Objective:
We evaluated the psychiatric comorbidities in adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder as ...a function of recalled symptom onset before and after the age of 7 years and whether the childhood attention-deficit/hyperactivity disorder symptoms were associated with psychiatric comorbidities.
Method:
In all, 214 adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder and 174 non-attention-deficit/hyperactivity disorder controls (aged 17–40 years) received psychiatric interviews to confirm their previous and current attention-deficit/hyperactivity disorder status and other psychiatric diagnoses. Demographics and risks of lifetime psychiatric disorders were compared among three groups: (1) attention-deficit/hyperactivity disorder, onset <7 years (early-onset); (2) attention-deficit/hyperactivity disorder, onset between 7 and 12 years (late-onset) and (3) non-attention-deficit/hyperactivity disorder controls. We also tested the effects of attention-deficit/hyperactivity disorder symptoms on the risk of later psychiatric comorbidities by Cox regression analyses.
Results:
Regardless of the age of onset, attention-deficit/hyperactivity disorder was significantly associated with a wide range of psychiatric comorbidities. There were similar comorbid patterns between early- and late-onset attention-deficit/hyperactivity disorder. Regardless of attention-deficit/hyperactivity disorder diagnosis, increased severity of attention-deficit/hyperactivity disorder symptoms was associated with higher risks of oppositional defiant disorder, conduct disorder, dysthymia and sleep disorder but not major depression, which was associated with the attention-deficit/hyperactivity disorder diagnosis.
Conclusion:
Our findings suggest that elevating the threshold of age of onset to 12 years in Diagnostic and Statistical Manual of Mental disorders, 5th edition would not over-diagnose attention-deficit/hyperactivity disorder in the adult population. Recalled childhood attention-deficit/hyperactivity disorder symptom severity was correlated with conduct disorder, oppositional defiant disorder, dysthymia and sleep disorders.
AbstractA small amount of research has been conducted in dealing with pavement shadow–affected cracks detection. Hence, this research aims to develop the illumination compensation model (ICM) and ...k-means clustering algorithm–based crack detection considering the influence of pavement shadows. First, the shadow area was divided into the umbra area and the penumbra area according to the illumination mechanism. Then, the shadow removal methods for different areas were analyzed separately. Since the intensity of the umbra shadow area changes homogeneously, the ICM approach can be a convenient way for shadow removal. While the intensity of penumbra area changes drastically, the cubic sample interpolation operation was conducted in advance, followed by ICM to finalize the shadow removal. After that, the k-means clustering algorithm was used to extract the crack region from the road background. Finally, based on the segmented binary crack image, the orientation, crack length, width, aspect ratio, area, and blocks were calculated for comprehensive crack-type classification and severity evaluation. Experiments were conducted to compare the performance of the proposed approach with traditional threshold segmentation, Poisson equation, contourlet transformation, and CrackTree, which demonstrated optimistic performance of the proposed method in terms of average precision (93.58%), recall (94.15%), and F-measure (93.86%).
Over half of Australia’s disease burden is due to morbidity, predominantly chronic conditions. Health-related quality of life instruments provide measures of morbidity and health status across ...different dimensions with EQ-5D being one of the most widely used. This study reports EQ-5D-5L general population norms for Queensland, Australia using the recently published Australian value set.
Population survey results from cross-sectional computer-assisted telephone interviews for Queensland adults in 2022 and 2023 were analyzed. EQ-5D-5L, as well as modifiable risk factors and sociodemographic data were collected. Using the recently published final Australian EQ-5D-5L value set, mean utility scores were calculated for Queensland, as well as by sociodemographic characteristics, including remoteness and socioeconomic area-based measures, and modifiable risk factors, such as smoking and body mass index. Results were combined with life tables to estimate quality-adjusted life expectancy (QALE) for subgroups with different lifestyles.
The EQ-5D utility score for the Queensland adult population was 0.916. Smoking daily, being obese or older in age, or living in the most disadvantaged socioeconomic area were associated with lower mean scores. QALE was 6.1 and 7.9 years shorter than the life expectancy for Queensland males and females, respectively, but generally, those who reported having healthier lifestyles had higher mean utility scores and thus longer QALE.
In addition to reporting Queensland EQ-5D-5L general population norms, these results demonstrate potential QALE gains in people following healthier lifestyles. The results support investment in prevention and may motivate further studies in this important area.
•The final Australian EQ-5D-5L value set was recently published. EQ-5D-3L population norms for Queensland, Australia were reported previously.•This article updated population norms for Queensland using the EQ-5D-5L, and by subgroups based on modifiable risk factors, including quality-adjusted life-years.•The article provides a benchmark for future economic evaluation using EQ-5D-5L for Queensland and similar Australian states and territories.
Podocytes are specialized actin-rich epithelial cells that line the kidney glomerular filtration barrier. The interface between the podocyte and the glomerular basement membrane requires integrins, ...and defects in either α3 or β1 integrin, or the α3β1 ligand laminin result in nephrotic syndrome in murine models. The large cytoskeletal protein talin1 is not only pivotal for integrin activation, but also directly links integrins to the actin cytoskeleton. Here, we found that mice lacking talin1 specifically in podocytes display severe proteinuria, foot process effacement, and kidney failure. Loss of talin1 in podocytes caused only a modest reduction in β1 integrin activation, podocyte cell adhesion, and cell spreading; however, the actin cytoskeleton of podocytes was profoundly altered by the loss of talin1. Evaluation of murine models of glomerular injury and patients with nephrotic syndrome revealed that calpain-induced talin1 cleavage in podocytes might promote pathogenesis of nephrotic syndrome. Furthermore, pharmacologic inhibition of calpain activity following glomerular injury substantially reduced talin1 cleavage, albuminuria, and foot process effacement. Collectively, these findings indicate that podocyte talin1 is critical for maintaining the integrity of the glomerular filtration barrier and provide insight into the pathogenesis of nephrotic syndrome.
REM sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment. The International RBD Study Group developed the RBD Symptom Severity Scale (RBDSSS) to assess symptom severity for ...clinical or research use. We assessed the psychometric and clinimetric properties of the RBDSSS in participants enrolled in the North American Prodromal Synucleinopathy (NAPS) Consortium for RBD.
NAPS participants, who have polysomnogram-confirmed RBD, and their bedpartners completed the RBDSSS (participant and bedpartner versions). The RBDSSS contains 8 questions to assess the frequency and severity/impact of (1) dream content, (2) vocalizations, (3) movements, and (4) injuries associated with RBD. Total scores for participant (maximum score = 54) and bedpartner (maximum score = 38) questionnaires were derived by multiplying frequency and severity scores for each question. The Clinical Global Impression Scale of Severity (CGI-S) and RBD symptom frequency were assessed by a physician during a semistructured clinical interview with participants and, if available, bedpartners. Descriptive analyses, correlations between overall scores, and subitems were assessed, and item response analysis was performed to determine the scale's validity.
Among 261 study participants, the median (interquartile range) score for the RBDSSS-PT (participant) was 10 (4-18) and that for the RBDSSS-BP (bedpartner) was 8 (4-15). The median CGI-S was 3 (3-4), indicating moderate severity. RBDSSS-BP scores were significantly lower in women with RBD (6 vs 9,
= 0.02), while there were no sex differences in RBDSSS-PT scores (8 vs 10.5,
= 0.615). Positive correlations were found between RBDSSS-PT vs RBDSSS-BP (Spearman
= 0.561), RBDSSS-PT vs CGI-S (
= 0.556), and RBDSSS-BP vs CGI-S (
= 0.491, all
< 0.0001). Item response analysis showed a high discriminatory value (range 1.40-2.12) for the RBDSSS-PT and RBDSSS-BP (1.29-3.47).
We describe the RBDSSS with adequate psychometric and clinimetric properties to quantify RBD symptom severity and good concordance between participant and bedpartner questionnaires and between RBDSSS scores and clinician-assessed global severity.
Lipoprotein(a) Lp(a) is a lipid molecule with atherogenic, inflammatory, thrombotic, and antifibrinolytic effects, whose concentrations are predominantly genetically determined. The association ...between Lp(a) and cardiovascular diseases (CVDs) has been well-established in numerous studies, and the ability to measure Lp(a) levels is widely available in the community. As such, there has been increasing interest in Lp(a) as a therapeutic target for the prevention of CVD. The impact of the currently available lipid-modifying agents on Lp(a) is modest and heterogeneous, except for the monoclonal antibody proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), which demonstrated a significant reduction in Lp(a) levels. However, the absolute reduction in Lp(a) to significantly decrease CVD outcomes has not been definitely established, and the magnitude of the effect of PCSK9i seems insufficient to directly reduce the Lp(a)-related CVD risk. Therefore, emerging therapies are being developed that specifically aim to lower Lp(a) levels and the risk of CVD, including RNA interference (RNAi) agents, which have the capacity for temporary and reversible downregulation of gene expression. This review article aims to summarize the effects of Lp(a) on CVD and to evaluate the available evidence on established and emerging therapies targeting Lp(a) levels, focusing on the potential reduction of CVD risk attributable to Lp(a) concentrations.
•Stakeholders overwhelmingly responded positively to drug checking technology.•Concerns about drug checking legality may be best addressed with policy changes.•Provider-client rapport may be a key ...factor in drug checking program success.
The opioid epidemic is one of the greatest public health crises of our times, driven increasingly by synthetic opioids such as fentanyl in the heroin supply. The implementation of drug checking in community settings has the potential to reduce the burden of fatal overdose, provide harm reduction education around safer drug consumption, and increase health access among people who use drugs (PWUD). To inform program development, we explored stakeholder opinions on drug checking technologies and implementation considerations.
This study, from the larger FORECAST study, utilized semi-structured in-depth interviews (n = 32) with a range of stakeholders in Baltimore, Boston, and Providence, many of whom were service providers. Stakeholders represented various roles and levels in organization types including harm reduction, public health, peer groups, and advocates. Interviews were audio recorded and transcribed. Data were coded using a priori codes; the coded text was analyzed for key themes.
Stakeholders responded positively to drug checking technology, though they shared apprehensions regarding service implementation. Primary topics requiring consideration included: utility in fentanyl endemic areas, trust and rapport between providers and PWUD, legality and policy concerns. Additional considerations included: technology accuracy, cost, ease of distribution, and service delivery setting.
Stakeholders overwhelmingly supported the concept of drug checking with the goals of providing needed risk reduction information and resources to PWUD and serving as a point for greater engagement in services. Programs need to be tailored to local circumstances. Law enforcement buy-in and policy change will be critical aspects of providing drug checking services.
•Of n = 563 people who use opioids non-medically in Baltimore, 30% recently (past 6 months) overdosed and 46% reported unmet mental health need.•Unmet mental health need was associated with greater ...odds of experiencing a recent overdose.•Woman gender played a significant role in the model, with woman gender associated with daily psychological pain and unmet mental health need.•Improving access to mental healthcare for people who use drugs (particularly women) may be an important harm reduction measure to prevent non-fatal overdose.
Significant associations exist between psychological pain, unmet mental health need, and frequency and severity of substance use among people who use drugs (PWUD), but no studies have analyzed the relationship of these variables to non-fatal overdose.
We conducted a cross-sectional survey of people who used opioids non-medically in Baltimore, Maryland (n = 563) as part of a broader harm reduction-focused evaluation (PROMOTE). The outcome was self-reported recent (past 6 months) non-fatal overdose; exposures of interest were recent self-reported unmet mental health need, experiencing daily “long-lasting psychological or mental pain” (vs. < daily), and daily multi-opioid use (vs. none/one opioid used). Path analysis was used to model direct relationships between these variables, personal characteristics (race, gender, experiencing homelessness, drug injection) and overdose.
30% of the sample had experienced a recent non-fatal overdose, 46% reported unmet mental health need, 21% reported daily psychological pain, and 62% used multiple types of opioids daily. After adjusting for covariates, daily multi-opioid use (aOR = 1.78, p = 0.03) and unmet mental health need (aOR = 2.05, p = 0.01) were associated with direct, significant increased risk of recent overdose. Significant pathways associated with increased odds of unmet mental health need included woman gender (aOR = 2.23, p = 0.003) and daily psychological pain (aOR = 4.14, p = 0.002). In turn, unmet mental health need associated was with greater odds of daily multi-opioid use (aOR = 1.57, p = 0.05).
Unmet mental heath need and daily psychological pain are common experiences in this sample of PWUD. Unmet mental health need appears on several pathways to overdose and associated risk factors; improving access to mental healthcare for PWUD (particularly women) expressing need may be an important harm reduction measure.
Background
Co‐use of benzodiazepines and opioids significantly increases fatal overdose risk, yet few studies have examined co‐use of these drugs when obtained both with and without a prescription. ...We examined associations of daily co‐use of prescribed benzodiazepines/tranquilizers (BZD/TRQ) and prescribed and nonprescribed opioids among people who use street opioids (PWUO).
Methods
PWUO (N = 417) were recruited from Baltimore City and neighboring Anne Arundel County, Maryland, and surveyed on sociodemographic characteristics, structural vulnerabilities, healthcare access and utilization, substance use, and overdose experiences. Multivariable logistic regression was used to identify factors associated with self‐reported co‐use.
Results
Participants were 46 years old on average, and predominantly Black (74%) males (62%). Daily co‐use was reported by 22%. In multivariable analyses, odds of co‐use were significantly higher among participants who did not have a high school degree/GED (adjusted odds ratio aOR: 1.71, 95% confidence interval CI: 1.02–2.88), endorsed receiving mental health treatment in the past 6 months (aOR: 2.13, 95% CI: 1.28–3.56), reported daily use of powdered cocaine (aOR: 3.57, 95% CI: 1.98–6.45), and synthetic cannabinoids (aOR: 3.11, 95% CI: 1.40–6.93). Odds of co‐use were significantly lower among Black participants compared to white participants (aOR: 0.39, 95% CI: 0.19–0.82).
Conclusions and Scientific Significance
Clinicians working with PWUO or who prescribe BZDs or opioids should screen patients who use cocaine or synthetic cannabinoids, have low level of educational attainment, or recently accessed mental health services, as these patients may be at higher risk for daily co‐use of BZD/TRQ and opioids, and therefore lethal overdose.
In this randomized trial in subjects between 15 and 65 years old, a new acellular pertussis vaccine was safe and had an efficacy of 92 percent against documented, symptomatic
Bordetella pertussis
...infections. Among controls, the incidence of pertussis was 370 per 100,000 person-years. Vaccination of adults and adolescents could prevent pertussis and reduce the transmission of
B. pertussis
to young children.
In subjects between 15 and 65 years old, a new acellular pertussis vaccine was safe and had an efficacy of 92 percent against documented, symptomatic
Bordetella pertussis
infections.
Bordetella pertussis
infects the human respiratory tract and in nonimmune persons causes whooping cough, a severe illness associated with prolonged cough.
1
,
2
The severity of illness varies with age, immune status (prior immunization or infection), and probably such factors as the extent of exposure and the virulence of the organism. Disease risk and severity are greatest in unimmunized infants.
3
–
5
During the past 50 years, routine pediatric pertussis immunization has dramatically decreased the pediatric disease burden.
1
,
2
In the United States, the annual incidence of pertussis fell from 157 per 100,000 persons in the prevaccine era to less than 1 . . .
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