Tag: pubmed

Gut Liver. 2023 Oct 6. doi: 10.5009/gnl230094. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett’s esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE.

METHODS: A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics.

RESULTS: A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC.

CONCLUSIONS: High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.

PMID:37800316 | DOI:10.5009/gnl230094

J Int Neuropsychol Soc. 2023 Oct 6:1-10. doi: 10.1017/S1355617723000620. Online ahead of print.

ABSTRACT

OBJECTIVE: The Cognitive Change Index (CCI-20) is a validated questionnaire that assesses subjective cognitive complaints (SCCs) across memory, language, and executive domains. We aimed to: (a) examine the internal consistency and construct validity of the CCI-20 in patients with movement disorders and (b) learn how the CCI-20 corresponds to objective neuropsychological and mood performance in individuals with Parkinson’s disease (PD) or essential tremor (ET) seeking deep brain stimulation (DBS).

METHODS: 216 participants (N = 149 PD; N = 67 ET) underwent neuropsychological evaluation and received the CCI-20. The proposed domains of the CCI-20 were examined via confirmatory (CFA) and exploratory (EFA) factor analyses. Hierarchical regressions were used to assess the relationship among subjective cognitive complaints, neuropsychological performance and mood symptoms.

RESULTS: PD and ET groups were similar across neuropsychological, mood, and CCI-20 scores and were combined into one group who was well educated (m = 15.01 ± 2.92), in their mid-60’s (m = 67.72 ± 9.33), predominantly male (63%), and non-Hispanic White (93.6%). Previously proposed 3-domain CCI-20 model failed to achieve adequate fit. Subsequent EFA revealed two CCI-20 factors: memory and non-memory (p < 0.001; CFI = 0.924). Regressions indicated apathy and depressive symptoms were associated with greater memory and total cognitive complaints, while poor executive function and anxiety were associated with more non-memory complaints.

CONCLUSION: Two distinct dimensions were identified in the CCI-20: memory and non-memory complaints. Non-memory complaints were indicative of worse executive function, consistent with PD and ET cognitive profiles. Mood significantly contributed to all CCI-20 dimensions. Future studies should explore the utility of SCCs in predicting cognitive decline in these populations.

PMID:37800314 | DOI:10.1017/S1355617723000620

J Int Neuropsychol Soc. 2023 Oct 6:1-11. doi: 10.1017/S1355617723000619. Online ahead of print.

ABSTRACT

OBJECTIVE: The INECO Frontal Screening (IFS) and the Frontal Assessment Battery (FAB) are executive dysfunction (ED) screening tools that can distinguish patients with neurodegenerative disorders from healthy controls and, to some extent, between dementia subtypes. This paper aims to examine the suitability of these tests in assessing early-onset cognitive impairment and dementia patients.

METHOD: In a memory clinic patient cohort (age mean = 57.4 years) with symptom onset at ≤65 years, we analyzed the IFS and the FAB results of four groups: early-onset dementia (EOD, n = 49), mild cognitive impairment due to neurological causes (MCI-n, n = 34), MCI due to other causes such as depression (MCI-o, n = 99) and subjective cognitive decline (SCD, n = 14). Data were gathered at baseline and at 6 and 12 months. We also studied the tests’ accuracy in distinguishing EOD from SCD patients and ED patients from those with intact executive functioning. Correlations with neuropsychological measures were also studied.

RESULTS: The EOD group had significantly (p < .05) lower IFS and FAB total scores than the MCI-o and SCD groups. Compared with the FAB, the IFS showed more statistically significant (p < .05) differences between diagnostic groups, greater accuracy (IFS AUC = .80, FAB AUC = .75, p = .036) in detecting ED and marginally stronger correlations with neuropsychological measures. We found no statistically significant differences in the EOD group scores from baseline up to 6- or 12-months follow-up.

CONCLUSIONS: While both tests can detect EOD among memory clinic patients, the IFS may be more reliable in detecting ED than the FAB.

PMID:37800312 | DOI:10.1017/S1355617723000619

Pediatrics. 2023 Oct 6:e2023062011. doi: 10.1542/peds.2023-062011. Online ahead of print.

ABSTRACT

BACKGROUND: Reducing child mortality in low-income countries is constrained by a lack of vital statistics. In the absence of such data, verbal autopsies provide an acceptable method to determining attributable causes of death. The objective was to assess potential causes of pediatric postdischarge mortality in children younger than age 5 years (under-5) originally admitted for suspected sepsis using verbal autopsies.

METHODS: Secondary analysis of verbal autopsy data from children admitted to 6 hospitals across Uganda from July 2017 to March 2020. Structured verbal autopsy interviews were conducted for all deaths within 6 months after discharge. Two physicians independently classified a primary cause of death, up to 4 alternative causes, and up to 5 contributing conditions using the Start-Up Mortality List, with discordance resolved by consensus.

RESULTS: Verbal autopsies were completed for 361 (98.6%) of the 366 (5.9%) children who died among 6191 discharges (median admission age: 5.4 months [interquartile range, 1.8-16.7]; median time to mortality: 28 days [interquartile range, 9-74]). Most deaths (62.3%) occurred in the community. Leading primary causes of death, assigned in 356 (98.6%) of cases, were pneumonia (26.2%), sepsis (22.1%), malaria (8.5%), and diarrhea (7.9%). Common contributors to death were malnutrition (50.5%) and anemia (25.7%). Reviewers were less confident in their causes of death for neonates than older children (P < .05).

CONCLUSIONS: Postdischarge mortality frequently occurred in the community in children admitted for suspected sepsis in Uganda. Analyses of the probable causes for these deaths using verbal autopsies suggest potential areas for interventions, focused on early detection of infections, as well as prevention and treatment of underlying contributors such as malnutrition and anemia.

PMID:37800272 | DOI:10.1542/peds.2023-062011

Psychiatr Danub. 2023 Oct;35(Suppl 2):423-431.

ABSTRACT

BACKGROUND: The role of nutrition in treating clinical depression has been widely discussed. Unhealthy lifestyle patterns, like lack of physical activity, junk food consumption, and irregular sleep patterns are common in depressed patients. Considering the mental and physical side-effects, the daily nutrition of these patients seems to be a plausible option for reducing depressive symptoms and enhancing treatment results.

METHODS: A PubMed search was done for meta-analyses published from January 2018 to June 2023 with the query: (diet) AND (psychiatric disorder) AND (depression). We selected meta-analyses that met specific criteria like including the entire diet or specific diet patterns and having depression or depressive symptoms as a primary or secondary outcome.

RESULTS: Out of 28 papers found, the 9 meta-analyses, selected for review, revealed different types of correlation between dietary patterns and the symptoms of depression and anxiety. Healthy diets were associated with higher intake of fruits, vegetables, nuts, and lower intake of pro-inflammatory food items like processed meats and trans fats. Adherence to such diets showed a negative association with incident depression in cross-sectional and longitudinal studies. A diet mostly including ultra-processed foods was associated with higher odds of depressive and anxiety symptoms. Women were found to be more susceptible than men both in developing the depressive symptoms with unhealthy diet and in reducing the symptoms of depression and anxiety with improvement of diet quality. Statistically significant improvement in symptoms of depression and anxiety in both sexes was observed in study groups assigned for individual consultations of a dietician and a psychotherapist when compared with group sessions or general recommendations.

CONCLUSIONS: Research on the correlation of healthy dietary patterns and symptoms of depression and anxiety has mainly focused on non-clinical populations. The evidence supports an inverse association between healthy eating habits and symptoms of depression. Further research should be encouraged on the eating habits of clinically depressed individuals and the underlying physiological mechanisms of uncontrolled food intake.

PMID:37800271

Psychiatr Danub. 2023 Oct;35(Suppl 2):364-369.

ABSTRACT

BACKGROUND: School attendance problems have an impact on the social, academic, and professional development of young people. School refusal and truancy are described as school attendance problems. Clarifying the developmental trajectory of school refusal would allow a better understanding of the phenomenon including earlier detection and improved management. Following a dimensional model, we can consider school refusal as an internalizing problem and truancy as an externalizing problem implying the existence of different risk factor profiles.

SUBJECT AND METHOD: We conducted a retrospective study on four groups of child and adolescent inpatients (school refusal (SR), truancy (TR), behavior disorder without deschooling (BD), and eating disorder (ED). Each subject was included in one of the groups based on a checklist criterion and the diagnoses made at the end of hospitalization. We then compared groups with descriptive statistics (Chi^² and Fisher’s exact test) to highlight the developmental trajectory and the possible risk factors profile in SR.

RESULTS: Delayed language development, attachment disorder, attentional deficit and hyperactivity disorder, physical abuse, and substance abuse were predominantly reported in BD and TR. Learning disorders were mostly present in BD, TR, and SR. Family interactions were more violent and aggressive in BD and TR than in ED and SR. We observed more violent and conflictual relationships with peers in BD and TR. In SR, subjects seemed to experiment with more isolation and rejection. Behavioral disorder non-specified, ODD, and CD seemed more frequent in BD and TR. We found anxiety disorder and mood disorders more frequently in the SR group.

CONCLUSION: Inpatients with severe SR are characterized by internalizing problems and difficulties in emotional dysregulation and problems socializing with peers. Inpatients with BD and TR were associated with externalizing problems and difficulties in behavioral regulation skills.

PMID:37800257

Psychiatr Danub. 2023 Oct;35(Suppl 2):353-358.

ABSTRACT

Empathy is the complex prosocial cognitive capacity to recognize and react to the emotions of others. An empathic attitude from medical doctors is essential to build a good relationship with patients. In engineering education there is an hypervalorization of technical skills in disadvantage of these affective elements. Psychopathy is the lack of considerations toward others. These two important personality traits shape social interactions. In this study we analyzed, through the network theory, these characteristics in a young population of medical and engineering university students in Belgium. The aim of this study was therefore to estimate the individual network structure of these traits in both groups, as well as estimate whether there is a fundamental difference in the way that these traits connect in these two populations. Medical and engineering students completed online three self-report questionnaires about empathy and psychopathy traits. There were 178 responders without exclusions due outliers. No significant differences were found in psychopathic traits between the two groups. There was a statistically significant difference in empathic concerns, the medical students being more empathic than their peers in engineering. Psychopathic traits did not vary significantly between the two groups. This study provided insights into the differences in empathic and psychopathic traits among those students. Future research should explore the factors that contribute to these differences and investigate the potential impact of targeted interventions or curricular modifications in cultivating empathy and minimizing antisocial behaviors in both fields.

PMID:37800255

Psychiatr Danub. 2023 Oct;35(Suppl 2):347-352.

ABSTRACT

BACKGROUND: Stigmatization of morbidity in health care workers, the incidence of disease, the disease that interferes with the disease of medical care. Social distancing by clinicians is an integral part of the stigmatization that depends on the behavior of the patient and the level of awareness of the clinician.

METHODS: The modified Bogardus Social Distance Self-Assessment Scale (BSDS) was used to evaluate the indicators of social distance phenomena. The assessment was performed by clinicians for the following groups of patients with the following mental disorders: alcohol use disorder, bipolar disorder, depression, drug addiction, epilepsy, mental retardation, schizophrenia. All statistical calculations were performed using IBM SPSS-27 software (IBM Corp. 2021, licensed to Samara State Medical University). P-value ≤ 0.05 was determined as significant for the between-group (PSY vs NPHP) comparisons using a nonparametric Wilcoxon test.

RESULTS: The study included 141 clinicians: PSY (n=20; 36.2±4.2 y.o.) and NPHP (n=121; 25.9±2.2 y.o.). The NPHP group included general practitioners (GP)/physicians (n=29; 20.6%), surgeons (n=19; 13.5%), obstetrician-gynecologists (n=26; 18.4%), neurologists (n=11; 7.8%), pediatricians (n=6; 4.3%), and other subspecialists (including urologists, tuberculosis specialists, ophthalmologists, and dermatologists) (n=30; 21.3%). The study included 141 students at the Samara State Medical University who were trained in psychiatry. An anonymous survey was conducted on the BSDS scale before and after training. Our analysis of the data showed that the social distance of clinicians in terms of coverage reaches different values depending on the mental disorder, but with common trends both before and after the psychiatry training course. Mean (SD) social distance scores recurred from 2.8 (1.3) for bipolar disorder to 5.3 (1.5) for addiction in the predevelopment group and 2.9 (1.3), 5.4 (1.4) in the group of clinicians after training, respectively.

CONCLUSIONS: Social distancing scores among clinicians in contemporary Russia were highest for drug addicts, and lowest for depression and bipolar disorder. Stigmatization among clinicians appears to affect the delivery of care to certain categories of patients, which requires further study. Higher social distance scores in patients with drug addiction may be associated with higher stigma and lack of compassion towards these patients. Conversely, lower rates of social distancing and the corresponding emotional acceptance of people with depression and bipolar disorder by clinicians may interfere with timely diagnosis and the availability of appropriate early, treatable care. The awareness of clinicians regarding psychopathological manifestations does not affect the level of social distance, but increases it in relation to mentally healthy individuals with normal behavior.

PMID:37800254

Psychiatr Danub. 2023 Oct;35(Suppl 2):302-307.

ABSTRACT

BACKGROUND: Subjects suffering from psychiatric disorders are frequently hospitalized due to medical comorbidities. In the present study, we analyzed consultation-liaison psychiatry (CLP) activity in a General Hospital, describing the sociodemographic, diagnostic, and therapeutic characteristics of the evaluated subjects, as well as reasons for consultation requests.

SUBJECTS AND METHODS: Data concerning psychiatric consultation performed at the Perugia General Hospital during a 1-year period (01/06/2022-20/06/2023) were collected and analyzed by means of descriptive statistics.

RESULTS: A total of 707 psychiatric consultations were performed. The primary reason that led to psychiatric consultations was psychomotor agitation. 85 (18.5%) patients attempted suicide; the most frequent modality was the assumption of drugs at non-therapeutic doses. The 72% of the sample (n=509) presented a clear-cut medical comorbidity. In most cases, subjects were referred to Community Mental Health and Addiction services (n=22, 32.4%).

CONCLUSIONS: CLP plays a crucial role in the perspective of the overall well-being of hospitalized subjects, but also for the overall management of complex cases. Despite this, a homogeneous approach with standardized guidelines is needed in this field.

PMID:37800245

Psychiatr Danub. 2023 Oct;35(Suppl 2):287-291.

ABSTRACT

The COVID-19 pandemic has left emotional consequences for healthcare workers. Dramatic results are obtained on compassion fatigue, burnout, and hopelessness in healthcare workers (HCWs) of older adults with Alzheimer’s disease. Our study evaluated differences in these factors during and after the pandemic in 48 HCWs. The results showed a statistically significant difference in the Satisfaction of Compassion (P=0.014; during vs post-pandemic) and in the subscale of Secondary Trauma (P=0.005) and Burnout (P=0.49) in CFSS. The results were not statistically significant on the BHS scale (P=0.285). However, hopelessness was found in a higher percentage of HCWs at the end of the pandemic than during the pandemic period (respectively: 35.67% vs 31.67%).

PMID:37800242