group [13%]; RR, 1.99; 95% CI, 1.16-3.34; P = .02) in favor of SA. There were no significant differences in adverse event rates between the groups, evidencing the intervention’s safety. Most participants reported mild pain at the needle application site (33 patients [94%] in the SA group vs 32 patients [91%] in the NSA group). Five participants dropped out of the study due to adverse events.

CONCLUSIONS AND RELEVANCE: The results of this randomized clinical trial suggest that SA over 6 weeks is safe. Although there was no statistically significant difference between groups for the primary efficacy outcome, patients receiving SA did experience greater symptom remission at 3 months. A larger sample size and longer intervention are needed to further evaluate the efficacy of SA for depression.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05855421.

PMID:38032640 | DOI:10.1001/jamanetworkopen.2023.45138

JAMA Netw Open. 2023 Nov 1;6(11):e2345793. doi: 10.1001/jamanetworkopen.2023.45793.

ABSTRACT

IMPORTANCE: The association between attention-deficit/hyperactivity disorder (ADHD) and schizophrenia has received increased attention; however, evidence on the association between psychiatric comorbidities and subsequent schizophrenia in patients with ADHD is limited.

OBJECTIVE: To investigate the risk of being diagnosed with schizophrenia in children and adolescents with ADHD considering the presence of psychiatric comorbidity.

DESIGN, SETTING, AND PARTICIPANTS: This was a population-based, retrospective cohort study using the Health Insurance Review and Assessment claims database from January 1, 2007, to December 31, 2019. Participants were children and adolescents aged 5 to 19 years who received an ADHD diagnosis between January 1, 2010, and December 31, 2018, in the nationwide claims data of Korea. Data were analyzed from January 2010 to December 2019.

INTERVENTIONS OR EXPOSURES: The presence of psychiatric comorbidity was assessed from diagnosis records within 1 year before ADHD diagnosis. Comorbidities were further categorized according to the number of comorbidities and specific comorbid disorders.

MAIN OUTCOMES AND MEASURES: Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs, examining the association between psychiatric comorbidities and the risk of being diagnosed with schizophrenia. Furthermore, the occurrence of psychiatric comorbidity during the follow-up period was explored among patients without psychiatric comorbidity at baseline.

RESULTS: A total of 211 705 patients with newly diagnosed ADHD were included. A total of 157 272 patients (74.3%) were male, and the age of 5 to 9 years showed the highest distribution (115 081 patients [54.4%]). Patients with psychiatric comorbidity had a significantly higher risk of being diagnosed with schizophrenia than those without (adjusted HR, 2.14; 95% CI, 2.05-2.23). The association between schizophrenia and psychiatric comorbidity became progressively greater with the increasing number of comorbidities. Several individual psychiatric disorders showed an association with development of schizophrenia, with ASD, intellectual disability, tic disorder, depression, and bipolar disorder being the top 5 disorders most associated. Furthermore, 3244 patients (73.8%) without psychiatric comorbidities experienced the emergence of other psychiatric disorders before schizophrenia occurrence.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study involving children and adolescents with ADHD, the presence of psychiatric comorbidity in patients with ADHD was associated with an increased risk of being diagnosed with schizophrenia, with an increased risk observed in multiple comorbidities and a wide variety of comorbidities. These findings highlight the significance of assessing and managing psychiatric comorbidities in patients with ADHD to decrease subsequent schizophrenia risk and allow for early intervention.

PMID:38032637 | DOI:10.1001/jamanetworkopen.2023.45793

Psychol Trauma. 2023 Nov 30. doi: 10.1037/tra0001612. Online ahead of print.

ABSTRACT

OBJECTIVE: The dissociative subtype of posttraumatic stress disorder (PTSD) was incorporated into the diagnostic criteria for PTSD in Diagnostic and Statisical Manual of Mental Disorders, Fifth Edition (DSM-5). The subtype requires the presence of persistent or recurrent depersonalization or derealization; however, several authors have suggested that a broader array of dissociative symptoms could be included in the criteria. The objective of the present study was to gather data on a wide range of dissociative symptoms in a sample of highly traumatized individuals.

METHOD: The authors administered a set of measures to 62 inpatients in a private psychiatric inpatient program specializing in PTSD and dissociative disorders.

RESULTS: Almost every participant met International Classification of Diseases, 11th Edition criteria for complex PTSD, DSM-5 criteria for the dissociative subtype of PTSD, and DSM-5 criteria for dissociative identity disorder or other specified dissociative disorder; these four diagnoses seem to identify largely the same patients and may not be separate disorders.

CONCLUSIONS: A broad range of dissociative symptoms was endorsed on the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule. The results support a recommendation that a broad array of symptoms be included in the criteria for the dissociative subtype of PTSD in future editions of the Diagnostic and Statistical Manual of Mental Disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38032629 | DOI:10.1037/tra0001612

J Consult Clin Psychol. 2023 Dec;91(12):694-707. doi: 10.1037/ccp0000846.

ABSTRACT

OBJECTIVE: Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico.

METHOD: 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions.

RESULTS: Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results.

CONCLUSIONS: Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38032621 | DOI:10.1037/ccp0000846

Health Psychol. 2023 Nov 30. doi: 10.1037/hea0001338. Online ahead of print.

ABSTRACT

OBJECTIVE: Technology is changing the way individuals socially connect. However, not much is known about how online forms of social exchanges might link to outcomes that predict longevity. This preregistered study examined the association between online social support and social negativity with self-rated health (SRH) and potential pathways responsible for such links.

METHOD: In this preregistered analysis, a sample of 1,356 U.S. residents was recruited based on the U.S. Census track. Participants were at least 18-year-old social media users and completed the study online. Well-validated measures of online social support, online social negativity, general offline perceived support, internet addiction, social anxiety, and SRH were obtained.

RESULTS: Main results indicate that both online social support and social negativity were related to better SRH. However, the association between social negativity and better SRH was due to its statistical overlap with online social support. The association between online social support and SRH was primarily mediated by offline social support.

CONCLUSIONS: These results highlight the importance of considering how positive and negative online social interactions are related to health outcomes. It also highlights potential pathways that might be targeted for interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38032612 | DOI:10.1037/hea0001338