Deaths from COVID-19 continue to rise, and this virus has asymmetric impacts on marginalized communities though specific impacts on sexual and gender minority communities are not well understood. ...From March 23 to June 20, 2020, in an online cross-sectional survey among 1380 US adults, we assessed physical symptoms, psychological symptoms, rumination, and perceived social support in order to describe differences between sexual and gender minority (n = 290) and cisgender heterosexual (n = 1090) respondents. Sexual and gender minority respondents had more frequent COVID-19-associated physical symptoms and depression and anxiety symptoms. Sexual and gender minorities had a significantly higher proportion of depression and anxiety scores exceeding the clinical concern threshold. Longitudinal studies on the physical and psychological impacts of COVID-19 among sexual and gender minority communities are needed to inform interventions to eliminate these disparities.
Purpose This report reveals the results of a multicenter, randomized, controlled study using transurethral prostate convective water vapor thermal energy to treat lower urinary tract symptoms ...associated with benign prostatic hyperplasia. Materials and Methods Men 50 years old or older with an International Prostate Symptom Score of 13 or greater, maximum flow rate of 15 ml per second or less and prostate size 30 to 80 cc were randomized 2:1 between thermal therapy with the Rezūm® System and control. Thermal water vapor was injected into the transition zone and median lobe as needed. The control procedure was rigid cystoscopy with simulated active treatment sounds. The primary end point compared International Prostate Symptom Score reduction at 3 months. Treatment subjects were followed for 12 months. Results There were 197 men randomized (active 136, control 61). Thermal therapy and control International Prostate Symptom Score was reduced by 11.2 ± 7.6 and 4.3 ± 6.9 respectively (p <0.0001). Treatment subject baseline International Prostate Symptom Score of 22 decreased at 2 weeks (18.6, p=0.0006) and by 50% or greater at 3, 6 and 12 months, p <0.0001. The peak flow rate increased by 6.2 ml per second at 3 months and was sustained throughout 12 months (p <0.0001). No de novo erectile dysfunction was reported. Adverse events were mild to moderate and resolved quickly. Conclusions Convective water vapor thermal therapy provides rapid and durable improvements in benign prostatic hyperplasia symptoms and preserves erectile and ejaculatory function. Treatment can be delivered in an office or hospital setting using oral pain medication and is applicable to all prostate zones including the median lobe.
Background: Prospective evidence on psychological outcomes for children with specific language impairments (SLI) is accumulating. To date, there has been no attempt to summarise what this evidence ...says about the strength of link between SLI and later child and adolescent emotional and behavioural (EB) outcomes.
Methods: We undertook a systematic review and meta‐analysis (following PRISMA guidelines and involving a literature search to June 2012 of seven databases, including MEDLINE and PsychAPA) of prospective, cohort studies of children with SLI and typical language development (TLD) reporting on the incidence and severity of EB problems later in childhood or adolescence.
Results: Nineteen follow‐up reports of eight cohorts with 553 SLI children and 1533 TLD controls were identified. Initial assessment was at 3–8.8 years of age and follow‐up duration from 2 to 12 years. Pooled across comparable studies, SLI children were about two times more likely to show disorder levels of overall internalising problems, overall externalising and ADHD problems than TLD children. Compared with the average TLD child (50 percentile), at follow‐up, the symptom severity of the average SLI child was at the 72 percentile (95% CI 65–79 percentile) on internalising symptoms, the 69 percentile (95% CI 63–74 percentile) on externalising symptoms and the 60 percentile (95% CI 52–68 percentile) on AHDH severity. The findings about risk to specific mental disorders and the severity of specific problems were inconclusive.
Conclusions: Relative to typical children, SLI children experience clinically important increases in the severity of diverse emotional, behavioural and ADHD symptoms and more frequently show a clinical level of these problems. The small number of studies included in pooled analysis and methodological heterogeneity reduce the precision and generalisability of the findings. Most studies do not account for initial levels of EB problems.
Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under investigation.
To compare the efficacy ...and safety of PAE and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPO at 2 yr of follow-up.
A randomised, open-label trial was conducted. There were 103 participants aged ≥40 yr with refractory LUTS/BPO.
PAE versus TURP.
International Prostate Symptoms Score (IPSS) and other questionnaires, functional measures, prostate volume, and adverse events were evaluated. Changes from baseline to 2 yr were tested for differences between the two interventions with standard two-sided tests.
The mean reduction in IPSS after 2 yr was 9.21 points after PAE and 12.09 points after TURP (difference of 2.88 95% confidence interval 0.04–5.72; p = 0.047). Superiority of TURP was also found for most other patient-reported outcomes except for erectile function. PAE was less effective than TURP regarding the improvement of maximum urinary flow rate (3.9 vs 10.23 ml/s, difference of –6.33 –10.12 to –2.54; p < 0.001), reduction of postvoid residual urine (62.1 vs 204.0 ml; 141.91 43.31–240.51; p = 0.005), and reduction of prostate volume (10.66 vs 30.20 ml; 19.54 7.70–31.38; p = 0.005). Adverse events were less frequent after PAE than after TURP (total occurrence n = 43 vs 78, p = 0.005), but the distribution among severity classes was similar. Ten patients (21%) who initially underwent PAE required TURP within 2 yr due to unsatisfying clinical outcomes, which prevented further assessment of their outcomes and, therefore, represents a limitation of the study.
Inferior improvements in LUTS/BPO and a relevant re-treatment rate are found 2 yr after PAE compared with TURP. PAE is associated with fewer complications than TURP. The disadvantages of PAE regarding functional outcomes should be considered for patient selection and counselling.
Prostatic artery embolisation is safe and effective. However, compared with transurethral resection of the prostate, its disadvantages regarding subjective and objective outcomes should be considered for individual treatment choices.
A marked improvement of lower urinary tract symptoms secondary to benign prostatic obstruction can be found 24 mo after prostatic artery embolisation (PAE), and the procedure is associated with fewer adverse events than transurethral resection of the prostate (TURP). However, improvements of subjective and objective outcomes are superior after TURP, and PAE might not represent a definitive treatment for a relevant proportion of patients. This should be considered for patient selection and counselling.
The role of orexin in Parkinson's disease Braun, Alisha; Manavis, Jim; Yamanaka, Akihiro ...
Journal of neuroscience research,
March 2024, 2024-Mar, 2024-03-00, 20240301, Letnik:
102, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Emerging evidence has implicated the orexin system in non‐motor pathogenesis of Parkinson's disease. It has also been suggested the orexin system is involved in the modulation of motor control, ...further implicating the orexin system in Parkinson's disease. Parkinson's disease is the second most common neurodegenerative disease with millions of people suffering worldwide with motor and non‐motor symptoms, significantly affecting their quality of life. Treatments are based solely on symptomatic management and no cure currently exists. The orexin system has the potential to be a treatment target in Parkinson's disease, particularly in the non‐motor stage. In this review, the most current evidence on the orexin system in Parkinson's disease and its potential role in motor and non‐motor symptoms of the disease is summarized. This review begins with a brief overview of Parkinson's disease, animal models of the disease, and the orexin system. This leads into discussion of the possible roles of orexin neurons in Parkinson's disease and levels of orexin in the cerebral spinal fluid and plasma in Parkinson's disease and animal models of the disease. The role of orexin is then discussed in relation to symptoms of the disease including motor control, sleep, cognitive impairment, psychological behaviors, and the gastrointestinal system. The neuroprotective effects of orexin are also summarized in preclinical models of the disease.
This review discusses the role of the orexin system in Parkinson's disease. It covers the role of orexin neurons, levels of orexin in the disease, neuroprotective properties of orexin, and the role of orexin in motor and non‐motor symptoms of the disease.
•This study aimed to update the former meta-analyses, and give an overview of the evidence from RCTs that focused on the efficacy of CBT for patients with somatoform disorders and medically ...unexplained physical symptoms.•It suggested that CBT is effective for somatoform disorders and MUPS by reducing physical symptoms, anxiety symptoms and depressive symptoms, improving physical functioning. The efficacy of CBT on alleviating somatic symptoms, anxiety and depressive symptoms were sustained on follow-up.•The results of subgroup analysis indicated that CBT was particularly beneficial to reduce the somatic symptoms when the session duration was over50 min, group based, and applied affective and good interpersonal strategies.
This systematic review and meta-analysis aimed to update and give an overview of the evidence from published literature that focused on the efficacy of cognitive behaviour therapy (CBT) in the management of somatoform disorders and medically unexplained physical symptoms (MUPS).
A comprehensive literature search was carried out through an electronic search of various databases on randomized controlled trials (RCTs). Primary outcome was the severity of somatic symptoms. Secondary outcomes were also measured based on severity of anxiety symptoms, severity of depressive symptoms, social functioning, physical functioning, doctor visits and the compliance with CBT, as well as follow-up visits. Effects were summarized by a random effects model using mean differences or odds ratio with 95% confidence intervals (CIs).
A total of 15 RCTs comprising 1671 patients with somatoform disorders or MUPS were enrolled in our systematic review and meta-analysis. The main analysis revealed that CBT could alleviate somatic symptoms: −1.31 (95% CI: −2.23 to −0.39, p = 0.005); anxiety symptoms: -1.89 (95% CI: −2.91 to −0.86; p < 0.001); depressive symptoms: −1.93 (95% CI: −3.56 to −0.31; p = 0.020); improve physical functioning: 4.19 (95% CI: 1.90 to 6.49; p < 0.001). The efficacy of CBT on alleviating somatic symptoms, anxiety and depressive symptoms were sustained on follow-up. CBT may not be effective in reducing the number of doctor visits: −1.23 (95% CI: −2.97 to 0.51; p = 0.166); and improving social functioning: 3.27 (95% CI: −0.08 to 6.63; p = 0.056). The results of subgroup analysis indicated that CBT was particularly beneficial when the duration of session was more than 50 min to reduce the severity of somatic symptoms from pre to post treatment time, when it was group based and applied affective and developed good interpersonal strategy during the treatment. Longer duration and frequency such as more than 10 sessions and 12 weeks treatments had significant effect on reduction of the comorbid symptoms including depression and anxiety, but they may underpin low level of compliance of CBT based treatments.
CBT is effective for the treatment of somatoform disorders and MUPS by reducing physical symptoms, psychological distress and disability.
Patients with epilepsy can experience different neuropsychiatric symptoms related (peri-ictal) or not (interictal) with seizures. Peri-ictal symptoms can precede (pre-ictal) or follow (post-ictal) ...the seizure, or even be the expression of the seizure activity (ictal). Neuropsychiatric symptoms, such as irritability and apathy, are among the most frequent pre-ictal manifestations. Ictal fear is reported by around 10% of patients with focal seizures, and sometimes can be difficult to differentiate from panic attacks. Post-ictal anxiety, mood and psychotic symptoms are also frequently reported by patients. Peri-ictal phenomena can occur as isolated symptom or as a cluster of symptoms, sometimes resembling a full-blown psychiatric syndrome. Actually, peri-ictal and interictal neuropsychiatric manifestations seem to be closely associated.
Background
Living with a progressive disease as muscular dystrophy (MD) can be challenging for the patient and the entire family from both emotional and practical point of view. We aimed to extend ...our previously published data about mental health in patients with MDs, also investigating coping profiles of both themselves and their parents. Furthermore, we wanted to verify whether psychological adaptation of patients can be predicted by coping strategies, taking also into account physical impairment, cognitive level and socioeconomic status.
Methods
112 patients with MDs, aged 2–32 were included. Their emotional and behavioural features were assessed through parent- and self-report Achenbach System for Empirically Based Assessment questionnaires and Strength and Difficulties Questionnaires. Development and Well-Being Assessment or Autism Diagnostic Observation Schedule were administered to confirm suspected diagnoses. Coping profile of both parents and patients was assessed through the self-administered New Italian Version of the Coping Orientation to the Problems Experienced questionnaire and its relationship with emotional/behavioural outcome was examined in linear regression analyses.
Results
High prevalence of intellectual disability and autism spectrum disorders was confirmed in Duchenne MD. Despite the high rate of internalizing symptomatology, we did not report higher rate of psychopathological disorders compared to general population. Parents tend to rely more on positive reinterpretation and less on disengagement coping. Avoidance coping, whether used by parents or patients, and ID, predicted increased emotional/behavioural problems.
Conclusions
Psychosocial interventions should address problems of anxiety and depression that people with MDs frequently experience, even through fostering parents’ and childrens’ engagement coping over disengagement coping.
Aim
Patients with heart failure experience multiple co‐occurring symptoms that lower their quality of life and increase hospitalization and mortality rates. So far, no heart failure symptom cluster ...study recruited patients from community settings or focused on symptoms predicting most clinical outcomes. Considering physical and psychological symptoms together allows understanding how they burden patients in different combinations. Moreover, studies predicting symptom cluster membership using variables other than symptoms are lacking. We aimed to (a) cluster heart failure patients based on physical and psychological symptoms and (b) predict symptom cluster membership using sociodemographic/clinical variables.
Design
Secondary analysis of MOTIVATE‐HF trial, which recruited 510 heart failure patients from a hospital, an outpatient and a community setting in Italy.
Methods
Cluster analysis was performed based on the two scores of the Hospital Anxiety‐Depression scale and two scores of the Heart‐Failure Somatic Perception Scale predicting most clinical outcomes. ANOVA and chi‐square test were used to compare patients' characteristics among clusters. For the predictive analysis, we split the data into a training set and a test set and trained three classification models on the former to predict patients' symptom cluster membership based on 11 clinical/sociodemographic variables. Permutation analysis investigated which variables best predicted cluster membership.
Results
Four clusters were identified based on the intensity and combination of psychological and physical symptoms: mixed distress (high psychological, low physical symptoms), high distress, low distress and moderate distress. Clinical and sociodemographic differences were found among clusters. NYHA‐class (New York Heart Association) and sleep quality were the most important variables in predicting symptom cluster membership.
Conclusions
These results can support the development of tailored symptom management intervention and the investigation of symptom clusters' effect on patient outcomes. The promising results of the predictive analysis suggest that such benefits may be obtained even when direct access to symptoms‐related data is absent.
Implications
These results may be particularly useful to clinicians, patients and researchers because they highlight the importance of addressing clusters of symptoms, instead of individual symptoms, to facilitate symptom detection and management. Knowing which variables best predict symptom cluster membership can allow to obtain such benefits even when direct access to symptoms‐data is absent.
Impact
Four clusters of heart failure patients characterized by different intensity and combination of psychological and physical symptoms were identified. NYHA class and sleep quality appeared important variables in predicting symptom cluster membership.
Reporting Method
The authors have adhered to the EQUATOR guidelines STROBE to report observational cross‐sectional studies.
Patient or Public Contribution
Patients were included only for collecting their data.
IMPORTANCE: Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm ...behaviors is limited. OBJECTIVE: To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year. INTERVENTIONS: Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed. MAIN OUTCOMES AND MEASURES: A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview. RESULTS: A total of 173 adolescents (163 94.8% female and 97 56.4% white; mean SD age, 14.89 1.47 years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 90.3% of 72 receiving DBT vs 51 78.9% of 65 receiving IGST with no suicide attempts; odds ratio OR, 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 56.9% of 72 receiving DBT vs 26 40.0% of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 54.2% of 72 receiving DBT vs 24 36.9% of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes. CONCLUSIONS AND RELEVANCE: The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01528020.
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