Co-occurring Conditions Research Articles

Collaborating With Jails to Provide Community-Based Medication for Opioid Use Disorder: Qualitative Perspectives from MOUD Treatment Providers.

As carceral settings increasingly offer medications for opioid use disorders (MOUD), community-based providers will need to navigate relationships with correctional agencies to ensure continuity of MOUD upon release. Although collaboration has been identified as critical between agencies, limited research is available that details how providers can work with jails. We describe the perspectives of MOUD providers about their experiences collaborating with jails that had recently begun to offer MOUD. We conducted hour-long interviews with 36 MOUD providers from 18 community-based agencies. Exploration, Preparation, Implementation, and Sustainment (EPIS) concepts informed data collection and analysis. MOUD providers described agency-specific (inner context) factors that facilitated collaboration, including staffing (employing staff with knowledge of co-occurring conditions) and agency culture (adaptability to change, recognition of gaps in services, being judgment-free). Providers also reported external factors as facilitators, such as broad community support of MOUD services and provision of training about MOUD to jail staff. Holding regular meetings, with a dedicated contact person, helped to overcome communication problems. However, the fragmentation of in-jail treatment services, exacerbated by jails' contracting with different healthcare providers, made it difficult to coordinate re-entry and establish agency relationships. Actively and intentionally building interagency partnerships and collaborating across interagency cultural and structural differences were bridging factors that developed and sustained collaborations. Our findings offer promising suggestions for establishing collaborations with carceral partners, including assessing internal agency conditions, seeking external community supports, committing to actively engaging and sustaining collaborations, and using interagency differences to develop mutually beneficial relationships.

A 10-year Longitudinal Study: The Relationship between Adverse Childhood Experiences, Mental Health Indicators, and Binge Eating Symptoms among Emerging Adults.

Although binge eating symptoms (BE) can contribute to worsened mental and physical health, little is known about factors associated with binge eating across the lifespan, hindering prevention and treatment. To investigate if there is an association between adverse childhood experiences (ACEs), adolescent and adult mental health conditions, and BE symptoms among young adults. One hundred and thirty-one junior high-school students participated in a series of assessments and 10 years later, 100 of these individuals participated in a follow-up assessment. Linear regression models were performed to estimate the association between ACEs, adolescent and emerging adult self-esteem, depression, and anxiety symptoms, and emerging adult BE symptoms. Among the sample, 26% had 1 ACEs, 18% had 2 ACEs, and 41% had ≥ 3ACEs. After adjusting for age, sex, and current mental health, there was a positive association between ACEs and increased levels of BE symptoms (β = 0.37, SE = 0.19, CI=(0.03; 0.7), p =.0485). Higher levels of emerging adult depression and anxiety symptoms (β = 0.02, SE = 0.01, CI=(0.01; 0.04), p =.0020) but not self-esteem (β = 0.04, SE = 0.05, CI=(-0.06; 0.14,) p =.4253), were associated with BE symptoms. Parental mental health, a parent experiencing a mental illness during the participant's childhood, was the only individual ACE associated with BE symptoms (β = 0.84, SE = 0.40, CI = 0.04, 1.64, p =.0409). Cumulative ACEs and emerging adult anxiety and depression symptoms were associated with BE symptoms. Findings indicate that ACEs, anxiety, and depression symptoms contribute to BE symptoms, highlighting the importance of screening for ACEs and mental health conditions. Persons struggling with BE symptoms may have co-occurring conditions, of which a traditional treatment for BE may not suffice.

About Whom Are We Talking When We Use Intellectual and Developmental Disabilities?

Communicating clearly about who is included in a population group is a critical element to effective dissemination and knowledge transfer. This narrative review highlights the inconsistency as it relates to communicating about individuals with intellectual disability (ID) and developmental disability (DD). There is enormous variability in the use of definitions and abbreviations in the field of intellectual disability and developmental disabilities. The lack of consistency has resulted in widely varying reported rates of prevalence and has contributed to confusion around the interpretation of research and clinical findings, population statistics, and policy decisions. The reported rates of prevalence for developmental disabilities published by different US federal agencies have ranged widely from 3% to 17%. This represents a 5-fold difference. Equally confusing is the inconsistent and ambiguous adoption of initialisms. These initialisms include ID/DD, IDD, and I/DD for which it is not always clear if these initialisms reference separate and independent populations (eg, ID or DD) or populations with co-occurring conditions (eg, persons with ID and DD). This Narrative Review discusses these issues and proposed a number of recommendations that would contribute to enhanced consistency and clarity of understanding for stakeholders, administrators, practitioners, researchers, and policy makers. Authors of scholarly works, clinical publications, policies, and position papers are encouraged to provide a clear operational definition as well as the choice of initialisms used (eg, ID/DD, IDD, I/DD, etc) when it is first used.

The Efficacy of Motivational Enhancement Therapy in Enhancing Readiness to Change Among Individuals with Alcohol and Substance Use Disorders: A Multi-Case Study

Substance use disorders (SUDs), encompassing alcohol and drug dependency, pose significant global health challenges. Motivational Enhancement Therapy (MET) has emerged as a client-centered intervention to enhance intrinsic motivation for behavioral change, particularly among individuals with ambivalence or resistance to conventional treatment approaches. This study examines the efficacy of MET in enhancing readiness to change in seven male patients undergoing inpatient rehabilitation for alcohol and substance use disorders through a multi-case study design. Each patient was evaluated using the Stages of Change Model (Prochaska & DiClemente, 1983) to assess motivational shifts over the intervention period. Results indicated that MET facilitated progression to advanced stages of change for most participants, with notable improvements in readiness to change for five of the seven cases. However, variability in outcomes highlighted the influence of individual factors such as baseline motivation and co-occurring conditions. Findings suggest MET’s utility as a tailored approach to addressing substance use, emphasizing its importance in clinical practice.

The role of co-occurring conditions and genetics in the associations of eating disorders with attention-deficit/hyperactivity disorder and autism spectrum disorder.

Eating disorders (EDs) commonly co-occur with other psychiatric and neurodevelopmental disorders including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); however, the pattern of family history and genetic overlap among them requires clarification. This study investigated the diagnostic, familial, and genetic associations of EDs with ADHD and ASD. The nationwide population-based cohort study included all individuals born in Denmark, 1981-2008, linked to their siblings and cousins. Cox regression was used to estimate associations between EDs and ADHD or ASD, and mediation analysis was used to assess the effects of intermediate mood or anxiety disorders. Polygenic scores (PGSs) were used to investigate the genetic association between anorexia nervosa (AN) and ADHD or ASD. Significantly increased risk for any ED was observed following an ADHD or ASD diagnosis. Mediation analysis suggested that intermediate mood or anxiety disorders could account for 44%-100% of the association between ADHD or ASD and ED. Individuals with a full sibling or maternal half sibling with ASD had increased risk of AN compared to those with siblings without ASD. A positive association was found between ASD-PGS and AN risk whereas a negative association was found between AN-PGS and ADHD. In this study, positive phenotypic associations between EDs and ADHD or ASD, mediation by mood or anxiety disorder, and genetic associations between ASD-PGS and AN and between AN-PGS and ADHD were observed. These findings could guide future research in the development of new treatments that can mitigate the development of EDs among individuals with ADHD or ASD.

The effect of anxiety and autism symptom severity on restricted and repetitive behaviors over time in children with fragile X syndrome

BackgroundRestricted and repetitive behaviors (RRBs) are highly prevalent and reduce function in individuals with fragile X syndrome (FXS). As transdiagnostic features of intellectual disability, elevated rates of RRBs in FXS could represent various underlying known co-occurring conditions in FXS such as anxiety or autism spectrum disorder (ASD), yet this distinction has not been investigated. Further, delineating whether RRBs are more indicative of anxiety or ASD in FXS may clarify phenotypic profiles within FXS and improve differential assessment.MethodsWe longitudinally examined the potentially independent or multiplicative effect of ASD and anxiety symptom severity on RRBs in 60 children with FXS. Anxiety was measured using the Child Behavior Checklist (CBCL), ASD severity was measured using the Childhood Autism Rating Scale (CARS), and RRBs were measured using the Repetitive Behavior Scale – Revised (RBS-R). We estimated a series of moderated regression models with anxiety and ASD symptoms at the initial assessment (Time 1) as predictors of RRBs at the outcome assessment two years later (Time 2), along with an anxiety-by-ASD interaction term to determine the potential multiplicative effect of these co-occurring conditions on RRBs.ResultsResults identified a significant interaction between ASD and anxiety symptom severity at the initial assessment that predicted elevated sensory-motor RRBs two years later. Increased sensory-motor RRBs were predicted by elevated ASD symptoms only when anxiety symptom severity was low. Likewise, increased sensory-motor RRBs were predicted by elevated anxiety symptoms only when ASD symptom severity was low. Interestingly, this relationship was isolated to Sensory-Motor RRBs, with evidence that it could also apply to total RRBs.ConclusionsFindings suggest that ASD and anxiety exert independent and differential effects on Sensory-Motor RRBs when at high severity levels and a multiplicative effect when at moderate levels, which has important implications for early and targeted interventions.

Response inhibition as a critical executive function in differentiating attention-deficit/hyperactivity disorder from autism spectrum disorder: a comprehensive attention test study.

Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are both associated with impairment in executive function, particularly in complex attention. Although previous studies using clinical assessments have attempted to delineate differences between these disorders, the findings have been inconclusive. Our study aims to elucidate the differences of endophenotype between ASD, ADHD, and their co-occurring condition utilizing a uniform computerized test. The study included children diagnosed with ASD, ASD co-occurring with ADHD (ASD+ADHD), or ADHD who completed the comprehensive attention test (CAT) at Severance Hospital between October 2013 to May 2023. We excluded children with intellectual disability and comorbid major psychiatric or neurologic disorders possibly affecting attention measurement. The participants were categorized into three groups for the comparative analysis of CAT measures: (a) ASD (n=112), (b) ASD+ADHD (n=155), and (c) ADHD (n=104). The study also conducted an exploratory analysis utilizing multivariate linear regression analysis to examine the association between the CAT measures and parent-reported scales. Notably, the ASD+ADHD and ADHD groups exhibited higher frequency of commission errors (CE) and perseveration errors (PE) compared to the ASD group. In the exploratory analysis, a significant negative association was observed between reaction time (RT) and both the social communication questionnaire (SCQ) and the child behavior checklist (CBCL) externalization scores in the ASD+ADHD and ADHD groups. The ASD+ADHD group tended to show higher standard deviation of reaction time (RTSD) compared to the ASD group. Our findings suggest that impaired response inhibition is more pronounced in ADHD compared to ASD. We propose altered visual attention, reflecting response inhibition, may serve as potential endophenotypic markers differentiating ADHD from ASD in attentional assessment. Elevated RTSD in the ASD+ADHD group demonstrates additive pathology, suggesting that the neurological mechanisms underpinning impaired sustained attention may differ between the two conditions.

Transition Readiness Among Youth Accessing Mental Health Services With Physical Health Co-Morbidities.

Transition readiness, or skills and preparation for navigating adult health care, is an important factor in the successful transition from child and adolescent mental health services (CAMHS) to adult care; however, predictors of transition readiness are not fully understood. One factor which may impact transition readiness among youth accessing CAMHS is the presence of a co-occurring physical health condition; however, this has not been previously examined. Within a cohort of youth receiving CAMHS, the objective of this study was to understand if there is an association between co-occurring physical health conditions and transition readiness and if this relationship is impacted by severity of mental health symptoms. This study was a secondary analysis of baseline data from the Longitudinal Youth in Transition Study, including 237 16- to 18-year-old youth accessing outpatient CAMHS from four different clinical sites. Participants completed self-report measures on mental health symptoms, functioning, service use, transition readiness, and physical health conditions. Multiple linear regression models were used to measure the association between the presence of health conditions and transition readiness scores as well as determine if there was an interaction between mental health symptoms and physical health conditions to predict transition readiness. Co-occurring physical conditions were reported by 41% of youth and were associated with greater overall transition readiness. There was no interaction between mental health symptom severity and co-occurring physical conditions, though attention problems were independently associated with lower transition readiness scores. Youth accessing CAMHS who have a co-occurring physical condition have overall greater transition readiness than youth without a co-occurring condition. Further research should explore the role of frequency and types of healthcare encounters in transition readiness for transition age youth needing ongoing mental health care to better understand how to support self-management and care navigation skill development.

Optimizing diversity, equity and inclusion in pragmatic clinical trials: Findings from the Pain Management Collaboratory

The National Institutes of Health, U.S. Department of Defense, and U.S. Department of Veterans Affairs established a Pain Management Collaboratory (PMC) in 2017, with the purpose of implementing and evaluating nonpharmacological approaches for management of pain and co-occurring conditions in military and veteran healthcare systems through the execution of pragmatic clinical trials. The purpose of the current study is to detail and critically examine recruitment and retention procedures across the PMC’s large-scale multi-site pragmatic clinical trials, with attention to efforts made by trialists to diversify their study samples. Team members from 11 pragmatic clinical trials completed semi-structured interviews that focused on the meaning of diversity to the trial teams when planning the composition of their samples, methods used to recruit and retain diverse samples of patients, and planned analyses that take into consideration diverse subgroups of patients. Nearly 18,000 patients have been enrolled across trials, 22 % of whom were assigned female sex at birth and 34 % of whom identify with a marginalized race or ethnicity. Respondents highlighted study site selection, formation of partnerships with patient groups, and leveraging of data informatics as strategies that aided in the recruitment of patients diverse in terms of birth sex, race, and ethnicity. Notably, trialists adopted a narrow definition of diversity that did not take into consideration multiple intersecting identities of trial participants. Based on experiences of the PMC, we provide 14 recommendations on ways to diversify patient samples in clinical pain research. PerspectiveThis article describes challenges posed, and opportunities provided, with pain pragmatic clinical trial designs, emphasizing approaches that optimize the inclusion of social identity groups that have historically been under-represented in pain research.

Association of self-harm and suicidality with psychiatric co-occurring conditions in autistic individuals: a systematic review and pooled analysis

Autistic individuals frequently experience psychiatric co-occurring conditions, but the association with self-harm/suicidality according to these conditions was not yet elucidated. We aimed to summarize the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic people. We systematically searched PubMed, Scopus, Embase, Web of Science, and Cochrane Database of Systematic Reviews until June 4, 2024 (PROSPERO registration number: CRD42023412860). Observational studies were included that provided information to calculate the odds ratio (OR) regarding the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic individuals. We summarized the identified associations by presenting OR range or meta-analyzing when 7 or more estimates are available. The systematic search found 20 eligible studies with 301,841 participants. Our findings suggested that autistic individuals with any psychiatric disorder (k=1; OR 3.55; 95% CI 1.27-9.98), ADHD (k=3; OR range: 1.07-1.65), or mood disorder (k=1; OR 1.26; 95% CI 1.05-1.51) may be associated with higher odds of self-harm than those without these conditions. We identified potential positive associations between suicidality and the following co-occurring conditions: any psychiatric disorder (k=1; OR 11.65; 95% CI 10.68-12.71), psychotic disorder (k=4; OR range: 1.95-10.97), mood disorder (k=3; OR range: 1.75-9.82), bipolar disorder (k=2; ORrange: 2.55-4.95), depressive disorder (k=10; pooled OR 2.29; 95% CI 1.39-3.77), trauma- and stress-related disorder (k=2; OR range: 1.28-10.47), and adjustment disorder (k=1; OR 3.52; 95% CI 2.89-4.28). We found psychiatric co-occurring conditions that may be associated with higher odds of self-harm/suicidality in autistic individuals. However, our findings should be interpreted with caution considering the limited number of included studies. We suggested that clinicians should remain vigilant for autistic individuals with psychiatric co-occurring conditions for their potentially higher likelihood of self-harm and suicidality. This research was supported by a grant of the R&D project, funded by the National Center for Mental Health (grant number: MHER22A01).

Autism spectrum disorder (ASD) presentations among referrals to a child and adolescent mental health service (CAMHS) inpatient unit in Ireland.

This retrospective chart review aimed to identify the intersection between young people with Autism Spectrum Disorder (ASD)'s needs and CAMHS inpatient service needs. A retrospective chart review was conducted on all referrals to a CAMHS inpatient unit over three years (n = 352). Referrals which specified a formal diagnosis or suspected diagnosis of ASD were identified (n = 111), and basic demographic data were collected. Young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Findings highlight the lack of a clear care pathway for young people with co-occurring autism or suspected autism and complex mental health problems.

Tobacco Smoke Exposure in Children and Adolescents: Prevalence, Risk Factors and Co-Morbid Neuropsychiatric Conditions in a US Nationwide Study.

Tobacco smoke exposure (TSE) is a major public health concern, impacting not only smokers but also those around them, particularly children and adolescents. TSE is linked to various neuropsychiatric conditions and significantly impacts quality of life. This study examines the prevalence, socio-demographic factors, and the impact of TSE on the severity of neurological and psychiatric co-morbidities. Data from the National Survey of Children's Health (NSCH) in the US from 2020 to 2021 were used in this study. We included 91,404 children and adolescents aged between 0 to 17 years for the TSE prevalence and socio-demographic analysis, and 79,182 children and adolescents aged between 3 and 17 years for the neuropsychiatric co-morbidities analysis. The mean age of these individuals was 8.7 (standard deviation: 5.3), and 11,751 (12.9%) had confirmed TSE. Our analysis showed that TSE is more common in males (53%) than females (47%). Additionally, the odds of TSE were higher in families with a lower income level and with American Indian/Native Alaska racial descent. We found that 36.4% of youths with TSE developed at least one co-morbid condition. The most common neuropsychiatric co-morbidities were anxiety problems (15.7%), Attention-Deficit Hyperactivity Disorder (ADHD) (15.5%), behavioral and conduct problems (13.7%), and learning disability (12%). Females had lower odds of co-morbid anxiety (OR: 0.3, p = 0.02) and Autism Spectrum Disorder (ASD) (OR: 0.9, p = 0.04) than males. Asians showed lower odds of co-morbid ADHD (OR: 0.3, p-value: 0.001), anxiety problems (OR: 0.4, p-value: 0.003), speech/other language disorder (OR: 0.4, p-value: 0.001), developmental delay (OR: 0.4, p-value: 0.001), behavioral and conduct problems (OR: 0.4, p-value: 0.003), and learning disability (OR: 0.5, p-value: 0.004). Conversely, American Indian children and adolescents had higher odds of co-morbid headaches (OR: 3, p-value: 0.005). TSE co-occurring with Tourette's Syndrome (TS) (OR: 4.4, p < 0.001), ADHD (OR: 1.3, p < 0.001), developmental delay (OR: 1.3, p < 0.001), behavioral problems (OR: 1.3, p < 0.001), headaches (OR: 1.3, p = 0.005), depression (OR: 1.2, p = 0.02), anxiety (OR: 1.2, p < 0.01), ASD (OR: 1.2, p < 0.001), and learning disability (OR: 1.2, p = 0.03) may contribute to a more severe manifestation. ADHD, behavioral/conduct problems, and learning disabilities were the most prevalent co-occurring conditions with TSE. Our findings show that 36.4% of youths with TSE had at least one neuropsychiatric comorbidity. Screening for these conditions in youths exposed to TSE is crucial for early detection and interventions to increase their mental health and well-being.

Co-occurring mental and substance use disorders in Australia 2020-2022: Prevalence, patterns, conditional probabilities and correlates in the general population.

Previous estimates from 2007 found that co-occurring mental and/or substance use disorders were a pervasive feature of Australia's mental health. Since that time there have been shifts and improvements in the conceptualisation and incorporation of co-occurring disorders in research and treatment settings. The current study provides up-to-date estimates on the prevalence of co-occurring mental and/or substance use disorders, highlights common patterns of co-occurrence, identifies significant correlates and examines any changes in the extent of co-occurring disorders since 2007. Data were from the two Australian National Surveys of Mental Health and Wellbeing conducted in 2020-2022 (N = 15,893) and 2007 (N = 8841). Descriptive statistics were estimated for the number of co-occurring conditions, correlations and pairwise conditional probabilities. Multinomial logistic and robust Poisson regressions were used to identify significant correlates and compare changes in co-occurring conditions across surveys. Approximately 46% of people with a mental or substance use disorder in the past 12 months experienced two or more diagnosable conditions. There was little evidence to suggest that the prevalence of co-occurring disorders has changed since 2007 (Prevalence Ratio (PR) = 1.08, 95% CI = 0.98-1.18). Subgroup analysis indicated that those aged 16-24 years were significantly more likely to experience any co-occurrence in 2020-2022 compared with those aged 16-24 years in 2007 (PR = 1.44, 95% CI = 1.17-1.77). Co-occurring mental and substance use disorders remain endemic in Australia. Indeed, they appear to be increasingly problematic in younger, more recent cohorts. The results suggest that continued effort is needed to develop and implement transdiagnostic interventions that target broad contextual and/or societal factors.

Risk of Developing Multimorbidity among Previously Healthy Immigrants and Long-term Ontario Residents

Background Multimorbidity is an important health issue associated with a greater risk of adverse health outcomes, more frequent hospitalizations, greater healthcare needs, and premature death. This study examined patterns of and the risk of developing multimorbidity between immigrants and long-term residents of Ontario. Methods We used a 1:1 matched retrospective observational open cohort design from 1995 to 2016, using routinely collected population-based administrative data at ICES. Multimorbidity was defined as two or more and three or more co-occurring chronic conditions. Chronic disease frequencies of dyads and triads were examined. Stratified multivariate Cox Proportional Hazard models examined the risk of developing multimorbidity and further by world regions of origin for immigrants compared to long-term residents. Results Hypertension and diabetes, in combination with chronic obstructive pulmonary disease, were the leading multimorbidity dyad and triad groups. After controlling for age, sex, and neighborhood income quintiles, immigrants from the Caribbean and South Asia had a greater risk of developing 2+ multimorbidity, compared to long-term residents. Refugees from North Africa and the Middle East (HR = 1.22 [95% CI: 1.03-1.42]) as well as refugees (HR = 1.78 [95% CI: 1.59 – 1.98]) and family immigrants from South Asia (HR: 1.08 [95% CI: 1.02-1.14]), had a higher risk of 3+ multimorbidity compared to long-term residents of Ontario. Conclusion These findings highlight the importance of routine population-based data collection on immigration status and world regions of origin to inform public health research. Investments in preventive health services and management of multimorbidity are needed for specific population groups.

Changes in Antipsychotic Medication Adherence Among Medicaid Beneficiaries with Schizophrenia During COVID-19.

To identify patterns of medication adherence during the pandemic and factors associated with these patterns among Medicaid-enrolled individuals with schizophrenia who had highly adherent medication use prior to the COVID-19 pandemic. We used Medicaid claims from Philadelphia to identify individuals with schizophrenia ≥ 18years of age, their demographic characteristics, and health service use. We used group trajectory models to identify adherence trends, and ANOVA to examine associations between adherence groups and demographic characteristics and service use. The sample included 1,622 individuals. A 4-group trajectory model best fit our data. Seventy percent of individuals averaged about 92% adherence throughout the study period; 10% experienced a pronounced decline when the pandemic started (pandemic non-adherers); 11% experienced a sharp decline mid-pandemic (late non-adherers); and 9% experienced a sharp decline at the beginning of the pandemic and returned to higher adherence after a year (disrupted adherers). Adherers were least likely to be diagnosed with a substance use disorder, and had more telehealth visits, mental health outpatient visits, and fewer emergency department visits on average. Late non-adherers were more likely than adherers to have substance use disorders and physical health conditions. Pandemic non-adherers had more co-occurring psychiatric disorders than adherers and had the lowest use of case management. Three in ten previously adherent individuals with schizophrenia became less adherent to antipsychotic medications, either at the onset or later in the pandemic. Our findings point to telehealth and case management as critical strategies for treatment engagement, especially during public health crises, and well as the need to address co-occurring conditions.

Identifying High-Risk Patterns in Single-Vehicle, Single-Occupant Road Traffic Accidents: A Novel Pattern Recognition Approach

Despite various interventions in road safety work, fatal and severe road traffic accidents (RTAs) remain a significant challenge, leading to human suffering and economic costs. Understanding the multicausal nature of RTAs, where multiple conditions and factors interact, is crucial for developing effective prevention measures in road safety work. This study investigates the multivariate statistical analysis of co-occurring conditions in RTAs, focusing on single-vehicle accidents with single occupancy and personal injury on Austrian roads outside built-up areas from 2012 to 2019. The aim is to detect recurring combinations of accident-related variables, referred to as blackpatterns (BPs), using the Austrian RTA database. This study proposes Fisher’s exact test to estimate the relationship between an accident-related variable and fatal and severe RTAs (severe casualties). In terms of pattern recognition, this study develops the maximum combination value (MCV) of accident-related variables, a procedure to search through all possible combinations of variables to find the one that has the highest frequency. The accident investigation proceeds with the application of pattern recognition methods, including binomial logistic regression and a newly developed method, the PATTERMAX method, created to accurately detect and analyse variable-specific BPs in RTA data. Findings indicate significant BPs contributing to severe accidents. The combination of binomial logistic regression and the PATTERMAX method appears to be a promising approach to investigate severe accidents, providing both insights into detailed variable combinations and their impact on accident severity.

Clinical and functional characteristics of co-occurring cerebral palsy and autism spectrum disorder among children and young adults

BackgroundTo examine clinical and functional factors associated with co-occurring cerebral palsy (CP) and autism spectrum disorder (ASD). MethodsData were collected from the electronic health records of 994 patients with CP aged 3 to 26 years (59 % males) who received services from a U.S. hospital system between January 1, 2016 and July 1, 2021. CP, ASD, and other co-occurring conditions were abstracted using International Classification of Diseases - 10th Revision (ICD-10) codes, diagnostic summaries, and clinical descriptions. Bivariate and adjusted multivariable analyses examined the association between ASD, CP type, Gross Motor Function Classification System (GMFCS) level, speech or language disorders, and mental or behavioral problems. ResultsPrevalence of ASD was 8.2 % among patients with CP. Patients with GMFCS levels III-V were less likely to have a diagnosis of ASD (adjusted odds ratio [AOR] = 0.21; 95 % confidence interval [CI], 0.11–0.41). However, speech or language disorders (AOR = 6.00; 95 % CI, 2.14–16.81) and mental or behavioral problems (AOR =8.79; 95 % CI, 4.99–15.49) were associated with significantly higher odds of ASD. ConclusionsChildren and young adults with co-occurring CP and ASD have higher prevalence of clinical and functional impairments compared with counterparts with CP without co-occurring ASD. Screening for both conditions is necessary because of the high prevalence of ASD in this population. It is also necessary to implement specialized assessment procedures to decrease the risk of misclassifying or overlooking ASD among children and young adults with CP.

Pain and unhealthy alcohol use among people living with HIV: A prospective cohort study.

Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time. The current study examined whether pain was associated with indices of unhealthy alcohol use, namely heavy drinking and alcohol use disorder (AUD) assessed 12 months later. The study sample (n = 207) was from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) Cohort, a prospective cohort of PLWH with a history of illicit substance or unhealthy alcohol use. We conducted logistic regression analyses to examine the associations between pain and both heavy drinking and AUD status (DSM-5 criteria) (yes/no) over time. In secondary analyses, we examined whether pain was associated with greater AUD severity and whether pain interference was associated with heavy drinking and AUD outcomes. We found that pain at baseline was associated with greater odds of AUD [aOR = 2.29 (95% CI: 1.13, 4.64), p = 0.02] but not heavy drinking [aOR = 0.91 (95% CI: 0.44, 1.88), p = 0.79] at 12 months. Pain was also associated with more severe AUD. Analyses of pain interference showed similar results. Pain is prospectively associated with higher odds of AUD among PLWH with a substance/unhealthy alcohol use history. Providers should routinely address pain among PLWH to improve AUD outcomes.

Sleep disturbance and other co-occurring conditions in autistic children: A network approach to understanding their inter-relationships.

Autistic children frequently have one or more co-occurring psychological, behavioral, or medical conditions. We examined relationships between child behaviors, sleep, adaptive behavior, autistic traits, mental health conditions, and health in autistic children using network analysis. Network analysis is hypothesis generating and can inform our understanding of relationships between multiple conditions and behaviors, directing the development of transdiagnostic treatments for co-occurring conditions. Participants were two child cohorts from the Autism Treatment Network registry: ages 2-5 years (n = 2372) and 6-17 years (n = 1553). Least absolute-shrinkage and selection operator (LASSO) regularized partial correlation network analysis was performed in the 2-5 years cohort (35 items) and the 6-17 years cohort (36 items). The Spinglass algorithm determined communities within each network. Two-step expected influence (EI2) determined the importance of network variables. The most influential network items were sleep difficulties (2 items) and aggressive behaviors for young children and aggressive behaviors, social problems, and anxious/depressed behavior for older children. Five communities were found for younger children and seven for older children. Of the top three most important bridge variables, night-waking/parasomnias and anxious/depressed behavior were in both age-groups, and somatic complaints and sleep initiation/duration were in younger and older cohorts respectively. Despite cohort differences, sleep disturbances were prominent in all networks, indicating they are a transdiagnostic feature across many clinical conditions, and thus a target for intervention and monitoring. Aggressive behavior was influential in the partial correlation networks, indicating a potential red flag for clinical monitoring. Other items of strong network importance may also be intervention targets or screening flags.

The Role and Importance of Physician and Health Care Professional Programs.

Physician Health Programs (PHPs) have been support-ing and advocating for health professionals for nearly four decades. Initially developed by state medical societies in the 1980s, PHPs recognized the need for therapeutic alterna-tives to disciplinary measures for physicians facing health issues that could impair their ability to practice safely. Originally focused on substance use disorders, PHPs have since expanded their services to encompass mental health and other co-occurring conditions.