The mortality effects of COVID-19 are a critical aspect of the disease's impact. Years of life lost (YLLs) can provide greater insight than the number of deaths by conveying the shortfall in life ...expectancy and thus the age profile of the decedents.
We employed data regarding COVID-19 deaths in the USA by jurisdiction, gender and age group for the period 1 February 2020 through 11 July 2020. We used actuarial life expectancy tables by gender and age to estimate YLLs.
We estimated roughly 1.2 million YLLs due to COVID-19 deaths. The YLLs for the top six jurisdictions exceeded those for the remaining 43. On a per-capita basis, female YLLs were generally higher than male YLLs throughout the country.
Our estimates offer new insight into the effects of COVID-19. Our findings of heterogenous rates of YLLs by geography and gender highlight variation in the magnitude of the pandemic's effects that may inform effective policy responses.
Pediatric obsessive-compulsive disorder (OCD) can be enormously taxing for affected youth and their families; the distress, impairment, and family upheaval that it brings are well documented.
Both ...exposure-based cognitive-behavioral therapy (CBT) and pharmacological interventions are efficacious for reducing symptoms and functional impairment, producing mean effect sizes of g = 1.21 and g = 0.50 respectively.
These treatments-whether administered alone or in combination-form the backbone of our current suite of interventions. They have helped countless young people to restore functioning and lead healthy, productive lives. Despite this encouraging picture, long-term outcomes for children and adolescents with OCD remain poorly understood. Even for youth who receive high-quality evidence-based care, it is unclear what to expect down the road, and this gap in understanding creates challenges for clinical decision making as well as angst for parents who, quite understandably, want to know what the future holds for their children. Although CBT often is recommended as the frontline intervention for pediatric OCD
and parents routinely report preferring to begin with nonmedication options,
data to help patients and families make fully informed treatment decisions are scarce. Most would like to know the long-term outcomes associated with various treatment options, and this is a challenge given that the typical length of follow-up in CBT trials for pediatric OCD is 3 to 6 months-well short of a typical school year. The study by Ivarsson et al.
is therefore a much-needed advance for the field, offering a first view of long-term outcomes for youth with OCD treated with evidence-based treatments.
To review the assessment and treatment of treatment-refractory pediatric obsessive-compulsive disorder (OCD).
A PubMed search was conducted to identify controlled trials in pediatric OCD. In ...addition, practice guidelines for the treatment of adults and children were further reviewed for references in treatment-refractory OCD across the lifespan.
Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) were found to be effective treatments for pediatric OCD. Evidence suggests that CBT is also effective even in pediatric patients with refractory OCD symptoms. Antipsychotic augmentation, raising SSRI dosage, and several glutamate-modulating agents have some evidence of efficacy in adults with treatment-refractory OCD but have not been studied in pediatric populations.
Several pharmacological treatment options exist for children with refractory OCD symptoms. However, little evidence-based data exist to guide treatment for our most challenging pediatric OCD patients. Further research is needed to evaluate the efficacy/side effect profile of commonly used interventions in treatment-refractory pediatric OCD.
A critical aspect of the opioid epidemic is its effect on the ability of opioid-dependent parents to care for their children. In this article we investigate the association between the rate of ...removals of children from their homes and the opioid prescription rate in Florida counties during 2012-15. We performed a panel data analysis of opioid prescriptions that also controlled for the prescription rates of benzodiazepines and stimulants and for other risk factors for child removal. We found that a one-standard-deviation increase in the opioid prescription rate was associated with a 32 percent increase in the removal rate for parental neglect. When we obtained subset samples by percentage of white residents, the estimated relationships were approximately twice as large in the counties with the highest concentration of whites than in the counties with the lowest. Policy makers should consider the opioid epidemic's effects on child welfare when determining the appropriate public health response.
Objective: The current study examined the mediating role of distress tolerance on the association between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use ...among an ethno-racially diverse sample of young adults with current pain.
Methods: Participants were 141 undergraduate college students (78.7% female, M age = 22.50, SD = 5.41) who reported experiencing current pain.
Results: Results indicated that distress tolerance statistically significantly explained the relationship between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use after controlling for the variance accounted for by pain intensity, negative affectivity, gender, and other substance misuses.
Conclusions: Clinical implications are discussed in terms of targeting distress tolerance in the context of pain-related disability among young adults with pain who are at risk for opioid misuse.
The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a ...comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques.
A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (
= 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM).
Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables.
Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD.
This book describes training, supervision, and consultation with specialized cognitive behavior therapy (CBT) approaches, to ensure proper implementation across a variety of clinical contexts. ...Although CBT is sometimes portrayed as a single treatment method, the expert contributors in this volume describe a diverse collection of cognitive behavioral theories and techniques, such as exposure therapy, acceptance and commitment therapy, dialectical behavior therapy, and child behavior management. Contributors also review application guidelines for a variety of settings, including public schools, inpatient and outpatient medical settings, and diverse client populations representing different religious and spiritual beliefs, cultural and ethnic backgrounds, and sexual and gender minorities. For each approach and setting, contributors describe key concepts and techniques, explain the characteristics of good and bad training cases, survey common trainee mistakes and supervision obstacles, and also address common ethical issues. This book is intended for CBT trainees and practitioners who seek training in specialized areas, and those trained in other theoretical orientations who seek to adapt CBT techniques to their practice.
There is little information on the clinical presentation, functional impact, and psychiatric characteristics of misophonia in youth, an increasingly recognized syndrome characterized by high ...emotional reactivity to certain sounds and associated visual stimuli.
One-hundred-two youth (8–17 years-old) with misophonia and their parents were recruited and compared with 94 youth with anxiety disorders. Participants completed validated assessments of misophonia severity, quality of life, as well as psychiatric symptoms and diagnoses.
The most common misophonia triggers included eating (96 %), breathing (84 %), throat sounds (66 %), and tapping (54 %). Annoyance/irritation, verbal aggression, avoidance behavior, and family impact were nearly universal. Misophonia severity was associated with internalizing symptoms, child-reported externalizing behaviors, and poorer quality of life. High rates of comorbidity with internalizing and neurodevelopmental disorders were found. Quality of life and externalizing behaviors were not significantly different between misophonia and anxiety samples; internalizing symptoms and autism characteristics were significantly higher among youth with anxiety disorders.
This self-selected sample was characterized by limited multicultural diversity.
This study presents misophonia as a highly impairing psychiatric syndrome. Future interdisciplinary work should clarify the mechanisms of misophonia, establish evidence-based treatments, and extend these findings to randomly sampled and more culturally diverse populations.
•Misophonia was associated with substantial functional impairment in this sample•Anger/irritation, avoidance behavior, and impact to family life were nearly universal•Anxiety disorders were common (45%) as were current or past depressive disorders (46%)•Other common comorbidities were attention-deficit/hyperactivity disorder (21%) and tic disorders (13%)•Youth with misophonia had elevated internalizing symptoms and autism features (though less than youth with anxiety)
•The CBT-based intervention has a positive effect on health outcomes in diabetic patients.•CBT-based interventions might be significantly effective for blood glucose management in diabetic patients ...when it is delivered as the group-based and face-to-face treatment method.•CBT-based intervention might be significantly effective when the psycho-education, behavioral strategies, cognitive strategies, goal-setting, and homework assignment strategies are applied as central strategies.
This meta-analysis aims to update former meta-analyses from randomized controlled trials (RCT) focused on the efficacy of CBT for diabetes.
Five databases were searched for RCTs. Primary outcomes were glycated hemoglobin (HbA1c), fasting blood glucose (FBS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Secondary outcomes were depression, anxiety and distress symptoms, quality of life, sleep quality.
32 RCTs were included. Results revealed that CBT could reduce HbA1c: −0.14% (95% CI: −0.25 to −0.02%, P = 0.020); FBS: −15.48 mg/dl (95% CI: −30.16 to −0.81 mg/dl, P = 0.040); DBP: −2.88 mmHg (95% CI: −4.08 to −1.69 mmHg, P < 0.001); depression symptoms: −0.90 (95% CI: −1.22 to −0.57, P < 0.001); anxiety symptoms: −0.28 (95% CI: −0.50 to −0.07, P = 0.009); improve sleep quality: −0.92 (95% CI: −1.77 to −0.07, P = 0.030). Subgroup analysis indicated that CBT has siginificantly reduced HbA1c when delivered as a group-based and face-to-face method, and psycho-education, behavioral, cognitive, goal-setting, homework assignment strategies were applied as central strategies.
CBT was an effective treatment for diabetes patients, significantly reduced their HbA1c, FBS, DBP, depression and anxiety symptoms, and improved sleep quality.
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