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Journal of Pediatric Urology Oct 2023Virtual medicine has the potential to improve access for underserved populations by facilitating timely remote evaluation. However, challenges in the real-world...
BACKGROUND
Virtual medicine has the potential to improve access for underserved populations by facilitating timely remote evaluation. However, challenges in the real-world implementation of this technology may paradoxically exacerbate health disparities. We sought to characterize families' digital access and how social determinants of health may impact virtual medicine access within pediatric urology. We hypothesized that disadvantaged socioeconomic status would be a barrier to virtual medicine access.
STUDY DESIGN
A digital access screening tool was prospectively developed and launched in July 2021. Schedulers are prompted to complete this optional screening questionnaire at the time of patient intake, for video or in-person encounters. The parent is screened for access to a device and reliable internet or cellular data that could be used to participate in a video visit. These represented the primary study outcomes. A modality preference for an in-person visit, video visit, or no preference was also recorded. Patient demographics were retrospectively evaluated, and socioeconomic status was estimated using the Distressed Communities Index generated for each patient's zip code. For each zip code, the Distressed Communities Index produces a normalized, comparative distress score ranging from 0 ("prosperous") to 100 ("distressed").
RESULTS
3885 patients were included, with median age of 5 years (IQR 1-11). Almost 74% were male, 71.3% were White, 20.9% had public insurance, and 2.9% required an interpreter. The median distress score was 14.2 (IQR 7.2-27.5). Screening revealed that 136 families (3.5%) lacked digital access. On multivariable logistic regression analysis, insurance type (p = 0.0020) and distress score (p = 0.0125) were significant predictors of digital access (Summary Table). Those patients who lacked access to a device (p < 0.0001) or reliable internet/cellular data (p < 0.0001) were more likely to prefer an in-person visit.
DISCUSSION
Family screening revealed that there is a small but significant proportion of families who lack digital access, and this cohort disproportionately represents underserved communities with higher distress scores, likely reflecting lower socioeconomic status. Those families without digital access were more likely to prefer an in-person visit. Improved identification of these socially complex "at-risk" patients can assist in the development of more inclusive health care strategies.
CONCLUSIONS
Despite the chance for virtual medicine to expand access for underserved populations, lack of digital tools may hinder its potential impact on health disparities in pediatric urology. Ongoing digital access screening and further studies are needed to design interventions tailored to the specific needs of our patients, allowing for more equitable pediatric urological care.
Topics: Child; Humans; Male; Infant; Child, Preschool; Female; Retrospective Studies; Urology; Telemedicine
PubMed: 37121815
DOI: 10.1016/j.jpurol.2023.04.007 -
Journal of Reproductive and Infant... Sep 2023Perinatal obsessive-compulsive disorder (POCD) is characterised by the presence of intrusive thoughts resulting in significant distress and urges to execute repeated...
INTRODUCTION
Perinatal obsessive-compulsive disorder (POCD) is characterised by the presence of intrusive thoughts resulting in significant distress and urges to execute repeated behaviours occurring in the perinatal period. POCD is largely understudied and existing literature has mostly studied POCD quantitatively.
OBJECTIVE
This qualitative study explores the experiences of 10 mothers randomly selected from a larger sample (N = 251; 86.8% White) who met high risk criteria based on the Postnatal Obsessive-Compulsive Scale (POCS≥16). These mothers were interviewed about their experiences with POCD retrospectively.
RESULTS
Qualitative analysis of the interviews (n = 10) revealed three main themes regarding women's experiences with POCD: 1) obsessions (i.e. safety, cleanliness), 2) compulsions (i.e. excessive checking for safety, excessive cleaning, researching information online), and 3) other emotional experiences (i.e. fear, panic, anxiety, suicidal ideation, guilt, shame, irritability/anger).
CONCLUSION
Mothers at high risk for POCD report obsessions and compulsions as well as other emotional experiences that are distressing, demonstrating the enduring impact of POCD beyond the perinatal period.
Topics: Pregnancy; Humans; Female; Mothers; Retrospective Studies; Obsessive-Compulsive Disorder; Anxiety; Anxiety Disorders
PubMed: 34894885
DOI: 10.1080/02646838.2021.2013457 -
NEJM Evidence Nov 2023Chronic kidney disease-associated pruritus (CKD-aP), formerly termed uremic pruritus, is a severely distressing condition that is common (60% of patients on dialysis)...
Chronic kidney disease-associated pruritus (CKD-aP), formerly termed uremic pruritus, is a severely distressing condition that is common (60% of patients on dialysis) and frequently underdiagnosed and untreated. The pruritus can be severe enough to diminish sleep and is associated with worse mortality rates, as demonstrated in several large studies. It can also occur in nondialysis patients with stage 3 to 5 CKD, with an increasing prevalence in patients with worsening kidney function, age, and medical comorbidities. The pathophysiology likely involves many factors and molecules..
Topics: Humans; Renal Insufficiency, Chronic; Renal Dialysis; Comorbidity; Pruritus; Prevalence
PubMed: 38320532
DOI: 10.1056/EVIDe2300227 -
The International Tinnitus Journal Dec 2023Tinnitus is the perception of sound when no external objective noise is present. It is not defined as an illness, but rather a symptom of an underlying process. Although... (Review)
Review
INTRODUCTION
Tinnitus is the perception of sound when no external objective noise is present. It is not defined as an illness, but rather a symptom of an underlying process. Although it is a widely prevalent and distressing otologic issue, its pathological mechanism is not entirely known.
AIM
The present paper aims to discover if tinnitus characteristics can guide us in the diagnosis of the pathology that produces it.
METHODS
This paper uses literature review approach from various publications, including PubMed and The International Tinnitus Journal which include discussed elements related to classification of tinnitus, characteristics of tinnitus, aetiology of different types of tinnitus, and patient's description of tinnitus. The study was conducted between December 2021 and June 2022 and included publications dated from 1992 until 2022. The focus was on the characteristics of tinnitus and their capability to guide the diagnosis process.
RESULTS
30 publications were found suitable for this research and described the proper characteristics of tinnitus and their significance in the diagnosis process.
CONCLUSION
The characteristics of tinnitus do not have the ability to firmly diagnose the pathology which determines tinnitus, yet it may guide the diagnosis.
Topics: Humans; Noise; Sound; Tinnitus
PubMed: 38050884
DOI: 10.5935/0946-5448.20230008 -
Nature Reviews. Neuroscience Apr 2024Expressions such as 'sleep on it' refer to the resolution of distressing experiences across a night of sound sleep. Sleep is an active state during which the brain... (Review)
Review
Expressions such as 'sleep on it' refer to the resolution of distressing experiences across a night of sound sleep. Sleep is an active state during which the brain reorganizes the synaptic connections that form memories. This Perspective proposes a model of how sleep modifies emotional memory traces. Sleep-dependent reorganization occurs through neurophysiological events in neurochemical contexts that determine the fates of synapses to grow, to survive or to be pruned. We discuss how low levels of acetylcholine during non-rapid eye movement sleep and low levels of noradrenaline during rapid eye movement sleep provide a unique window of opportunity for plasticity in neuronal representations of emotional memories that resolves the associated distress. We integrate sleep-facilitated adaptation over three levels: experience and behaviour, neuronal circuits, and synaptic events. The model generates testable hypotheses for how failed sleep-dependent adaptation to emotional distress is key to mental disorders, notably disorders of anxiety, depression and post-traumatic stress with the common aetiology of insomnia.
Topics: Humans; Memory; Emotions; Brain; Sleep; Psychological Distress; Neuronal Plasticity
PubMed: 38443627
DOI: 10.1038/s41583-024-00799-w -
Journal of Cardiopulmonary... Sep 2023Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI), particularly in younger women without classic... (Comparative Study)
Comparative Study
PURPOSE
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI), particularly in younger women without classic cardiac risk factors. Spontaneous coronary artery dissection is considered to be particularly stressful; however, few studies have quantified SCAD survivor stress levels. This study compared anxiety, depression, and distress levels in SCAD and non-SCAD AMI patients.
METHOD
A sample of 162 AMI (35 [22%] SCAD) patients was recruited from hospitals and via social media, in Australia and the United States. All had had their AMI in the past 6 mo. Participants completed an online questionnaire comprising the Generalized Anxiety Disorder-2 (GAD2), Patient Health Questionnaire-2 (PHQ2), Kessler-6 (K6), and Cardiac Distress Inventory (CDI). T-tests, χ 2 tests, Mann-Whitney tests, and analysis of covariance were used to compare SCAD and non-SCAD samples. Logistic regression was used to identify the unique predictors of anxiety, depression, and distress, controlling for relevant confounders.
RESULTS
Patients with SCAD were more commonly female and significantly younger than non-SCAD patients. Patients with SCAD scored significantly higher on the GAD2, PHQ2, K6, and CDI and a significantly larger proportion was classified as anxious, depressed, or distressed using these instruments. In logistic regression, together with mental health history, having had a SCAD-AMI predicted anxiety, depression, and distress, after controlling for female sex, younger age, and other confounding variables.
CONCLUSION
This study supports the view that anxiety, depression, and distress are more common after SCAD-AMI than after traditional AMI. These findings highlight the psychosocial impacts of SCAD and suggest that psychological support should be an important component of cardiac rehabilitation for these patients.
Topics: Aged; Female; Humans; Male; Middle Aged; Anxiety Disorders; Depression; Myocardial Infarction; Prevalence; Psychological Distress
PubMed: 36892564
DOI: 10.1097/HCR.0000000000000782 -
Children (Basel, Switzerland) Oct 2023The COVID-19 pandemic had a widespread impact on families with dependent children. To better understand the impact of the pandemic on families' health and relationships,...
BACKGROUND
The COVID-19 pandemic had a widespread impact on families with dependent children. To better understand the impact of the pandemic on families' health and relationships, we examined the association between mothers' and children's mental distress and family strain.
METHODS
Three waves of the COVID-19 Impact Survey were analyzed, collected from a subsample of mother-child pairs ( = 157) from the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort in Alberta, Canada. Latent class analyses were performed to determine patterns and group memberships in mothers' and children's mental distress and family strain. Multivariable logistic regression models were conducted to test associations between mothers' and children's mental distress and family strain trajectory classes.
RESULTS
Mothers with medium/high levels of mental distress were at increased odds of experiencing high family strain compared to those with low levels of distress (medium aOR = 3.90 [95% CI: 1.08-14.03]; high aOR = 4.57 [95% CI: 1.03-20.25]). The association between children's mental distress and family strain was not significant (aOR = 1.75 [95% CI: 0.56-5.20]).
CONCLUSION
Mothers' mental distress, but not children's, was associated with family strain during the pandemic. More distressed individuals experienced greater family strain over time, suggesting that this association may become a chronic problem.
PubMed: 38002816
DOI: 10.3390/children10111725 -
Orphanet Journal of Rare Diseases Aug 2023Itch is common and distressing in epidermolysis bullosa (EB) but has not previously been studied in depth in different recessive dystrophic EB (RDEB) subtypes.
BACKGROUND
Itch is common and distressing in epidermolysis bullosa (EB) but has not previously been studied in depth in different recessive dystrophic EB (RDEB) subtypes.
OBJECTIVES
As part of a prospective register study of the natural history of RDEB we explored features of itch, medications used, and correlation with disease severity and quality of life.
METHODS
Fifty individuals with RDEB aged 8 years and above completed the Leuven Itch Scale (LIS) (total 243 reviews over a 7-year period). Data included itch frequency, severity, duration, distress, circumstances, consequences, itch surface area and medications for itch. The iscorEB disease severity score and the validated EB quality of life tool, QOLEB, were compared to LIS domains and analysed by RDEB subtype.
RESULTS
Itch was frequent, present in the preceding month in 93% of reviews. Itch severity and distress were significantly greater in severe (RDEB-S) and pruriginosa (RDEB-Pru) subtypes compared to intermediate RDEB (RDEB-I). Itch medications were reported in just over half of reviews including emollients, topical corticosteroids and antihistamines; the proportion of participants not using medication despite frequent pruritus suggests limited efficacy. In inversa RDEB (RDEB-Inv) and RDEB-I, LIS domains correlated with iscorEB and QOLEB. In contrast to previous studies, correlations were lacking in RDEB-S suggesting that global disease burden relatively reduces the contribution of itch.
CONCLUSIONS
This comprehensive study of RDEB-associated itch highlights differences between RDEB subtypes, suggests an unmet need for effective treatments and could serve as control data for future clinical trials incorporating itch as an endpoint.
Topics: Humans; Epidermolysis Bullosa Dystrophica; Quality of Life; Epidermolysis Bullosa; Pruritus; Prospective Studies
PubMed: 37559055
DOI: 10.1186/s13023-023-02817-z -
Comprehensive Reviews in Food Science... Nov 2023The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not... (Review)
Review
The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.
Topics: Humans; Thirst; Ice; Sensation; Food; Water
PubMed: 37583300
DOI: 10.1111/1541-4337.13229