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Substance Abuse : Research and Treatment 2023The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the... (Review)
Review
The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.
PubMed: 37476500
DOI: 10.1177/11782218231186371 -
Neurology Aug 2023Comprehensive guidelines for the diagnosis, prognosis, and treatment of disorders of consciousness (DoC) in pediatric patients have not yet been released. We aimed to... (Review)
Review
BACKGROUND AND OBJECTIVES
Comprehensive guidelines for the diagnosis, prognosis, and treatment of disorders of consciousness (DoC) in pediatric patients have not yet been released. We aimed to summarize available evidence for DoC with >14 days duration to support the future development of guidelines for children, adolescents and young adults aged 6 months-18 years.
METHODS
This scoping review was reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3 blind reviews. Corresponding full-text articles rated as "in-scope" and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated.
RESULTS
On November 9, 2022, 2,167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the past 5 years. Overall, 2,161 individuals met the inclusion criteria; female patients were 527 of 1,554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%) and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near-Coma Scale, Level of Cognitive Functioning Assessment Scale, and Post-Acute Level of Consciousness scale. EEG, event-related potentials, structural CT, and MRI were the most frequently used instrumental techniques. In 29/53 (54.7%) cases, DoC improvement was observed, which was associated with treatment with amantadine.
DISCUSSION
The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence and have limited validity and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to the diagnosis, prognosis, and treatment of pediatric DoC.
Topics: Adolescent; Humans; Female; Child; Consciousness; Consciousness Disorders; Coma; Prognosis; Randomized Controlled Trials as Topic
PubMed: 37308301
DOI: 10.1212/WNL.0000000000207473 -
European Psychiatry : the Journal of... Jun 2023Whether non-genetic prognostic factors significantly influence the variable prognosis of antipsychotic-induced weight gain (AIWG) has not yet been systematically... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Whether non-genetic prognostic factors significantly influence the variable prognosis of antipsychotic-induced weight gain (AIWG) has not yet been systematically explored.
METHODS
Searches for both randomized and non-randomized studies were undertaken using four electronic databases, two trial registers, and via supplemental searching methods. Unadjusted and adjusted estimates were extracted. Meta-analyses were undertaken using a random-effects generic inverse model. Risk of bias and quality assessments were undertaken using Quality in Prognosis Studies (QUIPS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively.
RESULTS
Seventy-two prognostic factors were assessed across 27 studies involving 4426 participants. Only age, baseline body mass index (BMI), and sex were suitable for meta-analysis. Age (b=-0.044, 95%CI -0.157-0.069), sex (b=0.236, 95%CI -0.086-0.558), and baseline BMI (b=-0.013 95%CI -0.225-0.200) were associated with nonsignificant effects on AIWG prognosis. The highest quality GRADE rating was moderate in support of age, trend of early BMI increase, antipsychotic treatment response, unemployment, and antipsychotic plasma concentration. Trend of early BMI increase was identified as the most clinically significant prognostic factor influencing long-term AIWG prognosis.
CONCLUSIONS
The strong prognostic information provided by BMI trend change within 12 weeks of antipsychotic initiation should be included within AIWG management guidance to highlight those at highest risk of worse long-term prognosis. Antipsychotic switching and resource-intensive lifestyle interventions should be targeted toward this cohort. Our results challenge previous research that several clinical variables significantly influence AIWG prognosis. We provide the first mapping and statistical synthesis of studies examining non-genetic prognostic factors of AIWG and highlight practice, policy, and research implications.
Topics: Humans; Antipsychotic Agents; Prognosis; Psychotic Disorders; Weight Gain; Body Mass Index
PubMed: 37278237
DOI: 10.1192/j.eurpsy.2023.2417 -
Journal of Personalized Medicine May 2023To investigate the influence of endogenous and exogenous neuroendocrine analogues on the range and motion of jaw movement, mandibular growth, and factors affecting... (Review)
Review
Neuroendocrine Influencers and Associated Factors That Shape Jaw Movement and Growth in Temporomandibular Joint Disorder Management: A Systematic Review of Clinical and Radiographic Evidence.
OBJECTIVE
To investigate the influence of endogenous and exogenous neuroendocrine analogues on the range and motion of jaw movement, mandibular growth, and factors affecting condylar guidance in patients with temporomandibular joint disorders using clinical assessment and radiographic imaging.
MATERIAL AND METHODS
Eligible articles were extracted from eleven databases in early 2023 and screened following PRISMA protocols. Certainty of evidence and potential biases were assessed using the GRADE approach.
RESULTS
Nineteen articles were screened, with four deemed to be of high quality, eight of moderate quality, and the remaining seven of low to very low quality. Corticosteroids improve maximal incisal opening but not TMJ disorder symptoms. Higher doses worsen jaw movement and cause osseous deformity. Growth hormone affects occlusal development, and delayed treatment affects arch width. Sex hormone correlation with TMJ disorder is complex, with some studies showing a correlation between menstrual cycle phases and pain/limited mobility.
CONCLUSIONS
The evaluation of neuroendocrine influencers in relation to jaw movement in patients with temporomandibular joint disorders involves the complex interplay of potentially confounding factors that each require careful consideration to ensure accurate diagnoses and evaluations.
PubMed: 37241010
DOI: 10.3390/jpm13050840 -
BMC Public Health May 2023Polycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately...
BACKGROUND
Polycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately 6-26%, affecting 105 million people worldwide. This systematic review aimed to synthesize the evidence on the effects of physical activity on reproductive health functions among PCOS women.
METHODS
The systematic review includes randomization-controlled trials (RCTs) on physical exercise and reproductive functions among women with PCOS. Studies in the English language published between January 2010 and December 2022 were identified via PubMed. A combination of medical subject headings in terms of physical activity, exercise, menstrual cycle, hyperandrogenism, reproductive hormone, hirsutism, and PCOS was used.
RESULTS
Overall, seven RCTs were included in this systematic review. The studies investigated interventions of physical activity of any intensity and volume and measured reproductive functions and hormonal and menstrual improvement. The inclusion of physical activity alone or in combination with other therapeutic interventions improved reproductive outcomes.
CONCLUSION
The reproductive functions of women with PCOS can be improved with physical activity. Furthermore, physical activity can also reduce infertility, as well as social and psychological stress among women.
PROSPERO SYSTEMATIC REVIEW REGISTRATION
CRD42020213732.
Topics: Female; Humans; Adult; Polycystic Ovary Syndrome; Reproductive Health; Hyperandrogenism; Exercise; Menstrual Cycle
PubMed: 37173672
DOI: 10.1186/s12889-023-15730-8 -
Autism : the International Journal of... Nov 2023Although exclusion of racially and ethnically minoritized autistic individuals from research is a long-standing issue, we have yet to determine how exclusion impacts... (Review)
Review
Although exclusion of racially and ethnically minoritized autistic individuals from research is a long-standing issue, we have yet to determine how exclusion impacts areas of autism research important for identifying language impairment. Diagnosis depends on the quality of the evidence (i.e. research) and is often the pathway to gaining access to services. As a first step, we examined how research studies related to language impairment in school-age autistic individuals report participant socio-demographics. We analyzed reports using age-referenced assessments in English ( = 60), which are commonly used by both practitioners and researchers to diagnose or identify language impairment. Findings showed only 28% of studies reported information on race and ethnicity; in these studies, most (at least 77%) of the participants were white. In addition, only 56% of studies reported gender or sex specified what they were reporting (gender, sex, or gender identity). Just 17% reported socio-economic status using multiple indicators. Altogether, findings indicate broad issues with underreporting and exclusion of racially and ethnically minoritized individuals, which might overlay with other aspects of identity including socio-economic status. It is impossible to determine the extent and precise nature of exclusion without intersectional reporting. To ensure that language in autism research is representative of the autistic population, future research must implement reporting guidelines and broaden inclusion of who participates in research studies.
Topics: Humans; Female; Male; Autistic Disorder; Gender Identity; Autism Spectrum Disorder; Language; Language Development Disorders
PubMed: 37157821
DOI: 10.1177/13623613231166749 -
JAMA Neurology Jun 2023Progressive multifocal leukoencephalopathy can occur in the context of systemic sarcoidosis (S-PML) in the absence of therapeutic immune suppression and can initially be...
IMPORTANCE
Progressive multifocal leukoencephalopathy can occur in the context of systemic sarcoidosis (S-PML) in the absence of therapeutic immune suppression and can initially be mistaken for neurosarcoidosis or other complications of sarcoidosis. Earlier recognition of S-PML could lead to more effective treatment of the disease.
OBJECTIVE
To describe characteristics of patients with S-PML.
DESIGN, SETTING, AND PARTICIPANTS
For this case series, records from 8 academic medical centers in the United States were reviewed from 2004 to 2022. A systematic review of literature from 1955 to 2022 yielded data for additional patients. Included were patients with S-PML who were not receiving therapeutic immune suppression. The median follow-up time for patients who survived the acute range of illness was 19 months (range, 2-99). Data were analyzed in February 2023.
EXPOSURES
Sarcoidosis without active therapeutic immune suppression.
MAIN OUTCOMES AND MEASURES
Clinical, laboratory, and radiographic features of patients with S-PML.
RESULTS
Twenty-one patients with S-PML not receiving therapeutic immune suppression were included in this study, and data for 37 patients were collected from literature review. The median age of the 21 study patients was 56 years (range, 33-72), 4 patients (19%) were female, and 17 (81%) were male. The median age of the literature review patients was 49 years (range, 21-74); 12 of 34 patients (33%) with reported sex were female, and 22 (67%) were male. Nine of 21 study patients (43%) and 18 of 31 literature review patients (58%) had simultaneous presentation of systemic sarcoidosis and PML. Six of 14 study patients (43%) and 11 of 19 literature review patients (58%) had a CD4+ T-cell count greater than 200/μL. In 2 study patients, a systemic flare of sarcoidosis closely preceded S-PML development. Ten of 17 study patients (59%) and 21 of 35 literature review patients (60%) died during the acute phase of illness. No meaningful predictive differences were found between patients who survived S-PML and those who did not.
CONCLUSIONS AND RELEVANCE
In this case series, patients with sarcoidosis developed PML in the absence of therapeutic immune suppression, and peripheral blood proxies of immune function were often only mildly abnormal. Systemic sarcoidosis flares may rarely herald the onset of S-PML. Clinicians should consider PML in any patient with sarcoidosis and new white matter lesions on brain magnetic resonance imaging.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Young Adult; Leukoencephalopathy, Progressive Multifocal; Brain; Sarcoidosis; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 37093609
DOI: 10.1001/jamaneurol.2023.0841 -
Archives of Endocrinology and Metabolism Mar 2023Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is an autosomal recessive disorder caused by gene mutations, and its molecular diagnosis is widely used... (Review)
Review
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is an autosomal recessive disorder caused by gene mutations, and its molecular diagnosis is widely used in clinical practice to confirm the hormonal diagnosis. Hence, considering the miscegenation of the Brazilian population, it is important to determine a mutations panel to optimise the molecular diagnosis. The objective was to review the mutations' distribution among Brazilian regions. Two reviewers screened Brazilian papers up to February 2020 in five databases. The pair-wise comparison test and Holm method were used in the statistical analysis. Nine studies were selected, comprising 769 patients from all regions. Low proportion of males and salt-wasters was identified in the North and Northeast regions, although without significant difference. Large gene rearrangements also had a low frequency, except in the Center-West and South regions (p < 0.05). The most frequent mutations were p.I172N, IVS2-13A/C>G, p.V281L and p.Q318X, and significant differences in their distributions were found: p.V281L was more frequent in the Southeast and p.Q318X in the Center-West and Northeast regions (p < 0.05). Thirteen new mutations were identified in 3.8%-15.2% of alleles, being more prevalent in the North region, and six mutations presented a founder effect gene. Genotype-phenotype correlation varied from 75.9%-97.3% among regions. The low prevalence of the salt-wasting form, affected males and severe mutations in some regions indicated pitfalls in the clinical diagnosis. The good genotype-phenotype correlation confirms the usefulness of molecular diagnosis; however, the Brazilian population also presents significant prevalence of novel mutations, which should be considered for a molecular panel.
Topics: Male; Humans; Adrenal Hyperplasia, Congenital; Steroid 21-Hydroxylase; Brazil; Genotype; Phenotype; Mutation
PubMed: 37011374
DOI: 10.20945/2359-3997000000593 -
Frontiers in Neurology 2023Dizziness in children, which could not be diagnosed at an early stage in the past, is becoming increasingly clear to a large extent. However, the recognition of the...
BACKGROUND
Dizziness in children, which could not be diagnosed at an early stage in the past, is becoming increasingly clear to a large extent. However, the recognition of the diagnosis and management remains discrepant and controversial due to their complicated and varied etiology. Central and peripheral vestibular disorders, psychogenic and systemic diseases, and genetic pathogeny constitute childhood etiological entities. Further understanding of the etiology and the prevalence of vertigo disorders is of crucial importance and benefit in the diagnosis and management of pediatric patients.
METHODS
This systematic review and meta-analysis were conducted by systematically searching Embase, PubMed, the Cochrane Library, CNIK, the Chinese Wan-Fang database, CBM, the Chinese VIP database, and the Web of Science for literature on childhood vertigo disorders published up to May 2022. The literature was evaluated under strict screening and diagnostic criteria. Their quality was assessed using the Agency for Healthcare and Research Quality (AHRQ) standards. The test for homogeneity was conducted to determine the fixed effects model or random-effect model employed.
RESULTS
Twenty-three retrospective cross-sectional studies involving 7,647 children with vertigo disorders were finally included, with an AHRQ score >4 (high or moderate quality). Our results demonstrated that peripheral vertigo (52.20%, 95% CI: 42.9-61.4%) was more common in children than central vertigo (28.7%, 95% CI: 20.8-37.4%), psychogenic vertigo (7.0%, 95% CI: 4.8-10.0%), and other systemic vertigo (4.7%, 95% CI: 2.6-8.2%). The five most common etiological diagnoses associated with peripheral vertigo included benign paroxysmal vertigo of childhood (BPVC) (19.50%, 95% CI: 13.5-28.3%), sinusitis-related diseases (10.7%, 95% CI: -11.2-32.6%), vestibular or semicircular canal dysfunction (9.20%, 95% CI: 5.7-15.0%), benign paroxysmal positional vertigo (BPPV)(7.20%, 95% CI: 3.9-11.5%), and orthostatic dysregulation (6.8%, 95% CI: 3.4-13.0%). Vestibular migraine (20.3%, 95% CI: 15.4-25.2%) was the most seen etiological diagnosis associated with central vertigo in children. In addition, we found the sex-based difference influenced the outcome of psychogenic vertigo and vestibular migraine, while there was no significant difference in other categories of the etiology. For the management of vertigo, symptomatical management is the first choice for most types of vertigo disorder in pediatrics.
CONCLUSION
Complex etiology and non-specific clinical manifestations of vertigo in pediatrics are challenging for their diagnoses. Reliable diagnosis and effective management depend on the close cooperation of multiple disciplines, combined with comprehensive consideration of the alternative characteristics of vertigo in children with growth and development.
PubMed: 36937528
DOI: 10.3389/fneur.2023.1125488 -
Archives of Sexual Behavior Aug 2023Drug use before or during sex is a high-risk sexual behavior associated with adverse health risks and outcomes, such as increasing the likelihood of overdoses and of... (Meta-Analysis)
Meta-Analysis
Drug use before or during sex is a high-risk sexual behavior associated with adverse health risks and outcomes, such as increasing the likelihood of overdoses and of acquiring sexually-transmitted diseases. This systematic review and meta-analysis of three scientific databases examined the prevalence of the use of intoxicating substances, those tending to excite or stupefy the user on a psychoactive level, before or during sex, among young adults (18-29 years old). A total of 55 unique empirical studies met the inclusion criteria (48,145 individuals; 39% males), were assessed for risk of bias using the tools of Hoy et al. (2012), and were analyzed via a generalized linear mixed-effects model. The results produced a global mean prevalence of this sexual risk behavior of 36.98% (95% CI: 28.28%, 46.63%). Nonetheless, significant differences were identified between different intoxicating substances, with the use of alcohol (35.10%; 95% CI: 27.68%, 43.31%), marijuana (27.80%; 95% CI: 18.24%, 39.92%), and ecstasy (20.90%; 95% CI: 14.34%, 29.45%) significantly more prevalent than that of cocaine (4.32%; 95% CI: 3.64%, 5.11%), heroin (.67%; 95% CI: .09%, 4.65%), methamphetamine (7.10%; 95% CI: 4.57%, 10.88%), and GHB (6.55%; 95% CI: 4.21%, 10.05%). Moderator analyses showed that the prevalence of alcohol use before or during sex differed according to geographical sample origin, and increased as the proportion of ethnic whites in samples increased. The remaining demographic (e.g., gender, age, reference population), sexual (e.g., sexual orientation, sexual activity), health (e.g., drug consumption, STI/STD status), methodological (e.g., sampling technique), and measurement (e.g., timeframe) variables that were examined did not moderate prevalence estimates. Implications for sexual development interventions were discussed.
Topics: Humans; Male; Female; Young Adult; Adolescent; Adult; Prevalence; Sexual Behavior; Substance-Related Disorders; Sexually Transmitted Diseases; Alcohol Drinking
PubMed: 36897426
DOI: 10.1007/s10508-023-02572-z