Concurrent Disorders Research Articles

The role of childhood maltreatment and mental health disorders on suicidal behaviour in adolescents

BackgroundSuicide stands as a grave and pressing public health concern, ranking among the foremost causes of death in the youth demographics. While childhood maltreatment (CM) and mental disorders have garnered substantial attention as risk factors for suicide, there remains an enigmatic aspect concerning how these two elements interact, influencing the nature of suicidal ideation and suicidal behaviour, and the transition between them. ObjectiveThis study endeavours to shed light on the intricate interplay between CM, mental disorders, and suicide. Participants and settingWe gathered data from 289 adolescents aged 12–17 (87.2 % female) drawn from eight different hospitals across Spain, all of whom had attempted suicide within the past 10 days. MethodsWe assessed suicidal ideation severity and intensity, suicidal behaviour by attempts using the C-SSRS, and the presence of CM using CTQ and identified concurrent mental disorders according to the MINI. Regression analysis and moderation analysis were conducted by PROCESS macro. ResultsModeration analysis revealed that higher scores of CM were associated with a higher number of suicide attempts with the presence of a mental disorder. Additionally, we found that those with higher scores of CM reported less severe characteristics of suicidal ideation, when presenting along with an anxiety disorder. ConclusionsThese findings revealed CM increased risk of suicidal behaviour among young individuals. Additionally, the results suggest that adolescents with CM and anxiety disorder might under-report suicidal ideation. Hence, these findings offer a potential key to identifying and preventing suicide risk among young individuals.

Healthcare resource utilization and costs among treatment-naïve people with HIV in state Medicaids: analysis of multi-tablet vs. single-tablet antiretroviral regimen initiators with and without concurrent mental health disorders

BACKGROUND Research is needed to understand the impact of mental health disorders (MHD) on healthcare resource utilization (HCRU) and costs among people with human immunodeficiency virus (PWH). OBJECTIVES Examine the HCRU and cost burden among treatment-naïve PWH with and without MHD initiating single tablet antiretroviral regimens (STRs) and multi-tablet regimens (MTRs). METHODS A retrospective database analysis of US Medicaid population from Anlitiks’ All Payor Claims database between 01/01/16 to 06/30/23 was conducted. Treatment-naïve MTR-initiators vs STR-initiators (the index was the first prescription fill claim date) with ≥ 12-months pre- and post-index continuous enrollment and no pre-index HIV-2 diagnosis among PWH/MHD and PWH/no-MHD during 01/01/17-06/30/22 were selected. Demographics, clinical characteristics, HCRU and costs between MTR-initiators vs STR-initiators among PWH/MHD and PWH/no-MHD were described using Chi-square tests and Wilcoxon rank-sum or t-tests for categorical and continuous variables, as appropriate. HCRU and costs were examined using multivariable logistic and gamma-log link regression models, controlling for potential confounders. RESULTS MTR-initiators (PWH/MHD: n = 7,874, PWH/no-MHD: n = 3,612) vs. STR-initiators (PWH/MHD: 46,024, PWH/no-MHD: 23,452) were significantly younger (PWH/MHD: 43.6 vs. 47.2 years; PWH/no-MHD: 39.2 vs. 43.3 years) and more likely to be female (PWH/MHD: 46.4% vs. 35.7%; PWH/no-MHD: 42.3% vs 29.7%) in both groups (all p-values < 0.05). MTR-initiators vs. STR-initiators had significantly higher rates of inpatient (IP) hospitalizations (PWH/MHD: 28.9% vs. 27.1%; PWH/no-MHD:13.9% vs. 11.9%) and emergency department (ED) visits (PWH/MHD: 53.3% vs. 49.2%; PWH/no-MHD: 35.2% vs. 31.8%) among both those with and without MHD (all p-values < 0.05). MTR-initiators vs. STR-initiators also had significantly higher adjusted all-cause medical costs (PWH/MHD: $60,228 vs $40,634; PWH/no-MHD: $33,623 vs. $17,996) (all p-values < 0.05). CONCLUSIONS Among PWH/MHD and PWH/no-MHD, MTR-initiators experienced significantly higher HCRU, and 1.5 times greater costs compared to STR-initiators. In both MTR and STR-initiator groups, PWH/MHD cohort consistently demonstrated a greater HCRU and cost burden than PWH/no-MHD.

Risk Factors of Reoperation in Patients with Intestinal Behçet's Disease Treated by Initial Bowel Resection.

Background/Objectives: Intestinal Behçet's disease (iBD) often requires surgical intervention, with a significant proportion of patients needing reoperation. This study aimed to investigate the risk factors associated with reoperation in patients with iBD who underwent initial bowel resection and to evaluate the perioperative and long-term outcomes in these patients. Methods: This was a retrospective case-control study analyzing patients who underwent their initial bowel resection due to iBD between 2005-2021 at a tertiary referral hospital. Reoperation was considered a surgery due to postoperative complications (within 30 days of the initial surgery) or disease progression. Results: A total of 81 patients were included. The median follow-up duration was 107.1 months, during which 26 patients (32%) underwent reoperation. Multivariable analysis showed that the presence of hematological disorders (hazards ratio [HR], 9.13; 95% confidence interval [CI], 3.79-22.02, p < 0.001), higher c-reactive protein (CRP) levels before the initial surgery (HR, 1.01; 95% CI, 1.01-1.02, p < 0.001), and a shorter specimen resection length (HR, 0.96; 95% CI, 0.93-0.99, p = 0.011) were risk factors for reoperation. Patients who underwent reoperation had higher rates of postoperative complications (69.2% vs. 43.6%, p = 0.031), required longer antibiotic use (12 vs. 7 days, p = 0.012), and had extended hospital stays (18 vs. 9 days, p = 0.011). They also had worse 5-year survival rates than those who did not undergo reoperation (83.5% vs. 98.4%, p = 0.012). Conclusions: Concurrent hematological disorders, high preoperative CRP levels, and short specimen resection were associated with an increased risk of reoperation in patients with iBD who underwent their initial bowel resections. They also had worse perioperative and long-term outcomes.

Treatment of trigeminal neuralgia by acupuncture combined with Chinese medicine from the perspective of modern medicine: A review.

Trigeminal neuralgia (TN) is characterized by recurrent episodes of transient severe pain in its distribution area, with abrupt onset and termination. With the progression of the disease, patients are prone to concurrent psychiatric disorders, such as anxiety and depression, which seriously affect patients' quality of life. Currently, anticonvulsant drugs are commonly used in clinical practice as the primary treatment, but long-term use of drugs is prone to drug resistance, limiting clinical application. Acupuncture and traditional Chinese medicine (TCM), as alternative and complementary therapies, can make up for the deficiencies in modern medicine and are accepted by patients with the advantages of safety and effectiveness. TCM therapy works by promoting the release of endogenous opioid peptides, adjusting the level of inflammatory factors, and improving negative emotions to exert analgesic effects. This paper discusses the clinical efficacy and safety of acupuncture combined with Chinese medicine in the treatment of TN from the perspective of modern medicine and provides a theoretical basis for seeking better therapeutic targets.

Cerebral palsy: potential risk factors and functional status among children under three years, a case-control study in northwest Iran

BackgroundCerebral palsy (CP) is one of the most common motor-postural disorders in childhood. It occurs due to impairment in the developing brain—before, during, or after birth—and has a significant burden on the public health system. This study aimed to investigate the potential risk factors and detect the associated CP-related disorders.MethodsThis case-control study was conducted on 46 children with CP and 175 matched healthy children less than three years old who referred to the Children’s Hospital, Tabriz, Iran in 2022. Then, a checklist related to the mother’s medical history during current and previous pregnancies, a questionnaire related to perinatal factors of the newborn, types of CP, concurrent disorders, the Gross Motor Function Classification System (GMFCS), and Age and Stage Questionaire (ASQ) were completed. Data was analyzed using Statistical Package for the Social Sciences) SPSS(-21 software by descriptive and analytical statistics consisted of Chi-square, Independent t-test, and Binary logistic regression.ResultsFinally, 35 children with CP and 122 healthy children completed the study and were analyzed. The mean (standard deviation: SD) age of children in the CP group was 15.3 (6.2) and in the healthy group was 14.4 (6.6) months (p = 0.635). Spastic CP (82.9%) was the common type, and the most common prevailing form of the involved limb was quadriplegia (54.3%). The severity of the functional disorder in 39.3% of CP cases was at levels 4 and 5 (severe form). The most prevalent comorbidities were inability to walk (31.4%), speech delay (22.9%), epilepsy (11.4), and strabismus (8.6%). Children with CP had abnormal development in gross motor (82.9%), problem-solving (68.6%), personal-social (65.7%), fine motor (60%), and communication (54.3%). Moreover, duration of pregnancy (p = 0.023), birth weight lower than 2500 g (p = 0.002), problems in the current pregnancy [adjusted odds ratio (aOR) [95% CI]: 3.06 (1.87 to 8.54); p = 0.013] and problems in previous pregnancy ([aOR (95% CI): 4.8 (1.6 to 14.2); p = 0.005) were potential risk factors.ConclusionDue to accompanying movement, vision, and speech problems, especially high developmental disorders in children with CP, necessary measures to prevent the identified risk factors are very important.

Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

Best Practices in the Nursing Care of Patients With Injuries From Violence: An Integrative Review.

The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them. To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting. The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review. Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis. Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice.

Positive rate of canine pancreatic lipase immunoreactivity (SNAP cPL) in relationship with severity of clinical signs and concurrent disorders: a retrospective study

Acute pancreatitis (AP) is a common disorder characterized by the inflammation of the exocrine pancreas in dogs, and the severity of the clinical signs of pancreatitis varies greatly. Therefore, the diagnosis of pancreatitis is challenging. The canine pancreatic lipase immunoreactivity test (SNAP cPL; IDEXX Laboratories Inc., USA) is rapid and relatively accurate in diagnosing pancreatitis. The purpose of this study was to evaluate the positivity rate of the SNAP cPL test in dogs regarding the severity of gastrointestinal (GI) signs and concurrent diseases. Electronic medical records of dogs were reviewed. For retrospective classification, 80 dogs with GI signs who underwent the SNAP cPL test were enrolled. Additionally, concurrent diseases on the day of the SNAP cPL test were reviewed. A positive SNAP cPL test result was observed in 26 of the 80 dogs (32.5%) with GI signs. The severity of GI signs using a scoring system and the positivity rate of SNAP cPL were statistically related. Furthermore, dogs with concurrent chronic kidney disease had a significantly higher positivity rate of SNAP cPL than those without chronic kidney disease. This information might help clinicians to decide whether a SNAP cPL test is needed.

Identification of factors associated with vancomycin-induced acute kidney injury: A retrospective analysis using the Common Data Model.

Previous findings on predictors of vancomycin-induced acute kidney injury (AKI) are inconsistent. We aimed to identify the predictors of vancomycin-induced AKI using the Observational Medical Outcome Partnership Common Data Model. We analyzed data from patients treated with vancomycin between January 1, 2012, and May 31, 2022, who were positive for Staphylococcus aureus and had undergone oxacillin susceptibility tests. After excluding patients without data for vancomycin or baseline serum creatinine levels, 116 patients were included in the final dataset. Data up to the third measured vancomycin concentration were collected for each patient. Logistic regression models were used to estimate the odds ratio and 95% confidence interval for each variable associated with vancomycin-induced AKI. High baseline serum creatinine levels, intensive care unit admission, and concurrent renal disorders were significantly associated with vancomycin-induced AKI. Although high trough levels or area under the curve values were not significantly associated with vancomycin-induced AKI, both were significantly higher in patients with AKI than in those without AKI at the second vancomycin concentration measurement. The proportion with trough levels >20mg/L was higher in patients with AKI than in those without AKI at the third measurement. Our findings revealed that underlying renal disease and intensive care unit admission are more significantly associated with vancomycin-induced AKI than vancomycin pharmacokinetic parameters or dosage, likely due to vancomycin concentration-based dosage adjustment in clinical settings. Our findings may help develop strategies for reducing the incidence of vancomycin-induced AKI; however, further prospective studies are essential.

Risk of suicide after hospitalizations due to acute physical health conditions—a cohort study of the Norwegian population

BackgroundIt is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions.MethodsA Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide.ResultsA total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable.ConclusionsThe heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

Deepening the decisional processes under value-based conditions in patients affected by Parkinson’s disease: A comparative study

Patients affected by Parkinson’s disease (PD) display a tendency toward making risky choices in value-based conditions. Possible causes may encompass the pathophysiologic characteristics of PD that affect neural structures pivotal for decision making (DM) and the dopaminergic medications that may bias choices. Nevertheless, excluding patients with concurrent impulse control disorders, results are few and mixed. Conversely, other factors, such as individual differences (e.g., emotional state, impulsivity, consideration for future consequences) and cognitive functioning, in particular executive functions (EFs), are involved, even though few studies investigated their possible role. The present study investigated (1) the differences in value-based DM between 33 patients with PD without impulse control disorders and 33 matched healthy controls, and (2) the relationships among decisional performances, EFs, and individual differences in a group of 42 patients with PD who regularly undertake dopaminergic medications. All participants underwent an individual assessment to investigate value-based DM, cognitive abilities, and individual differences associated with DM. Nonparametric analyses showed the presence of riskier decisions in patients compared with healthy controls, depending on the characteristics of the decisional situation. Moreover, parameters of the decisional tasks involving the number of risky choices were significantly related to the posology of dopaminergic medications, EFs, and individual differences. Findings were discussed, highlighting possible clinical implications.

Interdisciplinary Pain Board for Managing Patients with Palliative Care Needs and Substance Use Disorder: A Pilot Study.

Context: Patients with cancer-related pain and concurrent substance use disorder (SUD) present a unique set of challenges for palliative care clinicians. A structured forum for interdisciplinary collaboration is needed to effectively manage this complex population. Objectives: Describe the feasibility and acceptability of a palliative care Complex Pain Board (CPB), an interdisciplinary team meeting to provide concrete care recommendations for patients with cancer-related pain and concurrent SUD and/or psychosocial complexity. Methods: We conducted a retrospective analysis of cases presented at CPB between May 2021 and June 2022 and a cross-sectional analysis of CBP participant surveys. Results: Among 28 cases included for analysis, gastrointestinal cancers (n = 7, 25.9%) and multiple myeloma (n = 5, 18.5%) were the most frequent cancer diagnoses. Primary reasons for referral were SUD (n = 22, 78.6%) and provider/team distress (n = 13, 46.4%). The most frequent recommendations made at CBP were encouraging interdisciplinary collaboration (n = 18, 64.3%), maintaining healthy boundaries (n = 15, 53.6%), and SUD management (n = 13, 46.4%). Of 14 scheduled meetings, most meetings involved the presentation of ≥1 cases (n = 12, 86%). Among 40 CBP participant surveys, most attendees (n = 38, 95%) were likely or highly likely to continue to attend. Conclusion: CPB is a feasible and acceptable intervention that allows for palliative care clinicians to collaborate and receive interdisciplinary team feedback and peer support on the management of patients with cancer-related pain and concurrent SUD and/or psychosocial complexity in the ambulatory care setting. Key Message: A regular, interdisciplinary team meeting (CPB) is a feasible and acceptable intervention to help palliative care clinicians manage challenging cases involving patients with cancer and concurrent SUD and/or psychosocial complexity.

Unexpected Observation of Disorder and Multiple Phase-Transition Pathways in Shock-Compressed Zr.

The response of materials under dynamic compression involves a complex interplay of various deformation mechanisms aimed at relieving shear stresses, yielding a remarkable diversity in material behavior. In this Letter, we utilize femtosecond x-ray diffraction coupled with nanosecond laser compression to reveal an intricate competition between multiple shear-relieving mechanisms within an elemental metal. Our observations in shocked-compressed single-crystal Zr indicate a disorder-mediated shear relaxation at lower pressures. Above the phase-transition pressure, we observe the increasing contribution of structural phase transition in relieving shear stress. We detect not one but three concurrent pathways during the transition from the hcp to a hex-3 structure. These complex dynamics are partially corroborated through multimillion-atom molecular dynamics simulations employing a machine-learned interatomic potential. Our observation of multiple concurrent pathways and disorder during shock compression underscore the far greater intricacies in the dynamic response of metals than previously assumed.

Attributes of multiple concurrent functional gastrointestinal disorders in female university students in South Korea

ABSTRACT Functional gastrointestinal disorders (FGIDs) are common in young adults, particularly women, who tend to develop multiple FGIDs over time. This study aimed to investigate the prevalence of multiple concurrent FGIDs among female university students and identify differences in dietary habits, academic stress, and quality of life (QOL) based on the number of concurrent FGIDs. This secondary analysis included data from 406 female participants, originally collected through an online survey from two universities in one city in Korea. The online survey was accessible only after participants were verified as students through their online community. Concurrent FGID was present in 25.8 percent (n = 16) of the participants with FGIDs (n = 62), with the most common being irritable bowel syndrome + functional dyspepsia overlap (43.8 percent, 7/16). Participants with multiple concurrent FGIDs consumed fewer grains and vegetables, while significantly more of them consumed instant food, fast food, milk, and tea/coffee. They experienced significantly higher academic stress and lower QOL than those without the disease. Female university students with concurrent FGIDs tend to have unhealthy dietary habits, and concurrent FGIDs negatively affect academic stress and QOL. Therefore, female university students should undergo early-stage screening for FGIDs, and a comprehensive program should address their dietary habits and stress-coping skills.

Rehospitalisation risk by hypnotics class in older patients with heart failure: a cohort study utilizing administrative claims data in Japan

BackgroundStudies comparing the safety of orexin receptor antagonists and other hypnotic types for older patients with heart failure (HF) remain lacking. This study aimed to compare orexin receptor antagonists (suvorexant)...

Inflammatory Bowel Disease-Associated Arthritis Is Associated with Concomitant Autoimmune and Inflammatory Disorders.

Extraintestinal Manifestations (EIMs) are a common and potentially debilitating complication of Inflammatory Bowel Diseases (IBD), sometimes requiring additional treatment beyond those used to control intestinal disease. IBD-associated arthritis (IAA), a form of spondyloarthritis, is associated with several factors including disease location, sex, and IBD type. However, much remains unknown about other clinical factors predicting development of EIMs. Our goal was to identify additional factors associated with IAA. Participants in the LOCATION-IBD cohort were included in this analysis. We performed univariate and multivariate analysis of demographics, clinical data, and patient-reported outcomes data. The LOCATION-IBD cohort included 182 participants with (n = 53) and without (n = 110) joint EIMs and with joint pain of unclear etiology (n = 19). In a multivariate analysis comparing those with and without joint EIMs, female sex (OR = 2.5, p = 0.014), the presence of concomitant autoimmune and inflammatory disorders (OR = 2.5, p = 0.038), and Crohn's disease (OR = 2.9, p = 0.026) were associated with the presence of joint EIMs. This analysis reveals patients with IAA are more likely to have concomitant autoimmune disorders. Further studies are needed to confirm this association, understand the mechanisms underlying the common pathogenesis of these concurrent disorders, and evaluate their impact on the treatment of IAA.

Accounting for Cognitive Impairment in Concurrent Disorders Treatment: Practical Resources to Meet the Needs of Our Most Complex Clients.

Much has been written about the interplay between mental health and substance use disorders. However, there is a third dimension, which often complicates the provision of care and renders many mainstream approaches less effective. Cognitive impairments, including those that arise from traumatic brain injury, are increasingly being recognized as an important consideration in addictions programming. This article will discuss the findings from a cross-sectorial partnership between the Centre for Addiction and Mental Health (CAMH) and Community Head Injury Resource Services of Toronto (CHIRS). Four recommendations for program administrators are proposed: (1) support screening for brain injury; (2) use free resources to train staff members to recognize, accommodate and address neurocognitive impairment; (3) establish cross-sector partnerships to facilitate collaborative programming and cross training for the most complex clients being served; (4) when developing new programming, include structures and behavioural interventions that have been shown to benefit individuals with cognitive impairment.

Obesity treatment in adolescents and adults in the era of personalized medicine.

In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has "tried everything"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.

Identifying risk factors for blood culture negative infective endocarditis: An international ID-IRI study

BackgroundBlood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. MethodsThe study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. ResultsBlood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963–0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970–4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564–6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012–2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599–4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC±SE = 0.707 ± 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. ConclusionCaution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.

Clinical decision support systems in addiction and concurrent disorders: A systematic review and meta-analysis.

This review aims to synthesise the literature on the efficacy, evolution, and challenges of implementing Clincian Decision Support Systems (CDSS) in the realm of mental health, addiction, and concurrent disorders. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Searches conducted in databases such as MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science through 25 May 2023, yielded 27,344 records. After necessary exclusions, 69 records were allocated for detailed synthesis. In the examination of patient outcomes with a focus on metrics such as therapeutic efficacy, patient satisfaction, and treatment acceptance, meta-analytic techniques were employed to synthesise data from randomised controlled trials. A total of 69 studies were included, revealing a shift from knowledge-based models pre-2017 to a rise in data-driven models post-2017. The majority of models were found to be in Stage 2 or 4 of maturity. The meta-analysis showed an effect size of -0.11 for addiction-related outcomes and a stronger effect size of -0.50 for patient satisfaction and acceptance of CDSS. The results indicate a shift from knowledge-based to data-driven CDSS approaches, aligned with advances in machine learning and big data. Although the immediate impact on addiction outcomes is modest, higher patient satisfaction suggests promise for wider CDSS use. Identified challenges include alert fatigue and opaque AI models. CDSS shows promise in mental health and addiction treatment but requires a nuanced approach for effective and ethical implementation. The results emphasise the need for continued research to ensure optimised and equitable use in healthcare settings.