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Addictive Behaviors Mar 2022Substance use disorders and non-substance addictive behaviors are major, growing health concerns. Efficient screening primary care settings encouraged but its widespread... (Review)
Review
BACKGROUND
Substance use disorders and non-substance addictive behaviors are major, growing health concerns. Efficient screening primary care settings encouraged but its widespread implementation is restricted without an appropriate screening approach for clinical practice or guidance for practitioners choose an appropriate screening test. This study aims to identify addictive disorder screening tests which are validated in primary care and suggest steps to help practitioners select the appropriate test.
METHOD
A systematic review of the literature through Pubmed, PsycINFO and The Cochrane Library was performed from database inception to December 21, 2020. The search strategy included three research topics: screening, addictive disorders, and primary care. Selection criteria included published studies evaluating the validity of an addictive disorder screening test in primary care settings.
RESULTS
8638 papers were selected, and 50 studies were included. Seventeen questionnaires validated in primary care covered the main substance use disorders, but none screened for non-substance addictive behaviors. Tests such as ASSIST, S2BI, SUBS and TAPS screen for a variety of substance use disorders while others such as TICS and CAGE-AID only have a few questions to improve feasibility. However, some shorter tests had weaker psychometric properties.
CONCLUSIONS
Seventeen addictive disorder screening tests validated in primary care are available. The feasibility and acceptability in primary care of the shorter tests needs to be assessed. A transversal screening test, adapted to the constraints of primary care, that enables clinicians to detect substance use disorders and non-substance addictive behaviors is needed.
Topics: Behavior, Addictive; Humans; Mass Screening; Primary Health Care; Psychometrics; Substance-Related Disorders
PubMed: 34864478
DOI: 10.1016/j.addbeh.2021.107180 -
Experimental Brain Research Feb 2022Tourette syndrome (TS) is a neurodevelopmental condition characterised by tics, which are stereotyped movements and/or vocalisations. Tics often cause difficulties in... (Review)
Review
Tourette syndrome (TS) is a neurodevelopmental condition characterised by tics, which are stereotyped movements and/or vocalisations. Tics often cause difficulties in daily life and many with TS express a desire to reduce and/or gain control over them. No singular effective treatment exists for TS, and while pharmacological and behavioural interventions can be effective, the results are variable, and issues relating to access, availability and side effects can be barriers to treatment. Consequently, over the past decade, there has been increasing interest into the potential benefits of non-invasive brain stimulation (NIBS) approaches. This systematic review highlights work exploring NIBS as a potential treatment for TS. On balance, the results tentatively suggest that multiple sessions of stimulation applied over the supplementary motor area (SMA) may help to reduce tics. However, a number of methodological and theoretical issues limit the strength of this conclusion, with the most problematic being the lack of large-scale sham-controlled studies. In this review, methodological and theoretical issues are discussed, unanswered questions highlighted and suggestions for future work put forward.
Topics: Humans; Motor Cortex; Tic Disorders; Tics; Tourette Syndrome; Transcranial Magnetic Stimulation
PubMed: 34643763
DOI: 10.1007/s00221-021-06229-y -
Frontiers in Neurology 2021Tourette syndrome (TS) is a neuropsychiatric disorder with multiple motor and vocal tics whose neural basis remains unclear. Diffusion tensor imaging (DTI) studies have...
Tourette syndrome (TS) is a neuropsychiatric disorder with multiple motor and vocal tics whose neural basis remains unclear. Diffusion tensor imaging (DTI) studies have demonstrated white matter microstructural alternations in TS, but the findings are inconclusive. In this study, we aimed to elucidate the most consistent white matter deficits in patients with TS. By systematically searching online databases up to December 2020 for all DTI studies comparing fractional anisotropy (FA) between patients with TS and healthy controls (HCs), we conducted anisotropic effect size-signed differential mapping (AES-SDM) meta-analysis to investigate FA differences in TS, as well as performed meta-regression analysis to explore the effects of demographics and clinical characteristics on white matter abnormalities among TS. A total of eight datasets including 168 patients with TS and 163 HCs were identified. We found that TS patients showed robustly decreased FA in the corpus callosum (CC) and right inferior longitudinal fasciculus (ILF) compared with HCs. These two regions preserved significance in the sensitivity analysis. No regions of increased FA were reported. Meta-regression analysis revealed that age, sex, tic severity, or illness duration of patients with TS were not linearly correlated with decreased FA. Patients with TS display deficits of white matter microstructure in the CC and right ILF known to be important for interhemispheric connections as well as long association fiber bundles within one hemisphere. Because the results reported in the primary literature were highly variable, future investigations with large samples would be required to support the identified white matter changes in TS.
PubMed: 34566829
DOI: 10.3389/fneur.2021.659250 -
Brain and Behavior Sep 2021Lower urinary tract symptoms (LUTS), such as voiding symptoms, overactive bladder, and interstitial cystitis, and anxiety disorders are often comorbid conditions in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Lower urinary tract symptoms (LUTS), such as voiding symptoms, overactive bladder, and interstitial cystitis, and anxiety disorders are often comorbid conditions in patients. However, the existing evidence regarding the rates and nature of the co-occurrence of these conditions has not been systematically evaluated. The aim of this study was to examine these relationships.
METHODS
We conducted a systematic review and meta-analysis to examine the relationship between LUTS and anxiety. We searched for articles published from January 1990 to July 2019 in PubMed, CENTRAL, PsycINFO, and Google Scholar. Outcomes were anxiety-related disorders and symptoms (clinically significant anxiety) and LUTS. We performed random-effects meta-analyses, inspected funnel plots, and applied the Egger's test to evaluate publication bias. We followed PRISMA guidelines and recorded our protocol on PROSPERO (ID = CRD42019118607).
RESULTS
We identified 814 articles, of which 94 fulfilled inclusion criteria, and 23 had sufficient data for meta-analysis. The odds ratio (OR) for clinically significant anxiety among individuals with LUTS was 2.87 (95% CI: 2.38,3.46, p < .001). The OR for LUTS among individuals with clinically significant anxiety was 2.87 (95% CI: 1.07,7.74, p < .001), although very few studies examined this relationship. A large value of I index suggests high heterogeneity between studies.
CONCLUSION
The results demonstrate a significant association between clinically significant anxiety and LUTS in both females and males. There were limited studies on younger individuals and on individuals ascertained for clinically significant anxiety, which should motivate further study in these areas. Understanding the co-occurrence of these conditions will lead to better prevention and interventions to ameliorate the progression of the symptoms and improve the quality of life. A thorough assessment of anxiety may provide more optimal care for LUTS patients.
Topics: Anxiety; Anxiety Disorders; Female; Humans; Lower Urinary Tract Symptoms; Male; Quality of Life; Urinary Bladder, Overactive
PubMed: 34402598
DOI: 10.1002/brb3.2268 -
Parkinsonism & Related Disorders Aug 2021To guide the neurologist and neurophysiologist with interpretation and implementation of clinical neurophysiological examinations, we aim to provide a systematic review... (Comparative Study)
Comparative Study
INTRODUCTION
To guide the neurologist and neurophysiologist with interpretation and implementation of clinical neurophysiological examinations, we aim to provide a systematic review on evidence of electrophysiological features used to differentiate between hyperkinetic movement disorders.
METHODS
A PRISMA systematic search and QUADAS quality evaluation has been performed in PubMed to identify diagnostic test accuracy studies comparing electromyography and accelerometer features. We included papers focusing on tremor, dystonia, myoclonus, chorea, tics and ataxia and their functional variant. The features were grouped as 1) basic features (e.g., amplitude, frequency), 2) the influence of tasks on basic features (e.g., entrainment, distraction), 3) advanced analyses of multiple signals, 4) and diagnostic tools combining features.
RESULTS
Thirty-eight cross-sectional articles were included discussing tremor (n = 28), myoclonus (n = 5), dystonia (n = 5) and tics (n = 1). Fifteen were rated as 'high quality'. In tremor, the basic and task-related features showed great overlap between clinical tremor syndromes, apart from rubral and enhanced physiological tremor. Advanced signal analyses were best suited for essential, parkinsonian and functional tremor, and cortical, non-cortical and functional jerks. Combinations of electrodiagnostic features could identify essential, enhanced physiological and functional tremor.
CONCLUSION
Studies into the diagnostic accuracy of electrophysiological examinations to differentiate between hyperkinetic movement disorders have predominantly been focused on clinical tremor syndromes. No single feature can differentiate between them all; however, a combination of analyses might improve diagnostic accuracy.
Topics: Accelerometry; Cross-Sectional Studies; Diagnosis, Differential; Dystonia; Electromyography; Humans; Hyperkinesis; Movement Disorders; Myoclonus; Neurophysiology; Tics; Tremor
PubMed: 34362669
DOI: 10.1016/j.parkreldis.2021.07.033 -
Journal of Psychopharmacology (Oxford,... Sep 2021Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary muscle movements manifesting as motor and vocal tics. In the majority, tics are... (Comparative Study)
Comparative Study
BACKGROUND
Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary muscle movements manifesting as motor and vocal tics. In the majority, tics are manageable without medication. Where tics cause discomfort or impair function, behavioural or pharmaceutical treatments may be considered.
AIMS
To provide a meticulous examination of the quality of evidence for the current pharmacological treatments for TS.
METHODS
PubMed and Google Scholar were searched to identify randomised, placebo-controlled trials (RCTs) of aripiprazole, risperidone, clonidine, guanfacine, haloperidol, pimozide, tiapride and sulpiride for the treatment of tics in children and adults with TS. Quality of reporting and risk of bias were assessed against the CONSORT checklist and Cochrane risk of bias criteria, respectively.
RESULTS
Seventeen RCTs were identified. Response rates reached 88.6% for aripiprazole, 68.9% for clonidine, 62.5% for risperidone and 19% for guanfacine. Statistically significant improvements were reported for all medications compared to placebo in at least one study and for at least one measure of tic severity. Most studies predated the CONSORT and Cochrane criteria and did not score highly when assessed on these measures.
CONCLUSIONS
There are relatively few placebo-controlled trials of commonly prescribed medications. Studies are often of poor quality and short duration. There is evidence for the efficacy of each medication, but no drug is clearly superior. Clonidine and guanfacine are better tolerated than antipsychotics, but less effective. There is too little evidence to determine whether adults respond differently from children.
Topics: Adult; Age Factors; Antipsychotic Agents; Child; Humans; Patient Acuity; Randomized Controlled Trials as Topic; Research Design; Tourette Syndrome; Treatment Outcome
PubMed: 34286606
DOI: 10.1177/02698811211032445 -
Sensors (Basel, Switzerland) Jun 2021Monitoring of motor symptom fluctuations in Parkinson's disease (PD) patients is currently performed through the subjective self-assessment of patients. Clinicians... (Meta-Analysis)
Meta-Analysis
Monitoring of motor symptom fluctuations in Parkinson's disease (PD) patients is currently performed through the subjective self-assessment of patients. Clinicians require reliable information about a fluctuation's occurrence to enable a precise treatment rescheduling and dosing adjustment. In this review, we analyzed the utilization of sensors for identifying motor fluctuations in PD patients and the application of machine learning techniques to detect fluctuations. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten studies were included between January 2010 and March 2021, and their main characteristics and results were assessed and documented. Five studies utilized daily activities to collect the data, four used concrete scenarios executing specific activities to gather the data, and only one utilized a combination of both situations. The accuracy for classification was 83.56-96.77%. In the studies evaluated, it was not possible to find a standard cleaning protocol for the signal captured, and there is significant heterogeneity in the models utilized and in the different features introduced in the models (using spatiotemporal characteristics, frequential characteristics, or both). The two most influential factors in the good performance of the classification problem are the type of features utilized and the type of model.
Topics: Humans; Machine Learning; Parkinson Disease; Wearable Electronic Devices
PubMed: 34207198
DOI: 10.3390/s21124188 -
Toxicology Letters Oct 2021Due to threats posed by Chemical Warfare Agents (CWAs) and accidents with Toxic Industrial Chemicals (TICs), the need for highly effective skin decontamination remains...
Due to threats posed by Chemical Warfare Agents (CWAs) and accidents with Toxic Industrial Chemicals (TICs), the need for highly effective skin decontamination remains relevant. Reactive Skin Decontamination Lotion (RSDL), composed of Dekon 139 and 2,3-butanedione monoxime, has been shown highly effective against CWAs and TICs. This systematic review compares RSDL efficacy to other decontaminating agents. Online search engines PubMed, Web of Science, and Embase were explored, and all literature containing quantitative data, comparing RSDL to other decontaminating agents, investigated. Year of publication, type of study (in vitro or in vivo), model (animal or human), toxin tested, and result of each relevant article were recorded. In total, 15 relevant papers, comprising a total of 18 experimental models, were identified. Nine studies concluded that RSDL was the most effective decontaminant tested against the toxin of interest. Four studies concluded that RSDL was not the most effective decontaminant tested against the toxin of interest. The remaining 5 studies concluded RSDL displayed similar efficacy to at least one of the other decontaminating agents tested against the toxin of interest. There is substantial evidence supporting the efficacy of RSDL as a decontaminating agent. However, there remains to be insufficient data on this important topic, and limitations on the usefulness of current data, when applied to the broad array of potential exposures.
Topics: Administration, Cutaneous; Animals; Chemical Warfare Agents; Decontamination; Hazardous Substances; Humans; Skin; Skin Cream
PubMed: 34147606
DOI: 10.1016/j.toxlet.2021.06.010 -
Journal of the American Geriatrics... Jun 2021Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND/OBJECTIVES
Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation.
DESIGN
Systematic review and meta-analysis.
SETTING
MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020).
PARTICIPANTS AND INTERVENTIONS
Studies describing the accuracy or reliability of virtual compared with in-person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in-person cognitive test scores in adults.
MEASUREMENTS
Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal.
RESULTS
Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in-person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41-0.62) and 0.63 (95% CI 0.4-0.9), respectively. Videoconference-based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in-person cognitive assessments in a third study. No studies compared telephone with in-person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in-person cognitive assessments in >2 studies with extractable data for meta-analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment.
CONCLUSION
Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty.
Topics: Cognition Disorders; Humans; Mental Status and Dementia Tests; Neuropsychological Tests; Telecommunications; Telemedicine
PubMed: 33948937
DOI: 10.1111/jgs.17190 -
European Child & Adolescent Psychiatry Apr 2022Lower urinary tract symptoms (LUTS), e.g., urinary frequency, pressure, urgency, and overactive bladder syndrome, are commonly reported in children with... (Meta-Analysis)
Meta-Analysis
Lower urinary tract symptoms (LUTS), e.g., urinary frequency, pressure, urgency, and overactive bladder syndrome, are commonly reported in children with attention-deficit/hyperactivity disorder (ADHD). Understanding the co-occurrence of these conditions has implications regarding clinical approaches, treatments, and improved quality of life. We conducted a systematic review and meta-analysis to examine the relationships between LUTS and ADHD in children. We searched for articles published between January 1990 and July 2019, in PubMed, CENTRAL, and PsycNet. Two authors independently screened all articles and extracted data. We performed random-effect meta-analyses for ADHD with pooled outcomes for LUTS. We identified 119 relevant articles in the literature and 18 articles fulfilled the inclusion criteria for the systematic review, of which, 5 articles had sufficient data for meta-analysis. Examining ADHD among individuals with LUTS, the odds ratio was 2.99 (95% CI 1.13, 7.88, p < 0.001), compared to controls. In multiple studies, the mean overall score for LUTS, using a standardized measure, was significantly higher in patients with ADHD in comparison to controls, and the severity of ADHD was positively associated with the severity of LUTS. Younger age in children was correlated with a higher LUTS score. Different subtypes of urinary incontinence demonstrated differences in behavioral problems and psychiatric comorbidity. Sex differences in LUTS were not consistent across articles. Our results indicate clinically significant associations between ADHD and LUTS in children. Because LUTS and ADHD are common disorders in children, clinicians should be aware of these associations as they inform optimal assessment and treatment strategies.
Topics: Attention Deficit Disorder with Hyperactivity; Child; Comorbidity; Female; Humans; Male; Quality of Life
PubMed: 33635440
DOI: 10.1007/s00787-021-01736-3