Chronic Difficulties Research Articles

O IMPACTO DO PILATES NO TRATAMENTO DA FIBROMIALGIA

Fibromyalgia is a chronic syndrome that causes diffuse muscle pain and increased sensitivity in specific points on the body. It mainly affects women between the ages of 30 and 60, but can occur in men and at younger ages. Symptoms include chronic pain, fatigue, sleep disturbances and cognitive difficulties. Pilates is adaptable to different populations and health conditions and can be customized to meet individual needs. This adaptability makes Pilates a versatile and inclusive therapeutic option, suitable for rehabilitation and health promotion programs. The objective, therefore, was to investigate the impact of the Pilates method in the treatment of fibromyalgia, evaluating its effects on reducing pain, improving physical function and quality of life for patients. Methodologically, a systematic review of the literature was incorporated, with a search for articles carried out in the PubMed and Google Scholar databases, starting from a period of 5 years (2019-2024). It was concluded, based on the available evidence, that Pilates can be considered as a complementary treatment option for patients with fibromyalgia. It is recommended that healthcare professionals consider including Pilates in multidisciplinary treatment programs for fibromyalgia, adapting intervention protocols as necessary to meet each patient’s specific needs. Even more so, the implementation of Pilates programs supervised by qualified professionals can guarantee the safety and effectiveness of this therapeutic intervention for patients with fibromyalgia.

General health and social outcomes 50 years after exposure to antenatal betamethasone: follow-up of a randomised controlled trial

BackgroundAntenatal corticosteroids are recommended for women at risk of preterm birth from 24 to 34 weeks’ gestation as they reduce neonatal morbidity and mortality, but evidence regarding their long-term effects on offspring is limited. This study assessed general health and social outcomes 50 years after antenatal exposure to corticosteroids.MethodsWe assessed 424 adult offspring of women who participated in the first randomised, double-blind, placebo-controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. The first 717 mothers received two intramuscular injections of betamethasone (6 mg betamethasone sodium phosphate and 6 mg betamethasone acetate) or placebo given 24 h apart and the subsequent 398 received two injections of double dose betamethasone (12 mg betamethasone sodium phosphate and 12 mg betamethasone acetate) or equivalent volume of placebo. Follow-up included a health questionnaire and consent for access to administrative data sources. Outcome categories included mental health (depression, anxiety, bipolar affective disorder, schizophrenia and treatment or hospital admission for any mental health disorder), general health (chronic kidney disease, cancer diagnosis, bone fracture, oral health, allergies, functional difficulties and physical activity) and social outcomes (educational attainment, employment and criminal convictions). Investigators remained blinded to treatment allocation. Analyses were adjusted for gestational age at entry, sex and clustering.ResultsWe assessed 424 adult offspring (46% of survivors; mean [SD] age 49.3 [1.0] years; 212 [50%] female). There was no difference in mental health, general health and social outcomes between those exposed to betamethasone and those exposed to placebo, with the exception that osteoporotic site fracture in adulthood was more likely to have occurred in the betamethasone group compared with placebo (adjusted relative risk 1.57, 95% CI 1.00, 2.48, p = 0.05). No dose–effect relationship was evident and there was no difference in the proportion with at least one fracture. Follow-up rate and lack of in-person assessments were the main limitations.ConclusionsThere is no evidence that antenatal corticosteroids have clinically important effects on general health and social outcomes up to 50 years of age.

Premature mortality and disparities in kidney healthcare for people with chronic kidney disease and severe mental health difficulties.

People with severe mental health difficulties, including schizophrenia, bipolar disorder and psychosis, have higher risk of chronic kidney disease (CKD). Little was known regarding clinical outcomes and utilisation of kidney care for people with CKD and severe mental health difficulties. We conducted a retrospective cohort analysis of individuals with CKD attending a tertiary renal unit in London, between 2006 and 2019. Individuals with severe mental health difficulty diagnoses were identified, and differences between those with and without severe mental health difficulties were analysed. Of the 5105 individuals with CKD, 112 (2.2%) had a recorded severe mental health difficulty diagnosis. The mean lifespan of those with severe mental health difficulties was 13.1 years shorter than those without severe mental health difficulties, t(1269) = 5.752, p < 0.001. People with severe mental health difficulties had more advanced CKD at their first nephrology appointment. There were no statistically significant differences between groups in the rates of kidney failure, age at onset of kidney failure, or time elapsed between first appointment and death/kidney failure. The number of inpatient admissions was similar between groups, but those with severe mental health difficulties had higher rates of emergency and ICU admissions. Among individuals on renal replacement therapy (RRT), those with severe mental health difficulties were less likely to receive a kidney transplant and peritoneal dialysis. For patients receiving haemodialysis, those with severe mental health difficulties had a higher proportion of shortened sessions, greater mean weight loss during sessions, and a higher proportion of serum potassium and phosphate levels outside normal ranges. Findings illustratea number of disparities in kidney healthcare betweenpeople with and without severe mental health difficulties, underscoring the need for interventions which prevent premature mortality and improve kidney care for this population.

Effects of adverse childhood experiences on university students' ability to lead healthy lives: an exploratory qualitative study in Lahore, Pakistan.

Adverse Childhood Experiences are a significant global public health concern as these experiences have adverse effects on all the health determinants. The interpretive phenomenological research design was used to explore the implications of adverse childhood experiences on the adult life of university students. An interpretive thematic analysis method was employed to analyze this study. Five major themes emerged after a comprehensive review of the information obtained from the interviews with the ten selected participants. These were (1) Chronic health struggles (2) Mental health disorders (3) Emotional and social difficulties (4) Paranoia and distrust and (5) Academic and professional under-performance. This study concludes that adverse childhood experiences have long-lasting negative effects on university students' health and behaviour, preventing them from leading healthy lives and excelling academically and professionally.

Veterans in Northern Ireland: Evaluation of chronic pain experience, service type, and physical and mental health functioning.

Chronic pain is common and associated with disruptions in quality of life (QoL) and psychosocial functioning. These issues are particularly pronounced in veterans, although data in this regard primarily come from the United States Veterans Affairs System, meaning less is known regarding veterans of other countries and regions. The present study evaluated veterans living in Northern Ireland (NI), a region with historic high rates of both chronic pain and psychosocial difficulties associated with the decades-long period of civil and military conflict preceding the 1999 armistice (the Good Friday Agreement). Unique to the Northern Ireland military operation was the initiation of Home Service battalions comprised of local recruits, a role with increased risk due to the conflict's nature and the fact that they were serving as a military and security presence in their home region. A cross-sectional assessment of veterans living in Northern Ireland (N = 722) provided details of service type (Home Service vs other service), current health conditions (including chronic pain), and current psychosocial functioning (including physical and mental health QoL, anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms). Findings indicated that those with chronic pain had worse QoL, anxiety, depression, and PTSD. Those with chronic pain were also more likely to have served in the Home Services, be unemployed, and be receiving disability payment. Contrary to hypotheses, there was no interaction between chronic pain and service type. These results extend previous work with veterans to the unique circumstances of a post-conflict military that engaged in operations within its own country and underscore the need for coordinated, efficacious interventions for co-morbid chronic pain and anxiety, depression, and PTSD.

Validation of the Swedish Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES).

In the head and neck cancer (HNC) population around 45% suffer from chronic swallowing difficulties after cancer treatment. Previously a measure for flexible endoscopic evaluation of swallowing (FEES) where swallowing efficiency, safety and overall ability is evaluated within the same framework has been lacking. The Dynamic Imaging Grade of Swallowing Toxicity for FEES (DIGEST-FEES) was developed in 2021 and provides such a measure for patients with HNC. The aim of this study was to translate and validate the DIGEST-FEES into Swedish (Sw-DIGEST-FEES). A translation of the protocol to Swedish was done through forward-backward translation. Two raters rated eighty-nine FEES recordings according to the Sw-DIGEST-FEES and five reference measures of swallowing ability: Yale Pharyngeal Residue Severity Rating Scale, Swallowing Performance Scale, Murray Secretion Scale, MD Anderson Dysphagia Inventory and Penetration Aspiration Scale. Intra- and interrater reliability was analyzed. Construct validity was evaluated by correlating the Sw-DIGEST-FEES ratings to the reference measures. A priori hypothesis was that the correlations would correspond to those of the reference measures included in the original English version. The Sw-DIGEST-FEES demonstrated retained psychometric properties. Construct validity was good. 79% of correlations to the reference measures were equal to or stronger than those in the original development. Inter-rater agreement of the Sw-DIGEST-FEES ranged from substantial to almost perfect (0.76-0.81). Intra-rater reliability was in general almost perfect (0.8-1). The Sw-DIGEST-FEES can be considered a valid and reliable protocol for use in evaluation of swallowing function in HNC patients.

The COVID-19 pandemic in Rio de Janeiro, Brazil: a focus on the most vulnerable

The effects of the COVID-19 pandemic permeate various spheres of society. In Brazil, marginalized populations who face chronic difficulties accessing minimum human and social rights have been most impacted. In Rio de Janeiro, socio-spatial inequality influenced the spread of infection in some areas to the detriment of others, laying bare social disparities. Descriptive analyses, calculations, and logistic regression were conducted to assess the tested variables associated with a higher likelihood of COVID-19 hospitalization from January 2020 to January 2021 in Rio de Janeiro. There was a profile of individuals more vulnerable to COVID-19 infection and variables demonstrating associations with worse outcomes. A historical and social context is associated with COVID-19 cases and complications and repercussions.

To Study of Construction wastages on Construction Project

The construction industry is an important cog in the wheel of national economies around the globe. Low productivity, unsafe working conditions, inadequate quality, and poor safety are some of the well-known chronic difficulties in the construction industry. In today's world, the construction sector is confronted with a number of critical issues. These include rising competition from outside, a lack of qualified workers, and the imperative to enhance the quality of building. In order to meet these problems, the sector must immediately increase efficiency, improve quality, and adopt new technology. Over the last several decades, a great deal of research and study has focused on the difficulties encountered by the construction industry. This research has sought to determine the root causes of these problems and, in some cases, has even proposed solutions.The study is to confirm and reevaluate the current state of productivity and performance in the local construction industry's activities and processes. The purpose of this is to gain a better understanding of the existing state of "lean" in the local construction sector by establishing new measurement parameters that are specific to waste and cycle time as they relate to the principles and concepts of Lean Construction.

Impact of Intrathecal Dexmedetomidine versus Intrathecal Fentanyl as Adjuvants to Bupivacaine on Post Spinal Urinary Retention in Knee Joint Arthroscopic Surgeries

Abstract Background Patients undergoing orthopedic surgery are prone to developing postoperative urinary retention (POUR). They have an estimated relative risk of 8% to 55% higher than other surgical patients. This inability to void increases patient’s risk of urinary tract infections (UTIs) and bacteremia, and can lead to chronic voiding difficulties due to bladder architecture alterations. A great degree of variability exists among studies describing the prevalence and risk factors of postoperative urinary retention and its management strategies. Objective To compare the effects of Dexmedetomidine or Fentanyl added to intrathecal bupivacaine in knee arthroscopic procedures in terms of the occurrence of postoperative urinary retention. Patients and Methods This prospective randomized clinical study was conducted at tertiary care hospital at Ain Shams University hospitals from September 2021 till Mars 2022 and performed on a total of 70 patients who assigned for knee joints orthoscopic surgery. Results The current study results revealed that the incidence of postoperative urine retention in dexmedetomidine group was 5.7% while was 28.6% in Fentanyl group, the difference was statistically significant. however, the need to postoperative urinary catheterization was statistically non-significantly among the two groups. The current study results revealed that the Time to achieve maximum block was significantly shorter in dexmedetomidine group and the duration of motor block statistically was significantly longer in dexmedetomidine group. Conclusion On the basis of current evidence, when compared to fentanyl, our study revealed that intrathecal dexmedetomidine, as adjuvant to local anesthetics for intrathecal injection, can statistically significantly prolong the duration of sensory and motor block, as well as the pain free period, meanwhile significantly reducing the incidence of urinary retention. Intrathecal dexmedetomidine seems to be an attractive alternative as an adjuvant to spinal bupivacaine in surgical procedures, especially those requiring long time. It has excellent quality of postoperative analgesia with minimal side effects.

Lack of autonomy and professional recognition as major factors for burnout in midwives: A systematic mixed-method review.

The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors. Mixed studies systematic review. PubMed, Scopus and Web of Science were sourced from 2018 and 2023. Inclusion criteria: quantitative cross-sectional or qualitative articles published in English within the last 5 years. studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three-step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research. Thirty-six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35-40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors. Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it. What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem. PREFERRED: Reporting items for systematic review and meta-analyses (PRISMA). No patient or public contribution.

Mental Health, Psychosocial Functioning, and Quality of Life in Adolescents With Hirschsprung Disease

BackgroundStudies of mental health in adolescents with Hirschsprung disease (HD) are scarce. This cross-sectional study investigates mental health, psychosocial functioning and quality of life in HD adolescents. MethodsAdolescents (12–18 years) treated at the Department of pediatric surgery at Oslo University Hospital were invited for participation. Mental health was assessed by interview; Child Assessment Schedule (CAS) and questionnaires; parental Child Behavior Checklist (CBCL) and adolescent Youth Self-Report (YSR). Psychosocial functioning was rated by Child Global Assessment Scale (cGAS). Adolescent Quality of Life was assessed by Pediatric Quality of Life inventory (PedsQL) and chronic family difficulties (CFD) by interview. Medical records were reviewed for somatic history. ResultsThirty-seven adolescents, 28 males, median age 14.3 years, participated. By CAS interview, 8 of 37 (44% of females and 14% of males) fulfilled criteria for psychiatric diagnosis all within emotional and related disorders. Twenty-seven percent had CBCL internalizing scores and 16% had YSR internalizing scores in clinical range indicating emotional problems. By interviewer rated cGAS, 27% were scored in clinical range. By PedsQL 16% reported reduced psychosocial health score. Increased CFD, lower psychosocial functioning and reduced QoL as well as less paternal education were significantly associated with psychiatric diagnosis. Twice as many (4/8) adolescents who either had a stoma or bowel management had a psychiatric diagnosis compared to those who had neither stoma nor bowel management (7/28). ConclusionNearly one in four adolescents with HD fulfilled criteria for psychiatric diagnosis. Mental health problems were associated with reduced psychosocial function and reduced QoL. Level of evidenceIII.

An injectable hydrogel dressing for controlled release of hydrogen sulfide pleiotropically mediates the wound microenvironment.

The healing of scalded wounds faces many challenges such as chronic inflammation, oxidative stress, wound infection, and difficulties in vascular and nerve regeneration. Treating a single problem cannot effectively coordinate the complex regenerative microenvironment of scalded wounds, limiting the healing and functional recovery of the skin. Therefore, there is a need to develop a multi-effect treatment plan that can adaptively address the issues at each stage of wound healing. In this study, we propose a scheme for on-demand release of hydrogen sulfide (H2S) based on the concentration of reactive oxygen species (ROS) in the wound microenvironment. This is achieved by encapsulating peroxythiocarbamate (PTCM) in the ROS-responsive polymer poly(ethylene glycol)-poly(L-methionine) (PMet) to form nanoparticles, which are loaded into a thermosensitive injectable hydrogel, F127-poly(L-aspartic acid-N-hydroxysuccinimide) (F127-P(Asp-NHS)), to create a scald dressing. The H2S released by the hydrogel dressing on demand regulates the wound microenvironment by alleviating infection, reducing oxidative stress, and remodeling inflammation, thereby accelerating the healing of full-thickness scalded wounds. This hydrogel dressing for the adaptive release of H2S has great potential in addressing complex scalded wounds associated with infection and chronic inflammation.

Psychosocial Functioning of Parents of Youth Receiving Intensive Interdisciplinary Pain Treatment.

Parents of youth with chronic pain report psychosocial difficulties, yet treatment often focuses on improving their child's functioning and pain. This study evaluated changes in parents' social and emotional functioning and explored predictors of change, as they completed a parent-focused intervention while their child was enrolled in an intensive interdisciplinary pain treatment (IIPT) program. Parents (n = 69) completed questionnaires at baseline and weekly (average duration of 4 weeks) during their child's participation in IIPT. Parents engaged in 3 groups per week providing education, therapeutic art, and psychotherapy (3 hr/week total). At baseline, 38% of parents reported scores in the clinically elevated range for at least 1 psychosocial variable. Linear mixed modeling for the full sample indicated reduced parent anxiety (t = -2.72, p<.01) and depression (t = -3.59, p<.001), but not increased emotional support (t = 1.86, p>.05) or reduced social isolation (t = -1.20, p>.05). For parents with at least moderately elevated psychosocial concerns, statistically significant improvements were observed for all 4 outcomes (all p's<.01). Psychological flexibility, cognitive reappraisal, and emotional suppression were found to be related to changes in parent outcomes (anxiety, depression, isolation, and support). Findings support the benefit of parent-focused interventions in addition to child-focused interventions. Many parents of youth participating in IIPT had elevated scores for at least 1 psychosocial concern at baseline. Brief, parent-focused intervention including psychoeducation, therapeutic art, and psychotherapy targeting mindfulness, acceptance, and values had a significant impact on these parents, particularly those with greater struggles at baseline.

Examining the rural–urban differentials in yoga and mindfulness practices among middle-aged and older adults in India: secondary analysis of a national representative survey

Physical activity and mental well-being play an important role in reducing the risk of various diseases and in promoting independence among older adults. Appropriate physical activity, including yoga and mindfulness practices, can help rectify the loss of independence due to aging and have a positive influence on physical health and functional activities. This study assessed rural–urban differences in yoga and mindfulness practices and their associated factors among middle-aged and older Indian adults. The total sample size considered for the current analysis was 72,250 middle-aged and older adults (aged ≥ 45 years). Bivariate and multivariable logistic regression analyses were used to estimate the prevalence of yoga and mindfulness practices and examine the associations of selected variables with yoga and mindfulness practices among the participants. Further, we used the Fairley decomposition technique to determine the factors contributing to rural–urban differences in the prevalence of yoga and mindfulness practices among middle-aged and older adults. More than 9% of middle-aged and older adults in rural areas and 14% in urban areas reported practicing yoga and mindfulness activities more than once per week. Adults aged ≥ 65 years were more likely to practice yoga and mindfulness activities than those who age 45–54 years were. Those with an education of ten years and above were 2.3 and 2.1 times higher likely to practice yoga in rural (AOR: 2.28; CI: 2.07–2.52) and urban (AOR: 2.13; CI: 1.91–2.37) areas compared to their uneducated peers, respectively. The largest contributors in diminishing the gap in yoga practice among participants were education (44.2%), caste (2.5%), chronic diseases such as hypertension (4.53%), diabetes (1.71%), high cholesterol (3.08%), self-reported pain (5.76%), and difficulties in instrumental activities of daily living (1.22%). The findings suggest that middle-aged and older adults in urban areas practice yoga and mindfulness activities more than their peers in rural areas do. Education level, household characteristics, and health outcomes such as chronic conditions, pain, and functional difficulties explain the observed differences in yoga and mindfulness practices across rural and urban areas. Age-appropriate healthy practices such as yoga and mindfulness should be encouraged to enhance the physical and mental well-being of middle-aged and older adults, especially in rural areas.

A Compassion-Focused Therapy group for young people who live in foster, adoptive or kinship care: Initial development, reflections, and ways forward

Care-experienced youth are more likely than their peers to present with earlier, more severe and more chronic mental health difficulties. This case study presents the development of a Compassion-Focused Therapy (CFT) group for young people who do not live with their birth families due to an early history of abuse and neglect, delivered by psychologists in a social care service. Eight adolescent girls (aged 12–16), who lived in foster, adoptive or kinship care, attended eight face-to-face weekly sessions of a ‘Building Your Self-Confidence’ group. Most of them attended all sessions, found the group ‘enjoyable’ and ‘interesting’, and reported finding it helpful to improve their self-confidence at least to some extent (‘a little’ or ‘yes’). On standardised measures, half of the caregivers reported improvements in their child’s mental health but none of the adolescents did themselves. These initial data pave the way to further optimise the application of group CFT for care-experienced youth and inform psychological treatment innovation in youth more generally.

Long-term trajectories of frailty phenotype in older cancer survivors: a nationally representative longitudinal cohort study.

Frailty is a dynamic process associated with adverse health outcomes. However, little is known about the long-term trajectories of frailty in older cancer survivors. To describe the trajectories of frailty phenotype over time amongst older cancer survivors and examine the socio-demographic and health-related predictors of different trajectories. Population-based longitudinal cohort study. Community-dwelling older adults in the United States. 1,763 older adults who were diagnosed with cancer from the National Health and Ageing Trends Study. Frailty was assessed by the Fried Frailty Phenotype. The group-based trajectory model was used to identify the trajectories of frailty. Multinomial logistic regression analyses were used to examine the socio-demographic and health-related predictors of different trajectories. Three frailty trajectories were identified; 52.8% of older cancer survivors had a sustained low risk of frailty over time, 25.0% had a low frailty risk at baseline but the risk increased steadily, and 22.3% had a high frailty risk with a slight change in the observed period. Older cancer survivors were at a high-risk frailty trajectory if they were older, female, African American, had lower education status, had lower annual income, were underweight or obese, self-rated poorer health, had more chronic conditions and difficulties with activities of daily living (ADL), and had worse cognitive functions (P < 0.05). Long-term frailty trajectories in older cancer survivors are heterogeneous. This study helps identify patients at high risk of sustained or deteriorating frailty and has the potential to inform targeted frailty management strategies addressing modifiable factors identified (e.g. body mass index, ADL).

Robotics for Autistic Children

A range of chronic difficulties known as autism spectrum disorders interfere with social interactions and communication. The state of the art shows how robots in particular can provide potential methods to advance ASD research and treatment. This review aims to investigate how robot-assisted therapy techniques support children with autism in increasing social contact and in imitating, recognizing, and expressing their feelings. If robots appear to be useful tools for assistive therapies was one of the paper's main questions. The study team behind this publication came to the conclusion that robots are extremely effective in the intervention process and provide ASD youngsters with a predictable and secure setting. In addition to the aforementioned, this project also discusses ethical concerns that therapists and researchers should keep in mind while human-robot interaction is taking place.

SLEEP DISTURBANCE AFTER TRAUMATIC BRAIN INJURY: NEW INSIGHT

Disruptions in sleep-wake cycles are particularly prevalent after a Traumatic Brain Injury (TBI). Sleep disruptions may occur as a main impact of brain damage or as a result of other neuropsychiatric sequelae of TBI, such as anxiety disorder, depressive disorders, substance abuse, chronic pain, and/or medication consumption. Chronic discomfort (headache and broad pain, presumably of central origin) and/or sleep difficulties (insomnia, disturbed breathing, periodic limb movements) occur in about one in five people with TBI. Disruptions in sleep-wake cycles linked with TBI need therapy. Although data specific to individuals with TBI is currently limited, cognitive-behavioral treatment and medication may be beneficial in alleviating sleep-wake problems in people who have sustained a TBI. This article aims to raise awareness of sleep disturbance after TBI to enhance diagnosis, assessment, and therapy and disclose new research opportunities.

Comorbidity in Congenital Hypothyroidism-A Nationwide, Population-based Cohort Study.

Patients with congenital hypothyroidism (CH) are affected more often than the general population by other chronic diseases and neurological difficulties. The aim of this nationwide population-based register study was to investigate the incidence of congenital malformations, comorbidities, and the use of prescribed drugs in patients with primary CH. The study cohort and matched controls were identified from national population-based registers in Finland. All diagnoses from birth until the end of 2018 were collected from the Care Register, and subject-specific prescription drug purchases were identified from The Prescription Register from birth until the end of 2017. Diagnoses of neonatal and chronic diseases were collected for 438 full-term patients and 835 controls (median follow-up time 11.6 years; range, 0-23 years). Newborns with CH were more often found to have neonatal jaundice (11.2% and 2.0%; P < .001), hypoglycemia (8.9% and 2.8%; P < .001), metabolic acidemia (3.2% and 1.1%; P = .007), and respiratory distress (3.9% and 1.3%; P < .003) as compared to their matched controls.Congenital malformations were diagnosed in 66 of 438 (15.1%) CH patients and in 62 of 835 (7.4%) controls (P < .001). The most commonly affected extrathyroidal systems were the circulatory and musculoskeletal systems. The cumulative incidence of hearing loss and specific developmental disorders was higher among CH patients than controls. The use of antidepressant and antipsychotic drugs was similar in CH patients and their controls. CH patients have more neonatal morbidity and congenital malformations than their matched controls. The cumulative incidence of neurological disorders is higher in CH patients. However, our results do not support the existence of severe psychiatric comorbidity.

Psychiatric disorders comorbid with general medical illnesses and functional somatic disorders: The Lifelines cohort study.

It is not clear why psychiatric disorders are more prevalent in the functional somatic syndromes than other general medical illnesses. This study assessed the correlates of psychiatric disorders in 3 functional syndromes and 3 general medical illnesses in a population-based sample. The Lifelines cohort study included 122,366 adults with relevant data for 6 self-reported conditions: irritable bowel syndrome (IBS), fibromyalgia, chronic fatigue syndrome (CFS), inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and diabetes. For each condition the proportion with a DSM-IV psychiatric disorder was assessed. In a cross-sectional design, logistic regression identified at baseline the variables most closely associated with current psychiatric disorder in participants with a pre-existing medical or functional condition. In a separate analysis the prevalence of psychiatric disorder prior to onset of these conditions was assessed. This was a longitudinal study with psychiatric disorder assessed at baseline in participants who subsequently developed a general medical or functional condition between baseline and follow-up. The prevalence of psychiatric disorder was higher (17-27%) in the functional somatic syndromes than the general medical illnesses (10.4-11.7%). The variables closely associated with psychiatric disorder were similar in the functional syndromes and general medical illnesses: stressful life events, chronic personal health difficulties, neuroticism, poor perception of general health, impairment of function due to physical illness and reported previous (lifetime) psychiatric disorder. The prevalence of psychiatric disorder prior to development of these disorder was similar to that of established disorders. Despite the difference in prevalence, the correlates of psychiatric disorders were similar in functional and general medical disorders and included predisposing and environmental factors. The increased rate of psychiatric disorder in functional somatic syndromes appears to be evident before onset of the syndrome.