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BMC Pediatrics Nov 2023Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children...
BACKGROUND
Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children with EA tend to carry the risk of self-harm, have longer periods of recovery and delayed hospital discharge. Consequently, EA needs to be monitored and risk factors ought to be emphasized to implement preventative measures. The objective of this study was to describe EA and to identify risk factors after pediatric ophthalmic or ENT surgery.
METHODS
Between September 2021 and December 2021, a cross-sectional study was conducted in 100 children aged of 0-12 years who underwent ophthalmic or ENT surgery. The Watcha scale was used to observe and record EA, which was defined at levels of 3 or 4 at any time in the post-anesthesia care unit (PACU). The pain intensity was graded with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale after surgery. Patient and surgery-related characteristics, the behavioral criteria of EA, the pharmacologic and non-pharmacologic interventions and recovery outcomes were objectively recorded. A binary logistic regression model was constructed to identify the associated factors of EA.
RESULTS
From the 100 analyzed children, 58 were males and 42 were females, and 44 patients received ophthalmic surgery and 56 ENT surgery. The median age was 6 (IQR 4-7) years. The overall incidence of EA among pediatrics was 30% (34.5% for ENT and 24.4% for ophthalmic surgery). High preoperative modified Yale Preoperative Anxiety scale (m-YPAS) grade (OR = 1.19, 95%CI 1.06-1.33, P = 0.003) and high postoperative FLACC score (OR = 3.36, 95%CI 1.88-6.02, P < 0.001) were risk factors for EA.
CONCLUSIONS
This study identified that preoperative anxiety and postoperative pain are associated with EA in children after ophthalmic or ENT surgery. Preoperative anxiety assessment and management, and administration of adjunct analgesic treatments should be considered in the routine care.
Topics: Male; Female; Child; Humans; Child, Preschool; Emergence Delirium; Cross-Sectional Studies; Sevoflurane; Methyl Ethers; Prevalence; Psychomotor Agitation; Risk Factors
PubMed: 37996779
DOI: 10.1186/s12887-023-04434-y -
Neuroscience Letters Jan 2024ADHD is a neurocognitive disorder characterized by attention difficulties, hyperactivity, and impulsivity, often persisting into adulthood with substantial personal and...
ADHD is a neurocognitive disorder characterized by attention difficulties, hyperactivity, and impulsivity, often persisting into adulthood with substantial personal and societal consequences. Despite the importance of neurophysiological assessment and treatment monitoring tests, their availability outside of research settings remains limited. Cognitive neuroscience investigations have identified distinct components associated with ADHD, including deficits in sustained attention, inefficient enhancement of attended Targets, and altered suppression of ignored Distractors. In this study, we examined pupil activity in control and ADHD subjects during a sustained visual attention task specifically designed to evaluate the mechanisms underlying Target enhancement and Distractor suppression. Our findings revealed some distinguishing factors between the two groups which we discuss in light of their neurobiological implications.
Topics: Humans; Attention Deficit Disorder with Hyperactivity; Dilatation; Impulsive Behavior; Psychomotor Agitation
PubMed: 37951300
DOI: 10.1016/j.neulet.2023.137556 -
Internal and Emergency Medicine Mar 2024To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes....
To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24-4.82), transfer to the ED observation unit (1.62, 1.23-2.15), chronic treatment with opiates (1.51, 1.09-2.09) and length of ED stay longer than 12 h (1.41, 1.02-1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37-0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83-2.78), need for hospitalization 25.6% and 25% (1.09, 0.83-1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24-4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80-2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82-2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.
Topics: Humans; Aged; Length of Stay; Delirium; Psychomotor Agitation; Aftercare; Patient Discharge; Emergency Service, Hospital; Risk Factors
PubMed: 37865623
DOI: 10.1007/s11739-023-03440-3 -
JMIR Mental Health Oct 2023Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)-9...
BACKGROUND
Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)-9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2.
OBJECTIVE
This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments.
METHODS
All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores ≥10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection.
RESULTS
The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2≥2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2≥3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2≥2 and ≥3 cutoffs.
CONCLUSIONS
The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings.
PubMed: 37856186
DOI: 10.2196/48444 -
Psychiatria Danubina Oct 2023The present retrospective study was aimed at analyzing the socio-demographic and clinical correlates of the duration of involuntary treatment (IT) in a Psychiatric...
OBJECTIVES
The present retrospective study was aimed at analyzing the socio-demographic and clinical correlates of the duration of involuntary treatment (IT) in a Psychiatric Inpatient Unit in central Italy.
SUBJECTS AND METHODS
We reviewed clinical charts of subjects admitted following IT, extracting sociodemographic and clinical information. We used the duration of the IT as a "proxy" for the early cessation of the conditions that determined the need for involuntary commitment. Hospitalizations were thus labeled as "short-IT" and "ultra-short-IT" depending on their duration (< 7 days or < 3 days). Bivariate analyses (p<0.05). were performed to compare "short-ITs" with hospitalizations that were longer that 7 days. The same procedure was repeated for comparing "ultra-short-ITs" with hospitalizations lasting >3 days.
RESULTS
In the present sample (362 subjects, 459 hospitalizations), 112 (24.4%) hospitalizations belonged to the "short-IT" and 56 (12.2%) to the "ultra-short-IT" subgroups. Both subgroups were characterized by a lower prevalence of single marital status and by a higher prevalence of admissions due to psychomotor agitation. The diagnoses of schizophrenia spectrum and mood disorders were less frequent in the two subgroups, with lower antipsychotic prescription rates, while higher prevalence of substance-related and impulse control disorders were detected. Both hospitalization types were more frequently followed by a "revolving door". As for "short-IT", subjects were referred to the ward by community mental health services in fewer cases.
CONCLUSIONS
The early cessation of IT is more frequent in case of subjects who do not suffer from a serious psychiatric disorder and are referred to the inpatient ward due behavioral disturbances. The engagement with community mental health services should be improved in order to propose possible alternative solutions to IT and avoid revolving doors.
Topics: Humans; Hospitalization; Inpatients; Involuntary Treatment; Mental Disorders; Retrospective Studies; Schizophrenia
PubMed: 37800259
DOI: No ID Found -
Psychiatria Danubina Oct 2023Subjects suffering from psychiatric disorders are frequently hospitalized due to medical comorbidities. In the present study, we analyzed consultation-liaison psychiatry... (Observational Study)
Observational Study
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.
Topics: Humans; Hospitals, General; Psychiatry; Mental Disorders; Comorbidity; Referral and Consultation
PubMed: 37800245
DOI: No ID Found -
Scientific Reports Oct 2023Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations....
Associations among the workplace violence, burnout, depressive symptoms, suicidality, and turnover intention in training physicians: a network analysis of nationwide survey.
Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations. Relationships among a demanding workload, workplace violence, burnout, and intention to turnover have also been reported. The current study examined the principal components and propagating patterns of mental health and working environment interactions in training physicians. A total of 1981 training physicians completed online self-report questionnaires during September-October (midpoint of the training year) 2020. Regularized partial correlations in a mixed graphical model (MGM) and joint probability distributions (directed acyclic graph; DAG) were estimated for four subtypes of workplace violence (verbal abuse/physical violence perpetrated by clients/hospital staff), three burnout subdomains (Maslach Burnout Inventory), thoughts about quitting, and nine depressive symptoms, including suicidality, comprising the DSM-5 diagnostic criteria for major depressive disorder (assessed using the Patient Health Questionnaire-9). Thoughts of death/self-harm showed directional dependencies on the joint probability distributions of psychomotor agitation/retardation, concentration difficulty, self-reproach, and sadness in the DAG. In the MGM, a partial correlation with psychomotor agitation/retardation (r = 0.196) accounted for 56.5% of the variance in thoughts of death/self-harm. Partial correlations with concentration difficulties (r = 0.294), self-reproach (r = 0.257), changes in appetite (r = 0.184), and worker-on-worker physical violence (r = 0.240) in the MGM accounted for 54.4% of the variance in psychomotor agitation/retardation. Thoughts about quitting were partially correlated with and dependent upon the joint probability distributions of emotional exhaustion (r = 0.222), fatigue (r = 0.142), anhedonia (r = 0.178), and sadness (r = 0.237). In contrast, worker-on-worker (r = 0.417) and client-on-physician (r = 0.167) verbal abuse had regularized partial correlations with directional dependencies on thoughts about quitting. Organization-level interventions aiming to reduce the worker-on-worker violence and individual-level approaches of clinical screening program and psychiatric counseling clinic are required. Follow-up studies to verify the effectiveness of these interventions for training physicians are needed.
Topics: Humans; Depression; Workplace Violence; Intention; Depressive Disorder, Major; Psychomotor Agitation; Suicide; Burnout, Professional; Surveys and Questionnaires; Physicians; Workplace
PubMed: 37798353
DOI: 10.1038/s41598-023-44119-1 -
Bone Research Sep 2023Skeletal stem and progenitor cells (SSPCs) perform bone maintenance and repair. With age, they produce fewer osteoblasts and more adipocytes leading to a loss of...
Skeletal stem and progenitor cells (SSPCs) perform bone maintenance and repair. With age, they produce fewer osteoblasts and more adipocytes leading to a loss of skeletal integrity. The molecular mechanisms that underlie this detrimental transformation are largely unknown. Single-cell RNA sequencing revealed that Notch signaling becomes elevated in SSPCs during aging. To examine the role of increased Notch activity, we deleted Nicastrin, an essential Notch pathway component, in SSPCs in vivo. Middle-aged conditional knockout mice displayed elevated SSPC osteo-lineage gene expression, increased trabecular bone mass, reduced bone marrow adiposity, and enhanced bone repair. Thus, Notch regulates SSPC cell fate decisions, and moderating Notch signaling ameliorates the skeletal aging phenotype, increasing bone mass even beyond that of young mice. Finally, we identified the transcription factor Ebf3 as a downstream mediator of Notch signaling in SSPCs that is dysregulated with aging, highlighting it as a promising therapeutic target to rejuvenate the aged skeleton.
Topics: Animals; Mice; Osteogenesis; Adipocytes; Adiposity; Aging; Arthrodesis; Mice, Knockout; Psychomotor Agitation
PubMed: 37752132
DOI: 10.1038/s41413-023-00283-8 -
BMC Psychiatry Sep 2023Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and highly heritable neurodevelopmental disorder of major societal concern. Diagnosis can be challenging...
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and highly heritable neurodevelopmental disorder of major societal concern. Diagnosis can be challenging and there are large knowledge gaps regarding its etiology, though studies suggest an interplay of genetic and environmental factors involving epigenetic mechanisms. MicroRNAs (miRNAs) show promise as biomarkers of human pathology and novel therapies, and here we aimed to identify blood miRNAs associated with traits of ADHD as possible biomarker candidates and further explore their biological relevance.
METHODS
Our study population consisted of 1126 children (aged 5-12 years, 46% female) from the Human Early Life Exposome study, a study spanning six ongoing population-based European birth cohorts. Expression profiles of miRNAs in whole blood samples were quantified by microarray and tested for association with ADHD-related measures of behavior and neuropsychological functions from questionnaires (Conner's Rating Scale and Child Behavior Checklist) and computer-based tests (the N-back task and Attention Network Test).
RESULTS
We identified 29 miRNAs significantly associated (false discovery rate < .05) with the Conner's questionnaire-rated trait hyperactivity, 15 of which have been linked to ADHD in previous studies. Investigation into their biological relevance revealed involvement in several pathways related to neurodevelopment and function, as well as being linked with other neurodevelopmental or psychiatric disorders known to overlap with ADHD both in symptomology, genetic risk, and co-occurrence, such as autism spectrum disorder or schizophrenia. An additional three miRNAs were significantly associated with Conner's-rated inattention. No associations were found with questionnaire-rated total ADHD index or with computer-based tests.
CONCLUSIONS
The large overlap of our hyperactivity-associated miRNAs with previous studies on ADHD is intriguing and warrant further investigation. Though this study should be considered explorative and preliminary, these findings contribute towards identifying a set of miRNAs for use as blood-based biomarkers to aid in earlier and easier ADHD diagnosis.
Topics: Humans; Child; Female; Male; Attention Deficit Disorder with Hyperactivity; MicroRNAs; Autism Spectrum Disorder; Birth Cohort; Biomarkers; Psychomotor Agitation
PubMed: 37749515
DOI: 10.1186/s12888-023-05199-5 -
JAMA Network Open Sep 2023Influenza-like illness (ILI) activity has been associated with increased risk of cardiopulmonary (CP) events during the influenza season. High-dose trivalent influenza... (Randomized Controlled Trial)
Randomized Controlled Trial
Temporal Association Among Influenza-Like Illness, Cardiovascular Events, and Vaccine Dose in Patients With High-Risk Cardiovascular Disease: Secondary Analysis of a Randomized Clinical Trial.
IMPORTANCE
Influenza-like illness (ILI) activity has been associated with increased risk of cardiopulmonary (CP) events during the influenza season. High-dose trivalent influenza vaccine was not superior to standard-dose quadrivalent vaccine for reducing these events in patients with high-risk cardiovascular (CV) disease in the Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated Heart Failure (INVESTED) trial.
OBJECTIVE
To evaluate whether high-dose trivalent influenza vaccination is associated with benefit over standard-dose quadrivalent vaccination in reducing CP events during periods of high, local influenza activity.
DESIGN, SETTING, AND PARTICIPANTS
This study was a prespecified secondary analysis of INVESTED, a multicenter, double-blind, active comparator randomized clinical trial conducted over 3 consecutive influenza seasons from September 2016 to July 2019. Follow-up was completed in July 2019, and data were analyzed from September 21, 2016, to July 31, 2019. Weekly Centers for Disease Control and Prevention (CDC)-reported, state-level ILI activity was ascertained to assess the weekly odds of the primary outcome. The study population included 3094 patients with high-risk CV disease from participating centers in the US.
INTERVENTION
Participants were randomized to high-dose trivalent or standard-dose quadrivalent influenza vaccine and revaccinated for up to 3 seasons.
MAIN OUTCOMES AND MEASURES
The primary outcome was the time to composite of all-cause death or CP hospitalization within each season. Additional measures included weekly CDC-reported ILI activity data by state.
RESULTS
Among 3094 participants (mean [SD] age, 65 [12] years; 2309 male [75%]), we analyzed 129 285 person-weeks of enrollment, including 1396 composite primary outcome events (1278 CP hospitalization, 118 deaths). A 1% ILI increase in the prior week was associated with an increased risk in the primary outcome (odds ratio [OR], 1.14; 95% CI, 1.07-1.21; P < .001), CP hospitalization (OR, 1.13; 95% CI, 1.06-1.21; P < .001), and CV hospitalization (OR, 1.12; 95% CI, 1.04-1.19; P = .001), after adjusting for state, demographic characteristics, enrollment strata, and CV risk factors. Increased ILI activity was not associated with all-cause death (OR, 1.00; 95% CI, 0.88-1.13; P > .99). High-dose compared with standard-dose vaccine did not significantly reduce the primary outcome, even when the analysis was restricted to weeks of high ILI activity (OR, 0.88; 95% CI, 0.65-1.20; P = .43). Traditionally warmer months in the US were associated with lower CV risk independent of local ILI activity.
CONCLUSIONS AND RELEVANCE
In this secondary analysis of a randomized clinical trial, ILI activity was temporally associated with increased CP events in patients with high-risk CV disease, and a higher influenza vaccine dose did not significantly reduce temporal CV risk. Other seasonal factors may play a role in the coincident high rates of ILI and CV events.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02787044.
Topics: United States; Humans; Male; Aged; Cardiovascular Diseases; Influenza, Human; Virus Diseases; Influenza Vaccines; Heart Failure; Psychomotor Agitation
PubMed: 37707817
DOI: 10.1001/jamanetworkopen.2023.31284