bluuebunny/crossref_metadata_2025 huggingface dataset:
REM sleep behaviour disorder
Authors: Pérez-Carbonell Laura , Leschziner Guy
Published: February 2022

Parasomnias are undesirable physical events or experiences associated with sleep. Episodes are usually classified according the stage of sleep during or from which they occur. Non-rapid eye movement (NREM) parasomnias occur from deep NREM sleep and often involve complex behaviours that may appear purposeful but are not conscious or under deliberate control. There are a number of different types/presentations of NREM parasomnias. These may range from common manifestations such as sleeptalking, sleepwalking or night terrors, to the rarer sleep-related eating disorder or sexsomnia.
Clinical features can facilitate the differential diagnosis, but polysomnography may be needed, particularly to assess potential concomitant sleep disorders that might represent precipitating factors. Medical treatment is often not indicated, but clonazepam or antidepressants may be used in more severe cases. Safety aspects, treating concomitant sleep disorders and avoiding trigger factors are key aspects of management.
Other parasomnias
Authors: Gnoni Valentina , Leschziner Guy
Published: February 2022

Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by abnormal behaviours arising during REM sleep. Described for the first time in humans just over 30 years ago, RBD is a condition of increasing clinical and research interest.
Two forms of RBD have been identified: idiopathic (primary) and symptomatic (secondary). Idiopathic RBD may be the initial form of presentation of a neurodegenerative disorder. The secondary form of RBD is associated with an established neurological disorders, such as Parkinson’s disease (PD), dementia with Lewy bodies (DLB), multisystem atrophy (MSA) or narcolepsy.
The diagnosis of RBD can often be straightforward, but does require confirmation by polysomnography to avoid misdiagnosis. The diagnosis is important, due to potential risks to the patient and their bedpartner, but also because of prognostic implications.
Medications influencing sleep
Authors: Lyons Elaine , d’Ancona Grainne
Published: February 2022

Sleep disturbance affects 50% to 80% of all patients with psychiatric disorders. Slow-wave sleep (SWS) and rapid eye movement (REM) sleep have been of significant interest to neurologists, psychiatrists and psychologists; SWS because of its putative role in brain repair, detoxification, homeostatic maintenance and in cognitive function, and REM sleep because of its suggested involvement in memory, neurodevelopment and emotional regulation. To date, little is known about the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. Moreover, in clinical practice, sleep disturbance is still often regarded as an epiphenomenon of the primary psychiatric disorder.
Sleep disorders increase the risk of developing episodes of psychiatric disorders. Also, insomnia, defined as difficulty initiating or maintaining sleep resulting in daytime consequences, is common among psychiatric disorders. Several other potential comorbid sleep disorders, including OSA, restless leg syndrome (RLS), periodic limb movement disorder (PLMD), and REM behaviour disorder (RBD) are known to modulate psychiatric symptom expression.
It is increasingly recognised that sleep and psychiatric disorders may share a bidirectional relationship. Therefore, concurrent and aggressive management of sleep should be a pivotal part of the clinical management in all psychiatric disorders.
No License to Kill
Authors: Brenner Jay
Published: February 2022

Homicidal patients can be challenging to manage because they often have comorbid medical issues and mental health diagnoses. A thorough interview and exam can help to ascertain the best next steps to take with these individuals. Usually, this includes medical screening tests and involuntary commitment to a mental health facility.
Spiraling Out of Control
Authors: Grover Purva
Published: February 2022

In the last few years, the number of pediatric patients coming to the emergency department for mental health evaluation and assessment has increased dramatically. Unique aspects of their care include social demographics and assessment, family history, presenting symptoms, and risk factors. Unlike other patients, pediatric patients can be de-escalated by verbal methods, by distraction, by deflection, and sometimes by appropriately working with families at bedside. This chapter covers unique aspects of pediatric psychiatric emergencies. The author offers resources and some basic tips and tricks to handle these patients in the emergency department. The unique aspects of pediatric care will be highlighted. Statistics are provided regarding the scope of these situations in the emergency department.
“Everything Hurts and I’m Weak, Doc”
Authors: Krause Chadd K.
Published: February 2022

Somatic symptom disorders (SSD) are characterized by excessive thoughts, feelings, or behaviors about physical symptoms, such as pain, that result in significant distress and disruptions in daily activities and functioning. SSDs present a unique challenge for the emergency physician, whose responsibility is to evaluate for, exclude, and rapidly treat immediate threats to life, limb, and vision, because these disorders are associated with disproportionate and persistent thoughts related to symptoms that may or may not be accompanied by objective medical causes. Emergency department evaluation should include only the diagnostic testing that is necessary to exclude an emergency medical condition because unnecessary testing can be detrimental. Treatment requires an ongoing, multidisciplinary approach with behavioral and mindfulness therapies, and in some cases pharmacologic treatments.
Suicidal Ideation with Vague and Contradicting History
Authors: Nguyen Melinda , Moussa Mohamad
Published: February 2022

The DSM-5 definition of malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives. These external incentives can include obtaining goods and services, such as food and shelter, or avoiding responsibility, such as attending work or legal proceedings. Malingering can commonly be found in the emergency department, yet it is difficult not only to diagnose it definitively but also to confront the patient on the issue. Given that the prevalence of suspicion of malingering in patients who present to the emergency department with behavior consistent with malingering is 33%, with the prevalence of strong suspicion of malingering in 20% of patients, it is vital to be able to recognize the signs of malingering to optimize the care of patients and provide them with alternative actions.
Integrating Clinical and Empirical Approaches to Personality
Authors: Shedler Jonathan
Published: February 2022

There is a schism between science and practice in conceptualizing personality. Approaches derived from the research laboratory can strike clinical practitioners as clinically naïve. Approaches derived from clinical observation and theory can strike researchers as speculative and unfalsifiable. The Shedler-Westen Assessment Procedure (SWAP) for personality diagnosis and case formulation bridges the science–practice divide by combining the strengths of clinical and empirical methods. It relies on clinicians to do what clinicians do best: describe individual patients they know well. It relies on statistical methods to do what they do best: combine information optimally to maximize reliability and validity. This chapter discusses the use of the SWAP for personality diagnosis and case formulation, reviews evidence for reliability and validity, and describes an improved system for personality diagnosis that is both scientifically sound and clinically meaningful.
Mentalization-based Treatment
Authors: Drozek Robert P. , Henry Jonathan T.
Published: February 2022

This chapter provides a broad introduction to the theory, practice, and evidence base of mentalization-based treatment (MBT). “Mentalization” refers to the fundamental psychological capacity to “read,” access, and reflect on mental states (e.g., thoughts, emotions, desires, beliefs, attitudes) in oneself and other people. The mentalization-based theory of personality disorders is reviewed, with a focus on the relevance of mentalizing to the developmental experiences and functional challenges associated with personality disorders. The authors summarize the clinical indications for MBT, as well as existing research supporting MBT’s utility in addressing symptoms of borderline personality disorder, antisocial personality disorder, and adolescent self-injury. As a treatment, MBT works to strengthen patients’ ability to initiate and maintain mentalizing under circumstances of emotional and interpersonal stress. Key facets of MBT’s therapeutic approach are considered, including the structure and format of treatment, the therapeutic stance, clinical interventions, and working within the therapeutic relationship. A detailed case example is offered to illustrate the practical application of MBT’s therapeutic techniques.
Employing Psychodynamic Process-oriented Group Psychotherapy with Personality Disorders
Authors: Pollock Kenneth M. , Feinstein Robert E.
Published: February 2022

This chapter gives a brief history of how personality disorders (PDs) have been viewed and treated in both individual and group psychotherapy. Cognitive-behavioral group treatments have led to the development of structured programs, some of them theoretically eclectic, that treat homogenously diagnostic groups of PDs. However, before, during, and after the development of these programs, psychodynamic and existentially oriented groups have continued to treat personality traits and disorders in unstructured, diagnostically heterogeneous groups. This chapter presents a transtheoretical “friendly” psychodynamic model of group interventions. It employs the unique properties of groups and group strategies in the treatment of maladaptive personality traits and disorders, which are illustrated using clinical vignettes. Groups offer a wider range of intervention opportunities than individual therapy. Psychodynamic process-oriented group therapy focuses upon therapist-induced, group patient examination of here-and-now interactional processes. Groups are especially useful in treating patients with PDs who have dysfunctional needs to be other-validated instead of self-validating. Groups also facilitate the capacity to be psychologically present and empathize with others. They offer opportunities to practice repairing damaged relationships, as well as to develop new, meaningful, and rewarding interpersonal relationships. The importance of using countertransference to facilitate change and avoiding its pitfalls, in here-and-now groups, is also described. To further operationalize the use of the unique properties of groups, a toolbox of specific verbal interventions and a list of strategic group therapy tips are offered. In many ways, this chapter is a “How-to Manual” for conducting process-oriented group therapy with patients who have PDs.
Some Thoughts about Schizoid Dynamics
Authors: McWilliams Nancy
Published: February 2022

This chapter discusses inferential, phenomenologically oriented psychoanalytic understanding of people with schizoid tendencies. Patients with schizoid dynamics are more common than is typically thought, running the gamut from psychotically disturbed to enviably robust. The term “schizoid,” as used here, refers to the complex intrapsychic life of an introverted individual, rather than to the behavioral criteria for the DSM-5 diagnosis of schizoid personality disorder. High-functioning people with schizoid psychologies are found in the arts, the theoretical sciences, and the philosophical and spiritual disciplines. Their psychology may reflect a significant genetic predisposition toward a hypersensitive temperament and feelings of hyperpermeability. Because disruption of relationship with the few people to whom they feel authentically connected can be devastating, a common precipitant to seeking treatment is loss. Schizoid individuals can be remarkably attuned to unconscious thoughts, feelings, impulses, and nonverbal processes in others. Higher-functioning, interpersonally competent schizoid individuals tend to be attracted to psychoanalytic treatment. In psychotherapy, they can become conscious of dependent longings that stimulate defensive withdrawal and aware of a hunger for recognition of their subjectivity. A successful therapy involves the elaboration and acceptance of the self in the presence of an accepting, nonintrusive, responsive therapist. A therapist’s judicious self-disclosure can catalyze the therapy with schizoid clients because it may validate their subjective experience, which has often been dismissed as incomprehensible. Therapists must be aware, however, of the tendency of patients with schizoid dynamics to use the professional relationship as a substitute for developing intimate attachments in their daily life.
Narcissistic Personality Disorder
Authors: Gorun Alyson A. , Scherban Benjamin A. , Auchincloss Elizabeth L.
Published: February 2022

When we say that someone is a “narcissist,” we mean that they have an exaggerated sense of self-importance and are very self-involved. However, there is no agreement among clinicians or scientists as to how to formally diagnose narcissistic personality disorder (NPD). This chapter will provide an overview of NPD using clinical guidelines and experience, anecdotal reports, and the limited evidence-based research on this disorder. The topics covered include the epidemiology, common comorbidities, diagnostic considerations, psycho-social and cultural contributions, developmental origins and theories of narcissistic pathology, and biologic, neuropsychiatric, and genetic underpinnings of NPD. Typical transference and countertransference reactions that can occur during the treatment of NPD will also be discussed. Recommendations for various treatment approaches, and different treatment modalities for NPD will be reviewed.
Obsessive-compulsive Personality Disorder
Authors: Playfair Cynthia
Published: February 2022

Obsessive-compulsive personality disorder (OCPD) is one of the most common of all disorders and exists on a continuum from healthy to borderline to neurotic personality organization. Individuals with OCPD struggle with their concept of self and others, rigidly adhering to orderliness, perfectionism, and control. The “Personality Lane” model is a useful theoretical model for the early clinician to conceptualize and diagnose personality disorders. Clinical assessment of OCPD includes an interview, gathering collateral information from others, and psychometric tests when necessary. Obsessive-compulsive disorder (OCD) is often clinically confused and co-occurs with OCPD; however, it requires a vastly different treatment approach. A two-part treatment strategy first involves establishing trust and a relational base, then clarifying distorted thought patterns and interpreting sadomasochistic binds. While more data is needed, psychodynamic psychotherapy (PDP) and cognitive-behavioral therapy (CBT) are the two most common forms of therapy offered to OCPD patients.
Mental state examination
Authors: O'Dwyer Anne-Marie , Campion Mariel
Published: February 2022

The mental state examination (MSE) is equivalent to the ‘physical examination’ in medical practice. It is the examiner’s observation of the person’s current behaviour, in contrast to the history, which is the patient’s account. The two usually, but not always, coincide. For example, a person may say they are not hearing voices but may stop in mid-sentence during the interview to look around suspiciously as if responding to voices. Being able to accurately record these complex behaviours objectively requires:
• Knowledge of a well-learned structure for the examination.
• An ability to manage sometimes challenging circumstances.
• Knowledge of key elements of mental illness.
This chapter provides the knowledge needed for conducting a mental state examination, including:
• Key headings.
• Appearance and behaviour, speech, mood, thought form and content, perception, cognition, and insight.
• Suggestions for specific areas, including thoughts about self-harm or suicide.
• Structures for cognition and insight.
Practical tips include:
• A mnemonic and illustration for MSE structure.
• A grid to guide questions on thoughts of self-harm.
Psychiatry of intellectual disability (ID)
Authors: O'Dwyer Anne-Marie , Campion Mariel
Published: February 2022

This chapter discusses key information about the psychiatry of intellectual disability (ID). It is focused on the mental health needs of people with intellectual disability. The terms used to describe intellectual (learning) disability are reviewed together with the concept of intellectual developmental disorders (IDD)—a concept of neuro-developmental disorders with global impairment in general intellectual functioning including planning, judgement, learning, and abstract thinking. People with ID present with physical and mental illness, and it is important to be aware of the impact of ID on these presentations.
Key topics include:
• What is meant by ID.
• Causes and co-morbidities of ID.
• The impact ID may have on presentations of mental and physical illness.
• How to identify and manage challenging behaviours.
• Principles of intervention in ID.
Practical tips include:
• Key items to consider in deterioration of behaviour.
• Strategies for the management of challenging behaviour.
• Key behaviours (and pitfalls) in assessment in ID.
Combination of BMI1 and MAPK/ERK inhibitors is effective in medulloblastoma
Authors: Badodi Sara , Pomella Nicola , Lim Yau Mun , Brandner Sebastian , Morrison Gillian , Pollard Steven M , Zhang Xinyu , Zabet Nicolae Radu , Marino Silvia
Published: February 2022

Background

Epigenetic changes play a key role in the pathogenesis of medulloblastoma (MB), the most common malignant pediatric brain tumor.

Methods

We explore the therapeutic potential of BMI1 and MAPK/ERK inhibition in BMI1High;CHD7Low MB cells and in a preclinical xenograft model.

Results

We identify a synergistic vulnerability of BMI1High;CHD7Low MB cells to a combination treatment with BMI1 and MAPK/ERK inhibitors. Mechanistically, CHD7-dependent binding of BMI1 to MAPK-regulated genes underpins the CHD7-BMI1-MAPK regulatory axis responsible of the antitumour effect of the inhibitors in vitro and in a preclinical mouse model. Increased ERK1 and ERK2 phosphorylation activity is found in BMI1High;CHD7Low G4 MB patients, raising the possibility that they could be amenable to a similar therapy.

Conclusions

The molecular dissection of the CHD7-BMI1-MAPK regulatory axis in BMI1High;CHD7Low MB identifies this signature as a proxy to predict MAPK functional activation, which can be effectively drugged in preclinical models, and paves the way for further exploration of combined BMI1 and MAPK targeting in G4 MB patients.
Serologic and Cytokine Signatures in Children With Multisystem Inflammatory Syndrome and Coronavirus Disease 2019
Authors: Lapp Stacey A , Abrams Joseph , Lu Austin T , Hussaini Laila , Kao Carol M , Hunstad David A , Rosenberg Robert B , Zafferani Marc J , Ede Kaleo C , Ballan Wassim , Laham Federico R , Beltran Yajira , Hsiao Hui-Mien , Sherry Whitney , Jenkins Elan , Jones Kaitlin , Horner Anna , Brooks Alyssa , Bryant Bobbi , Meng Lu , Hammett Teresa A , Oster Matthew E , Bamrah-Morris Sapna , Godfred-Cato Shana , Belay Ermias , Chahroudi Ann , Anderson Evan J , Jaggi Preeti , Rostad Christina A
Published: February 2022

Background

The serologic and cytokine responses of children hospitalized with multisystem inflammatory syndrome (MIS-C) vs coronavirus disease 2019 (COVID-19) are poorly understood.

Methods

We performed a prospective, multicenter, cross-sectional study of hospitalized children who met the Centers for Disease Control and Prevention case definition for MIS-C (n = 118), acute COVID-19 (n = 88), or contemporaneous healthy controls (n = 24). We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD) immunoglobulin G (IgG) titers and cytokine concentrations in patients and performed multivariable analysis to determine cytokine signatures associated with MIS-C. We also measured nucleocapsid IgG and convalescent RBD IgG in subsets of patients.

Results

Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG than children with acute COVID-19 (median, 2783 vs 146; P < .001), and titers correlated with nucleocapsid IgG. For patients with MIS-C, RBD IgG titers declined in convalescence (median, 2783 vs 1135; P = .010) in contrast to patients with COVID-19 (median, 146 vs 4795; P < .001). MIS-C was characterized by transient acute proinflammatory hypercytokinemia, including elevated levels of interleukin (IL) 6, IL-10, IL-17A, and interferon gamma (IFN-γ). Elevation of at least 3 of these cytokines was associated with significantly increased prevalence of prolonged hospitalization ≥8 days (prevalence ratio, 3.29 [95% CI, 1.17–9.23]).

Conclusions

MIS-C was associated with high titers of SARS-CoV-2 RBD IgG antibodies and acute hypercytokinemia with IL-6, IL-10, IL-17A, and IFN-γ.
The NAC factor LpNAL delays leaf senescence by repressing two chlorophyll catabolic genes in perennial ryegrass
Authors: Yu Guohui , Xie Zheni , Lei Shanshan , Li Hui , Xu Bin , Huang Bingru
Published: February 2022

Expression of chlorophyll (Chl) catabolic genes during leaf senescence is tightly controlled at the transcriptional level. Here, we identified a NAC family transcription factor, LpNAL, involved in regulating Chl catabolic genes via the yeast one-hybrid system based on truncated promoter analysis of STAYGREEN (LpSGR) in perennial ryegrass (Lolium perenne L.). LpNAL was found to be a transcriptional repressor, directly repressing LpSGR as well as the Chl b reductase gene, NONYELLOWING COLORING1. Perennial ryegrass plants over-expressing LpNAL exhibited delayed leaf senescence or stay-green phenotypes, whereas knocking down LpNAL using RNA interference accelerated leaf senescence. Comparative transcriptome analysis of leaves at 30 d after emergence in wild-type, LpNAL-overexpression, and knock-down transgenic plants revealed that LpNAL-regulated stay-green phenotypes possess altered light reactions of photosynthesis, antioxidant metabolism, ABA and ethylene synthesis and signaling, and Chl catabolism. Collectively, the transcriptional repressor LpNAL targets both Chl a and Chl b catabolic genes and acts as a brake to fine-tune the rate of Chl degradation during leaf senescence in perennial ryegrass.
3D printed collagen/silk fibroin scaffolds carrying the secretome of human umbilical mesenchymal stem cells ameliorated neurological dysfunction after spinal cord injury in rats
Authors: Chen Chong , Xu Hai-Huan , Liu Xiao-Yin , Zhang Yu-Sheng , Zhong Lin , Wang You-Wei , Xu Lin , Wei Pan , Chen Ya-Xing , Liu Peng , Hao Chen-Ru , Jia Xiao-Li , Hu Nan , Wu Xiao-Yang , Gu Xiao-Song , Chen Li-Qun , Li Xiao-Hong
Published: February 2022

Although implantation of biomaterials carrying mesenchymal stem cells (MSCs) is considered as a promising strategy for ameliorating neural function after spinal cord injury (SCI), there are still some challenges including poor cell survival rate, tumorigenicity and ethics concerns. The performance of the secretome derived from MSCs was more stable, and its clinical transformation was more operable. Cytokine antibody array demonstrated that the secretome of MSCs contained 79 proteins among the 174 proteins analyzed. Three-dimensional (3D) printed collagen/silk fibroin scaffolds carrying MSCs secretome improved hindlimb locomotor function according to the Basso–Beattie–Bresnahan scores, the inclined-grid climbing test and electrophysiological analysis. Parallel with locomotor function recovery, 3D printed collagen/silk fibroin scaffolds carrying MSCs secretome could further facilitate nerve fiber regeneration, enhance remyelination and accelerate the establishment of synaptic connections at the injury site compared to 3D printed collagen/silk fibroin scaffolds alone group according to magnetic resonance imaging, diffusion tensor imaging, hematoxylin and eosin staining, Bielschowsky’s silver staining, immunofluorescence staining and transmission electron microscopy. These results indicated the implantation of 3D printed collagen/silk fibroin scaffolds carrying MSCs secretome might be a potential treatment for SCI.
Controversies in rheumatology: imaging of enthesitis in spondyloarthritis—does it mean anything for treatment decisions?
Authors: Balint Peter V , Poddubnyy Denis
Published: February 2022

Enthesitis is considered a hallmark manifestation of spondyloarthritis including axial spondyloarthritis and psoriatic arthritis. Detection of enthesitis might be challenging in both diagnostic and classification processes. In this debate, we discuss the controversy on the role of imaging in the detection of enthesitis including the relevance for treatment decisions in spondyloarthritis.
Examining mathematical creativity of prospective mathematics teachers through problem posing
Authors: Emre-Akdoğan Elçin
Published: February 2022

Students’ use of problem posing is an assessment tool for evaluating mathematical creativity, and it plays a substantial role in creative tasks. Integrating problem-posing tasks into a curriculum is beneficial for teaching and learning mathematics. The Photo-Math Project is an example of problem posing in terms of generating new problems. This study aimed to explore mathematical creativity in the problem posing of prospective mathematics teachers in the context of Photo-Math Projects. Data were collected from focus group interviews and Photo-Math Projects conducted in a calculus course for 22 first-year students studying at a mathematics education department in Turkey. The content of the calculus course included the function, limit and derivative concepts. Participants completed their Photo-Math Projects in 8 weeks. The challenges encountered while generating problems resulted in prospective mathematics teachers posing problems creatively. Sixteen prospective mathematics teachers were identified at the first and second levels of creativity, representing the domain-specific algorithm and the domain-specific algorithm and applications of definitions, respectively. Only four prospective mathematics teachers posed problems at the third level of creativity, representing the theoretical aspects of mathematical constructs such as theorems and definitions. In conclusion, the mathematical creativity that we assessed through students’ use of problem posing depends on students’ previous experiences.
Gestational Cd Exposure in the CD-1 Mouse Sex-Specifically Disrupts Essential Metal Ion Homeostasis
Authors: Jackson Thomas W , Baars Oliver , Belcher Scott M
Published: February 2022

In CD-1 mice, gestational-only exposure to cadmium (Cd) causes female-specific hepatic insulin resistance, metabolic disruption, and obesity. To evaluate whether sex differences in uptake and changes in essential metal concentrations contribute to metabolic outcomes, placental and liver Cd and essential metal concentrations were quantified in male and female offspring perinatally exposed to 500 ppb CdCl2. Exposure resulted in increased maternal liver Cd+2 concentrations (364 µg/kg) similar to concentrations found in non-occupationally exposed human liver. At gestational day (GD) 18, placental Cd and manganese concentrations were significantly increased in exposed males and females, and zinc was significantly decreased in females. Placental efficiency was significantly decreased in GD18-exposed males. Increases in hepatic Cd concentrations and a transient prenatal increase in zinc were observed in exposed female liver. Fetal and adult liver iron concentrations were decreased in both sexes, and decreases in hepatic zinc, iron, and manganese were observed in exposed females. Analysis of GD18 placental and liver metallothionein mRNA expression revealed significant Cd-induced upregulation of placental metallothionein in both sexes, and a significant decrease in fetal hepatic metallothionein in exposed females. In placenta, expression of metal ion transporters responsible for metal ion uptake was increased in exposed females. In liver of exposed adult female offspring, expression of the divalent cation importer (Slc39a14/Zip14) decreased, whereas expression of the primary exporter (Slc30a10/ZnT10) increased. These findings demonstrate that Cd can preferentially cross the female placenta, accumulate in the liver, and cause lifelong dysregulation of metal ion concentrations associated with metabolic disruption.
Making It Through March
Authors: Kennedy Maureen Shawn
Published: February 2022

After a bleak winter, the hopefulness of spring is just around the corner.
Adverse Childhood Experiences as Public Health Threat
Authors: SmithBattle Lee , Rariden Christina , Cibulka Nancy , Loman Deborah G.
Published: February 2022

Toxic stress has long-term effects on health and well-being.
Optimizing Older Adults' Medication Use
Authors: Zonsius Mary C. , Myftari Klodiana , Newman Michelle , Emery-Tiburcio Erin E.
Published: February 2022

This article is the third in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive.

The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
Preterm Delivery Is a Lifelong Risk Factor for Hypertension
Authors: Rosenberg Karen
Published: February 2022

According to this study:

Compared with women who delivered full term, those who had a preterm delivery or an extremely preterm delivery had a more than 1.6-fold risk and 2.2-fold risk of hypertension, respectively, within the next 10 years, even after adjustment for potential confounders.

Early evaluation and long-term risk reduction and monitoring for hypertension are recommended for women who have a history of preterm delivery.
Statin Use Associated with Diabetes Progression
Authors: Rosenberg Karen
Published: February 2022

According to this study:

In a large national cohort study, the use of statins was associated with increased risks of escalation of diabetes treatment and hyperglycemic complications.

The cardiovascular benefits of statins must be weighed against the risk of diabetes progression in patients with diabetes.
‘How Can Acute Care Recover from the Pandemic?’
Authors: McSpedon Corinne
Published: February 2022

A timely conversation with four nurse leaders.
Factors Affecting Slip Progression After In Situ Screw Fixation of Stable Slipped Capital Femoral Epiphysis
Authors: Makarewich Christopher A. , Wait Eric S. , Fedorak Graham T. , MacWilliams Bruce A.
Published: February 2022

Background:

Slip progression after in situ fixation of slipped capital femoral epiphysis (SCFE) has been reported as occurring in up to 20% of patients. We review SCFE treated with in situ single screw fixation performed at 2 hospitals over a 15-year period to determine the factors associated with slip progression.

Methods:

This case-control study reviews SCFE treated with in situ single cannulated screw fixation with minimum follow up of 1 year and full closure of the affected physis. Slip progression (failure) was defined as worsening of the Southwick slip angle of 10 or more degrees or revision surgery for symptomatic slip progression. Univariate and multivariate analyses were performed comparing success and failure groups for patient characteristics, screw type and position, and radiographic measurements.

Results:

Ninety three patients with 108 slips met all criteria, with 15 hips (14%) classified as having slip progression (failure). All failures had 3 threads or fewer across the physis. Five hips had 2 threads across the physis, and 4 of the 5 were classified as failures. Lower modified Oxford bone scores were found in the failure group, though the difference was small (0.9, P=0.013). Failure was also associated with partially threaded screws (P=0.001). Failed hips were associated with lower initial Southwick angles (32.8 degrees) than successful hips (40.4 degrees) (P=0.047). In the stepwise model for multivariate regression, 4 factors were identified as significant, with lower initial number of threads (P<0.0001), mild initial Southwick category (P=0.0050), male sex (P=0.0061), and partially threaded screw type (P=0.0116) predicting failure.

Conclusion:

This study is the largest to date evaluating risk factors for slip progression after SCFE fixation, and the first to consider revision surgery for symptomatic slip progression. For stable SCFE, we demonstrate that 4 threads across the physis with a fully threaded screw of 6.5 mm diameter or greater was sufficient to avoid slip progression. We provide a risk stratification for progression of slip showing that in some cases 3 threads across the physis may be sufficient.

Level of Evidence:

Level III—case-control study.
Does the Skeletal Phenotype of Osteogenesis Imperfecta Differ for Patients With Non-COL1A1/2 Mutations? A Retrospective Study in 113 Patients
Authors: Zerfu Tewodros , Yong Bicheng , Harrington Jennifer , Howard Andrew
Published: February 2022

Background:

Osteogenesis imperfecta (OI) is a heritable disease characterized by bone fragility and other extra skeletal manifestations. Most patients with OI have mutations in the COL1A1 or COL1A2 genes. However, a significant minority of patients with clinical OI have non-COL1A1/2 mutations, which have become easier to detect with the use of genetic panels. Traditional understanding of OI pathogenesis was expanded because of these new mutations, and their phenotypic-genotypic relationship is largely unknown. We hypothesized that patients with non-COL1A1/2 mutations have different skeletal clinical presentations from those with OI caused by COL1A1/2 mutations.

Methods:

Patients were categorized into 4 groups according to our modified functional classification, namely, quantitative COL1A1/2 haploinsufficiency (group 1), qualitative COL1A1/2 dominant negative mutations (group 2), mutations indirectly affecting type I collagen synthesis, processing and posttranslational modification (group 3) and mutations altering osteoblast differentiation and function (group 4). Both group 3 and 4 were classified as non-COL1A1/2 mutation group.

Results:

Of 113 OI patients included, 51 had COL1A1/2 quantitative haploinsufficiency mutations (group 1), 39 had COL1A1/2 qualitative dominant negative mutations (group 2), and 23 patients had OI caused by mutations in 1 of 9 other noncollagen genes (groups 3/4). Patients with non-COL1A1/2 mutations (groups 3 and 4) have severe skeletal presentations. Specifically, OI patients with non-COL1A1/2 mutations experienced more perinatal fractures, vertebral compression fractures and had more long bone deformities. Although the occurrence of scoliosis was similar, the cobb angle was larger in the non-COL1A1/2 mutation group. Radial head dislocations, ossification of interosseous membrane, extraskeletal ossification, cervical kyphosis, and champagne glass deformity of the pelvis were more frequent in this group.

Conclusions:

The clinical phenotype of OI in patients with non-COL1A1/2 is severe and has unique features. This information is useful for clinical diagnosis and prognosis.

Level of Evidence:

Level III.
Nebivolol and incident cardiovascular events in hypertensive patients compared with nonvasodilatory beta blockers
Authors: Huck Daniel M. , Rosenberg Michael A. , Stauffer Brian L.
Published: February 2022

Objective:

Nonvasodilatory beta blockers are associated with inferior cardiovascular event reduction compared with other antihypertensive classes, and there is uncertainty about first-line use of beta blockers for hypertension in guidelines. The third generation vasodilatory beta blocker nebivolol has unique beneficial effects on central and peripheral vasculature. Our objective was to compare longitudinal cardiovascular outcomes of hypertensive patients taking nebivolol with those taking the nonvasodilatory beta blockers metoprolol and atenolol.

Methods:

We performed a retrospective cohort analysis of hypertensive adults in the University of Colorado health system, without preceding diagnosis of cardiovascular or cerebrovascular disease. The primary outcome was composite incident heart failure, stroke, myocardial infarction, angina, or coronary revascularization. Mahalanobis 1:2 distance matching and Cox proportional hazards regression was used. Matching and regression variables included baseline demographics, socioeconomic factors, medical insurance type, prescribing provider type, cardiovascular risk factors, Charlson comorbidity index, other medications, and follow-up duration.

Results:

After matching, patients were predominantly women (54%, 3085 of 5705) and non-Hispanic Caucasian (79%, 4534 of 5705), with median age of 58. In matched Cox regression analysis, nebivolol was associated with 17% reduction in incident cardiovascular events compared with all nonvasodilatory beta blockers [hazard ratio 0.83, 95% confidence interval (CI) 0.74–0.94, P 
= 0.004], and 24% reduction compared with metoprolol (hazard ratio 0.76, CI 0.66–0.87, P = 0.0001).

Conclusion:

The vasodilatory beta blocker nebivolol was associated with reduced incident cardiovascular events compared with nonvasodilatory beta blockers. Additional study of other beta blockers is necessary to determine if this is a vasodilatory beta blocker class effect or is specific to nebivolol.

Graphical abstract:

http://links.lww.com/HJH/B916
Underlying Factors of Health Insurance Use Among Blacks and Hispanics With Ambulatory Care–Sensitive Conditions
Authors: Dean Caress A. , Liu Echu , Wiltshire Jacqueline , Elder Keith
Published: February 2022

This study examined satisfaction with and confidence in understanding health insurance use among Blacks and Hispanic Americans with ambulatory care–sensitive conditions. Using the 2013-2016 Health Reform Monitoring Survey data sets, descriptive statistics and ordinary least-square regressions estimated the association between satisfaction and confidence scores and racial or ethnic groups with ambulatory care–sensitive conditions. Compared with their White counterparts, Black (β = −.13; 95% confidence interval [CI], −0.19 to −0.06) and Hispanic (β = −0.41; 95% CI, −0.48 to −0.33) participants' standardized confidence scores were significantly lower. Research is needed to identify factors that may enhance this population's confidence level.
High-Impact Health Care
Authors: Smithline Neil
Published: February 2022

High-impact health care is a new, employer-driven model that builds on existing employer-direct contracts for primary care centers of excellence and accountable care organizations. High-impact health care proceeds both cautiously and boldly. Cautiously by contracting with providers only after developing relationships with them and assessing their performance—to assure they are top performers; boldly by elevating member feedback to being a top criterion for determining which physicians remain in the network. Driven by the collective purchasing power of large employers, high-impact health care can provide employers a unique path to value-based care.
Epidermolysis Bullosa Pruriginosa in Two Siblings: A Case Report
Authors: Suwanthaweemeesuk Jongjin , Phunmanee Chatip , Singthong Sasathorn , Kwangsukstid Oraya , Supsrisunjai Chavalit
Published: February 2022

Introduction:

Epidermolysis bullosa pruriginosa (EBP) is a rare clinical subtype of inherited dystrophic epidermolysis bullosa (DEB) caused by type VII collagen mutations. The onset of EBP is variable and may present in late adulthood. The clinical features of EBP include prurigo-like papules, plaques, nodules, or linear configuration on the lower extremities.

Here, we reported two sisters with EBP.

Case presentation:

We identified two Thai sisters with mild to moderate form of EBP, which resulted from a shared glycine substitution (Gly2287Val) in COL7A1 identified by genomic sequencing.

Discussion:

The histology and molecular findings of both cases supported a diagnosis of dystrophic EBP, however, the clinical manifestations differ between both cases.

Conclusion:

Molecular testing is the key for the diagnosis of EBP due to nonspecific clinical manifestation and histologic findings, however, there is no clear genotype-phenotype correlation in EBP.
Maternal weight and gestational diabetes impacts on child health
Authors: Dalrymple Kathryn V. , El-Heis Sarah , Godfrey Keith M.
Published: February 2022

Purpose of review

To review recent evidence linking maternal body mass index and gestational diabetes mellitus (GDM) with offspring health outcomes.

Recent findings

It is now established that the rising prevalences of maternal obesity and GDM are both making substantial contributions to the growing burden of childhood obesity and associated disorders. Strengthening evidence also links maternal obesity with increased offspring risks of cardiovascular disease, nonalcoholic fatty liver disease, lower respiratory tract infections during infancy, wheezing illnesses, asthma and attention deficit hyperactivity disorder during childhood, and with higher risks of psychiatric disorders and colorectal cancer in adulthood. GDM has been associated with increased offspring risks of cardiovascular disease, childhood wheeze/asthma (but not allergic sensitization), and with high refractive error, attention deficit hyperactivity and psychiatric disorders from childhood onwards.

The long-term consequences of maternal obesity and GDM for the offspring in childhood and later adult life present major challenges for public health across the life course and for future generations. Tackling these challenges requires a systems-based approach to support achieving a healthy weight in young people prior to conception, alongside new insights into population based preventive measures against gestational diabetes.
Is It Time for the Mental Health Field to Consider Unplanned Discharge a Key Metric of Patient Safety?
Authors: Riblet Natalie B. , Gottlieb Daniel J. , Watts Bradley V. , Levis Maxwell , Scott Robert , Shiner Brian
Published: February 2022

Mental health lacks robust measures to assess patient safety. Unplanned discharge is common in mental health populations and associated with poor outcomes. Clarifying whether unplanned discharge varies across settings may highlight the need to develop measures to reduce harms associated with this event. Unplanned discharge rates were compared across the Department of Veterans Affairs' acute inpatient and residential mental health treatment settings from 2009 to 2019. Logistic regression was used to create facility-level, adjusted unplanned discharge rates stratified by setting. Results were described using central tendency. Among 847,661 acute inpatient discharges, the mean unplanned discharge rate was 3.3% (range, 0%–18%). Among 358,117 residential discharges, the mean unplanned discharge rate was 17.9% (range, 1%–48.3%). Unplanned discharge is a marked problem in mental health, with large variation across treatment settings. Unplanned discharge should be measured as part of patient safety efforts.
Application of Rapid Digital Locating Technology in Emergency Treatment of Maxillofacial Space Infection
Authors: Xu Guikun , Ju Rui
Published: February 2022

Space infection occurs commonly in the oral and maxillofacial region, and is usually caused by odontogenic infection, resulting in acute symptoms through the maxillofacial space. if timely, correct, and effective treatment is not provided, local infection may quickly spread through the maxillofacial space and cause serious consequences such as suffocation, intracranial infection, and chest infection. A 55-year-old man visited our hospital with obvious swelling and pain in the right maxillofacial region. Maxillofacial computed tomography images showed revealed obvious low-density shadows on the inner side of the right mandibular angle and the right neck. Unlike the usual presentation of maxillofacial space infection, no obvious flushing or fluctuation was seen in the patient’s maxillofacial region due to the deep location of the infection. Blind puncture examination and incision exploration may cause unnecessary pain and trauma to the patient. Therefore, to accurately position the infection focus, the operator reconstructed the infection cavity in three-dimensional with digital technology. The puncture point and incision site were quickly determined by three-dimensional measurement and the use of the compass and straightedge construction method, thereby achieving free drainage with an accurate and minimally invasive incision. Following 1 week of routine flushing and dressing changes, the patient recovered and was discharged from hospital. To our knowledge, this is the first precise minimally invasive treatment of a maxillofacial space infection conducted with the aid of digital positioning technology.
Long-Term Results of Fibrous Dysplasia of the Paranasal Sinuses
Authors: Lee Dong Hoon , Lim Sang Chul
Published: February 2022

Introduction:

Fibrous dysplasia (FD) is a benign, idiopathic skeletal disorder, in which the normal bone and marrow are replaced by fibrous tissue and immature woven bone. The authors aim to analyze the long-term results of patients diagnosed with FD of the paranasal sinuses via imaging or surgical biopsy.

Methods:

The authors retrospectively enrolled 21 patients with FD of the paranasal sinuses from 2006 to 2021.

Results:

The mean age at the time of diagnosis of FD of the paranasal sinuses was very high at 45.9 years. The most common site ofoccurrence was the sphenoid sinus (71.4%). During the mean follow-up period of 52.8 months, there was no significant change in the size of FD of the paranasal sinuses, and there was no worsening of symptoms or complications. Endoscopic sinus surgery was performed in 16 patients (76.2%), of which 13 underwent only biopsy and 3 underwent partial resection.

Conclusions:

The most common site of FD of the paranasal sinuses was the sphenoid sinus, and the age at diagnosis was higher thanthat of patients with FD at other sites. Observation with serial radiologic examinations is recommended for asymptomatic FD of the para-nasal sinuses.