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Neurology(R) Neuroimmunology &... Sep 2024Retinal optical coherence tomography (OCT) provides promising prognostic imaging biomarkers for future disease activity in multiple sclerosis (MS). However, raw...
BACKGROUND AND OBJECTIVES
Retinal optical coherence tomography (OCT) provides promising prognostic imaging biomarkers for future disease activity in multiple sclerosis (MS). However, raw OCT-derived measures have multiple dependencies, supporting the need for establishing reference values adjusted for possible confounders. The purpose of this study was to investigate the capacity for age-adjusted scores of OCT-derived measures to prognosticate future disease activity and disability worsening in people with MS (PwMS).
METHODS
We established age-adjusted OCT reference data using generalized additive models for location, scale, and shape for peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GCIP) thicknesses, involving 910 and 423 healthy eyes, respectively. Next, we transformed the retinal layer thickness of PwMS from 3 published studies into age-adjusted scores (pRNFL-z and GCIP-z) based on the reference data. Finally, we investigated the association of pRNFL-z or GCIP-z as predictors with future confirmed disability worsening (Expanded Disability Status Scale score increase) or disease activity (failing of the no evidence of disease activity [NEDA-3] criteria) as outcomes. Cox proportional hazards models or logistic regression analyses were applied according to the original studies. Optimal cutoffs were identified using the Akaike information criterion as well as location with the log-rank and likelihood-ratio tests.
RESULTS
In the first cohort (n = 863), 172 PwMS (24%) had disability worsening over a median observational period of 2.0 (interquartile range [IQR]:1.0-3.0) years. Low pRNFL-z (≤-2.04) were associated with an increased risk of disability worsening (adjusted hazard ratio (aHR) [95% CI] = 2.08 [1.47-2.95], 3.82e). In the second cohort (n = 170), logistic regression analyses revealed that lower pRNFL-z showed a higher likelihood for disability accumulation at the two-year follow-up (reciprocal odds ratio [95% CI] = 1.51[1.06-2.15], = 0.03). In the third cohort (n = 78), 46 PwMS (59%) did not maintain the NEDA-3 status over a median follow-up of 2.0 (IQR: 1.9-2.1) years. PwMS with low GCIP-z (≤-1.03) had a higher risk of showing disease activity (aHR [95% CI] = 2.14 [1.03-4.43], = 0.04). Compared with raw values with arbitrary cutoffs, applying the score approach with optimal cutoffs showed better performance in discrimination and calibration (higher Harrell's concordance index and lower integrated Brier score).
DISCUSSION
In conclusion, our work demonstrated reference cohort-based scores that account for age, a major driver for disease progression in MS, to be a promising approach for creating OCT-derived measures useable across devices and toward individualized prognostication.
Topics: Humans; Female; Male; Tomography, Optical Coherence; Adult; Middle Aged; Disease Progression; Prognosis; Multiple Sclerosis; Retina; Severity of Illness Index
PubMed: 38941572
DOI: 10.1212/NXI.0000000000200269 -
The American Journal of Drug and... Jun 2024Medications for opioid use disorder (MOUD) reduce risks for overdose among correctional populations. Among other barriers, daily dosing requirements hinder treatment... (Review)
Review
Medications for opioid use disorder (MOUD) reduce risks for overdose among correctional populations. Among other barriers, daily dosing requirements hinder treatment continuity post-release. Extended-release buprenorphine (XR-BUP) may therefore be beneficial. However, limited evidence exists. To conduct a systematic review examining the feasibility and effectiveness of XR-BUP among correctional populations. Searches were carried out in Pubmed, Embase, and PsychINFO in October 2023. Ten studies reporting on feasibility or effectiveness of XR-BUP were included, representing = 819 total individuals (81.6% male). Data were extracted and narratively reported under the following main outcomes: 1) Feasibility; 2) Effectiveness; and 3) Barriers and Facilitators. Studies were heterogeneous. Correctional populations were two times readier to try XR-BUP compared to non-correctional populations. XR-BUP was feasible and safe, with no diversion, overdoses, or deaths; several negative side effects were reported. Compared to other MOUD, XR-BUP significantly reduced drug use, resulted in similar or higher treatment retention rates, fewer re-incarcerations, and was cost-beneficial, with a lower overall monthly/yearly cost. Barriers to XR-BUP, such as side effects and a fear of needles, as well as facilitators, such as a lowered risk of opioid relapse, were also identified. XR-BUP appears to be a feasible and potentially effective alternative treatment option for correctional populations with OUD. XR-BUP may reduce community release-related risks, such as opioid use and overdose risk, as well as barriers to treatment retention. Efforts to expand access to and uptake of XR-BUP among correctional populations are warranted.
PubMed: 38940929
DOI: 10.1080/00952990.2024.2360984 -
Clinical Psychology & Psychotherapy 2024Paranoia is relatively common but can lead to significant distress, impairment and need for care. Digital technologies offer a valuable extension to service provision... (Review)
Review
BACKGROUND
Paranoia is relatively common but can lead to significant distress, impairment and need for care. Digital technologies offer a valuable extension to service provision and are increasingly being integrated into healthcare. This systematic review evaluated feasibility, acceptability, and effectiveness of digitally enhanced psychological assessments and treatments for paranoia across the paranoia continuum (PROSPERO: CRD42023393257).
METHODS
Databases PsychINFO, EMBASE, MEDLINE and Web of Science were searched until 12 June 2023; the Effective Public Health Practice Project (EPHPP) quality assessment tool evaluated studies; and a narrative synthesis was conducted.
RESULTS
Twenty-seven studies met inclusion criteria (n = 3457, 23 assessment and 4 treatment, 2005-2023, most in Europe). Technologies included virtual reality (VR, n = 23), experience sampling methodology (ESM, n = 2), an app (n = 1) and a combination of VR and ESM (n = 1). Assessments involved monitoring paranoia under various virtual conditions or in everyday life. Treatments were generally integrated with Cognitive Behaviour Therapy (CBT), which involved using VR to test out threat beliefs and drop safety behaviours or using an app to support slowing down paranoid thinking. EPHPP ratings were strong (n = 8), moderate (n = 12) and weak (n = 7).
CONCLUSIONS
Digitally enhanced assessments and treatments showed promising acceptability, feasibility and treatment effectiveness. Limitations of studies include small sample sizes, lack of comparison groups and long-term data and limited randomised controlled trials. Results support the potential future integration of VR in the assessment of paranoia and show promise for treatments such as CBT, although further clinical trials are required. Investigation of other technologies is limited.
Topics: Humans; Paranoid Disorders; Cognitive Behavioral Therapy
PubMed: 38940680
DOI: 10.1002/cpp.3019 -
Death Studies Jun 2024For a minority of the bereaved, the loss of a significant other can trigger an overwhelming emotional reaction and impaired functioning across life domains, known as...
For a minority of the bereaved, the loss of a significant other can trigger an overwhelming emotional reaction and impaired functioning across life domains, known as prolonged grief disorder (PGD). Hence, ongoing efforts have been made to refine existing treatments to increase their efficacy and to accommodate the idiosyncrasies of grief reactions. This study presents the results of an open clinical trial of the feasibility and effectiveness of the Meaning in Loss (MIL) protocol in an online format. The brief intervention of 12 to 16 sessions combines constructivist and narrative strategies to explore and work through impediments to meaning reconstruction in loss. The sample included 25 participants diagnosed with PGD who were treated by six therapists. Baseline and post-therapy comparisons showed a significant improvement in all clinical measures (grief symptomatology, depression and general distress) and an increase of meaning making regarding the loss. Meaning making was found to be a prospective mediator of symptomatic improvement in grief across the course of therapy. These findings suggest the effectiveness of the MIL protocol in decreasing grief specific and associated symptomatology and argue for the relevance of further controlled evaluations of its efficacy. Moreover, results confirm previous findings that meaning making is a relevant factor in the evolution of grief reactions, including in the context of psychotherapy.
PubMed: 38940635
DOI: 10.1080/07481187.2024.2370633 -
Movement Disorders Clinical Practice Jun 2024Since the COVID-19 pandemic, movement disorder clinics have seen an increase in patients with an unusual type of tic-like symptoms: young adults with abrupt onset... (Review)
Review
BACKGROUND
Since the COVID-19 pandemic, movement disorder clinics have seen an increase in patients with an unusual type of tic-like symptoms: young adults with abrupt onset complex behaviors. It was quickly suspected that these patients suffered from functional neurological symptoms, later named Functional Tic-Like Behaviors (FTLB). Subsequent research on the differential diagnosis between FTLB and tics has been substantial and led to the development of diagnostic checklists.
OBJECTIVES
We conducted a theoretical reappraisal of the FTLB literature to clarify the validity of the concept and its diagnostic implications.
METHODS
This paper addresses several key aspects of the current FTLB literature: circular reasoning, the complications of the FTLB phenomenology and demographics, the impact of FTLB on tic literature at large, and issues with alignment of the FTLB concept with the diagnostic criteria for functional disorders.
RESULTS
The clinical approach to FTLB might involve circular reasoning due to a lack of clinical benchmarks. The FTLB phenomenology and demographics may need more work to ensure a lack of bias and a proper description of this patient group including a clear distinction from tics. The impact of the FTLB discussion on the wider literature needs consideration. The validation of positive signs may help with both these endeavors and pave way to the inclusion of FTLB within psychiatric classification systems. Furthermore, the coexistence of FTLB and tics within the same patient needs to be addressed.
CONCLUSION
More research may be needed to fully establish the diagnosis of FTLB and differentiate it from tics.
PubMed: 38940477
DOI: 10.1002/mdc3.14150 -
Alzheimer's & Dementia : the Journal of... Jun 2024Blood-based biomarkers are a cost-effective and minimally invasive method for diagnosing the early and preclinical stages of amyloid positivity (AP). Our study aims to...
INTRODUCTION
Blood-based biomarkers are a cost-effective and minimally invasive method for diagnosing the early and preclinical stages of amyloid positivity (AP). Our study aims to investigate our novel immunoprecipitation-immunoassay (IP-IA) as a test for predicting cognitive decline.
METHODS
We measured levels of amyloid beta (Aβ)X-40 and AβX-42 in immunoprecipitated eluates from the DELCODE cohort. Receiver-operating characteristic (ROC) curves, regression analyses, and Cox proportional hazard regression models were constructed to predict AP by Aβ42/40 classification in cerebrospinal fluid (CSF) and conversion to mild cognitive impairment (MCI) or dementia.
RESULTS
We detected a significant correlation between AßX-42/X-40 in plasma and CSF (r = 0.473). Mixed-modeling analysis revealed a substantial prediction of AßX-42/X-40 with an area under the curve (AUC) of 0.81 for AP (sensitivity: 0.79, specificity: 0.74, positive predictive value [PPV]: 0.71, negative predictive value [NPV]: 0.81). In addition, lower AβX-42/X-40 ratios were associated with negative PACC5 slopes, suggesting cognitive decline.
DISCUSSION
Our results suggest that assessing the plasma AβX-42/X-40 ratio via our semiautomated IP-IA is a promising biomarker when examining patients with early or preclinical AD.
HIGHLIGHTS
New plasma Aβ42/Aβ40 measurement using immunoprecipitation-immunoassay Plasma Aβ42/Aβ40 associated with longitudinal cognitive decline Promising biomarker to detect subjective cognitive decline at-risk for brain amyloid positivity.
PubMed: 38940303
DOI: 10.1002/alz.13909 -
Annals of Agricultural and... Jun 2024The aim of the study was to determine the risk factors for binge-watching (BW) among Polish medical and non-medical students.
Turn on the screen, turn off the loneliness - analysis of risk factors for binge-watching among Polish medical and non-medical students. A web-based cross-sectional study.
OBJECTIVE
The aim of the study was to determine the risk factors for binge-watching (BW) among Polish medical and non-medical students.
MATERIAL AND METHODS
A STROBE-compliant cross-sectional observational study, was carried out in Poland from July 2022 - March 2023. The web-based survey consisted of a personal questionnaire, a Binge-Watching Behaviour Questionnaire, a Scale of Motivation for Watching TV Series, a shortened version of the Ryff Well-Being Scale, and the De Jong Gierveld Loneliness Scale. Inclusion criteria were being a student and providing informed consent to participate. The study involved 726 respondents (70.5% female) with an average age of 22.41 (SD=3.89), including 308 (44%) medical students.
RESULTS
In the group of Polish medical students, the regression model was well-fitted F(10,287)=30.189; p<0.001, R2=0.496, and the risk factors were escape motivation (β=0.416; p<0.001), psychological well-being (β=-0.165; p=0.003), emotional loneliness (β=0.152; p=0.014), and social loneliness (β=-0.118; p=0.031). Among Polish students of other majors, the regression model was well-fitted F(10,378)=46.188; p<0.001, R2=0.538, and the influence of escape motivation (β=0.456; p<0.001), entertainment motivation (β=0.258; p<0.001), the psychological well-being of students (β=-0.134; p=0.004), and emotional loneliness (β=0.111; p=0.032) was demonstrated.
CONCLUSIONS
Students are in a high-risk group for behavioural addiction known as binge-watching. Emotional loneliness, the desire to escape from everyday life problems, and reduced psychological well-being intensified binge-watching in all the studied groups. Entertainment motivation and social loneliness differentiated the groups of Polish medical and non-medical students in terms of BW risk factors.
Topics: Humans; Poland; Female; Male; Cross-Sectional Studies; Loneliness; Risk Factors; Young Adult; Students, Medical; Adult; Students; Surveys and Questionnaires; Adolescent; Television; Internet
PubMed: 38940111
DOI: 10.26444/aaem/183779 -
Journal of Integrative Neuroscience Jun 2024Neurofeedback is a non-invasive brain training technique used to enhance and treat hyperactivity disorder by altering the patterns of brain activity. Nonetheless, the...
BACKGROUND
Neurofeedback is a non-invasive brain training technique used to enhance and treat hyperactivity disorder by altering the patterns of brain activity. Nonetheless, the extent of enhancement by neurofeedback varies among individuals/patients and many of them are irresponsive to this treatment technique. Therefore, several studies have been conducted to predict the effectiveness of neurofeedback training including the theta/beta protocol with a specific emphasize on slow cortical potential (SCP) before initiating treatment, as well as examining SCP criteria according to age and sex criteria in diverse populations. While some of these studies failed to make accurate predictions, others have demonstrated low success rates. This study explores functional connections within various brain lobes across different frequency bands of electroencephalogram (EEG) signals and the value of phase locking is used to predict the potential effectiveness of neurofeedback treatment before its initiation.
METHODS
This study utilized EEG data from the Mendelian database. In this database, EEG signals were recorded during neurofeedback sessions involving 60 hyperactive students aged 7-14 years, irrespective of sex. These students were categorized into treatable and non-treatable. The proposed method includes a five-step algorithm. Initially, the data underwent preprocessing to reduce noise using a multi-stage filtering process. The second step involved extracting alpha and beta frequency bands from the preprocessed EEG signals, with a particular emphasis on the EEG recorded from sessions 10 to 20 of neurofeedback therapy. In the third step, the method assessed the disparity in brain signals between the two groups by evaluating functional relationships in different brain lobes using the phase lock value, a crucial data characteristic. The fourth step focused on reducing the feature space and identifying the most effective and optimal electrodes for neurofeedback treatment. Two methods, the probability index (-value) via a -test and the genetic algorithm, were employed. These methods showed that the optimal electrodes were in the frontal lobe and central cerebral cortex, notably channels C3, FZ, F4, CZ, C4, and F3, as they exhibited significant differences between the two groups. Finally, in the fifth step, machine learning classifiers were applied, and the results were combined to generate treatable and non-treatable labels for each dataset.
RESULTS
Among the classifiers, the support vector machine and the boosting method demonstrated the highest accuracy when combined. Consequently, the proposed algorithm successfully predicted the treatability of individuals with hyperactivity in a short time and with limited data, achieving an accuracy of 90.6% in the neurofeedback method. Additionally, it effectively identified key electrodes in neurofeedback treatment, reducing their number from 32 to 6.
CONCLUSIONS
This study introduces an algorithm with a 90.6% accuracy for predicting neurofeedback treatment outcomes in hyperactivity disorder, significantly enhancing treatment efficiency by identifying optimal electrodes and reducing their number from 32 to 6. The proposed method enables the prediction of patient responsiveness to neurofeedback therapy without the need for numerous sessions, thus conserving time and financial resources.
Topics: Humans; Neurofeedback; Attention Deficit Disorder with Hyperactivity; Adolescent; Male; Female; Child; Electroencephalography; Cerebral Cortex; Brain Waves; Treatment Outcome
PubMed: 38940096
DOI: 10.31083/j.jin2306121 -
Journal of Child Psychology and... Jun 2024Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with...
BACKGROUND
Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real-world contexts.
METHODS
We assessed 73 adolescents [82.2% female; M = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m] with BED at baseline, posttreatment, 6-, 12-, and 24-month follow-up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition.
RESULTS
More impulsive decision-making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (β = .07; p = .019) and more frequent LOC eating following treatment (β = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T-scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (β = -.03; p = .003). Inhibition, concentration, attention, and parent-reported EF behavior symptoms were not associated with outcome, attendance, or attrition.
CONCLUSIONS
More impulsive decision-making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre-treatment EF.
PubMed: 38940077
DOI: 10.1111/jcpp.14031 -
Clinical Ophthalmology (Auckland, N.Z.) 2024This study investigates the association between self-reported birth weight (BW) and the prevalence of hypertensive retinopathy (HR) in a large population-based cohort in...
This study investigates the association between self-reported birth weight (BW) and the prevalence of hypertensive retinopathy (HR) in a large population-based cohort in Germany, as part of the Gutenberg Health Study (GHS). The study involved analyzing fundus photographs of 6855 participants, aged 35 to 74, to assess signs of HR, classified according to the Mitchell-Wong Classification. The research aimed to explore the correlation between fetal growth restriction indicated by BW and the frequency of HR. The results showed that the frequency of HR did not significantly differ among groups with different BW ranges. In the univariable analysis, HR was initially associated with high BW, but this association disappeared after adjusting for age, sex, and cardiovascular risk factors. No association was found between low BW and HR. The study reveals novel insights as there are no prior population-based studies specifically exploring this association.
PubMed: 38938591
DOI: 10.2147/OPTH.S461261