Discrepant Findings Research Articles

Interpretation discrepancies of abdominal imaging by on-call radiology residents: Evaluation of risk factors.

The aim of this study was to determine the rate, important findings, and risk factors related to discrepancies between on-call residents’ and attending radiologists’ interpretations of abdominal examinations. We identified 1132 eligible patients with abdominal radiology findings that were preliminary interpreted by on-call residents between February 2016 and September 2019. The preliminary interpretations were compared with the final interpretations by abdominal attending radiologists, including clinical data. The preliminary interpretations were analyzed by three radiologists in consensus, who categorized the reports according to organs, important findings (i.e., active bleeding, bowel obstruction, organ ischemia or infarction, and organ rupture), clinical outcomes, and discrepancies with respect to final interpretations. Multiple logistic regression analysis was used to evaluate the risk factors for important discrepant findings. Of 1132 patients, the bowel (n = 567, 50.1%) was the most common organ interpreted by on-call residents, followed by gallbladder/bile duct/pancreas (n = 139, 12.3%) and liver (n = 116, 10.2%). Of 1132, 359 patients (31.7%) had disease with 379 important findings: active bleeding (n = 222), organ rupture (n = 77), bowel obstruction (n = 52), bowel ischemia (n = 24), and organ infarction (n = 4). Sixty-four patients (5.6%) showed discrepancies, and 30 (2.6%) showed 32 important discrepant findings comprising 14 active bleeding, 10 bowel obstructions, 6 organ ruptures, and 2 cases of bowel ischemia. Of the 64 discrepant patients, 33 underwent delayed surgery (n = 18, 28.1%) or interventional treatment (n = 15, 23.4%). In multivariable analysis, bowel obstruction (adjusted odds ratio, 2.52; p = 0.049) was an independent risk factor for determining discrepancy between preliminary and final interpretations. The rate of overall and important discrepancies between on-call residents’ and final interpretations was low. However, given that the bowel was the most frequently interpreted organ, bowel obstruction was identified as a risk factor for discrepant interpretations. The identified risk factor and findings may be useful for residents to minimize discrepancies.

Editor's Choice – Real World Study of Mortality After the Use of Paclitaxel Coated Devices in Peripheral Vascular Intervention

This observational cohort study examined outcomes after peripheral vascular intervention (PVI) with paclitaxel coated devices (PCD) and non-PCD, and evaluated heterogeneity of treatment effect in populations of interest. The study included patients undergoing percutaneous transluminal angioplasty and or stent placement between 1 October 2015 and 31 December 2018 in the Vascular Quality Initiative Registry linked to Medicare claims. It determined differences in patient mortality and ipsilateral major amputation after PVI with PCD and non-PCD using Kaplan-Meier analyses and Cox regressions with inverse probability weighting in three cohorts: (A) patients treated for femoropopliteal or infrapopliteal occlusive disease with or without any other concurrent treatment (n= 11 452); (B) those treated for isolated superficial femoral or popliteal artery disease (n= 5 519); and (C) patients with inclusion criteria designed to approximate RCT populations (n= 2 278). The mean age of patients was 72.3 (SD= 10.9) years, and 40.6% were female. In cohort A, patients receiving PCD had a lower mortality rate (HR 0.88, 95% CI 0.79 - 0.98) than those receiving non-PCD. There was no significant difference in mortality between groups in cohort B (HR 0.91, 95% CI 0.80 - 1.04) and cohort C (HR 1.10, 95% CI 0.84 - 1.43). Patients receiving PCD did not have a significantly elevated risk of major amputation compared with those receiving non-PCD (cohort A: HR 0.84, 95% CI 0.70 - 1.00; cohort B: HR 0.84, 95% CI 0.67 - 1.06; and cohort C: HR 1.05, 95% CI 0.51 - 2.14). No increased patient mortality or major amputation was found at three years after PVI with PCD vs. non-PCD in this large, linked registry claims study, after accounting for heterogeneity of treatment effect by population. The analysis and results from three cohorts intended to mirror the cohorts of previous studies provide robust and niche real world evidence on PCD safety and help to understand and reconcile previously discrepant findings.

Giardia and growth impairment in children in high-prevalence settings: consequence or co-incidence?

Giardia is a common intestinal parasite worldwide, and infection can be associated with clear, and sometimes persistent symptomatology. However, in children in high-prevalence settings, it is most often not associated with or is perhaps even protective against acute diarrhea. Nonetheless, recent longitudinal studies in high-prevalence settings increasingly identify an association with long-term outcomes that has been difficult to discern. Recent studies have made progress in disentangling this apparent paradox. First, prospective, well characterized cohort studies have repeatedly identified associations between Giardia infection, gut function, and child growth. Second, experimental animal and in-vitro models have further characterized the biological plausibility that Giardia could impair intestinal function and subsequently child development through different pathways, depending upon biological and environmental factors. Finally, new work has shed light on the potential for Giardia conspiring with specific other gut microbes, which may explain discrepant findings in the literature, help guide future higher resolution analyses of this pathogen, and inform new opportunities for intervention. Recent prospective studies have confirmed a high, if not universal, prevalence of persistent Giardia infections in low-and-middle income countries associated with child-growth shortfalls and altered gut permeability. However, the predominance of subclinical infections limits understanding of the true clinical impact of endemic pediatric giardiasis, and global disease burdens remain uncalculated. Integrating the role of Giardia in multipathogen enteropathies and how nutritional, microbial, metabolic, and pathogen-strain variables influence Giardia infection outcomes could sharpen delineations between pathogenic and potentially beneficial attributes of this enigmatic parasite.

Analyzing Big Data in Entrepreneurship: Replicating and Extending Evans and Leighton (1989)

Analyzing big data requires the use of more powerful big data analytical techniques. The risk of not employing such techniques is that we misunderstand the true relationships in fundamental issues. In the study, we replicate and extend Evans and Leighton (1989) to revisit the entrepreneurial entry problem using a traditional logistic regression and one type of big data techniques – random forests. Through comparing the discrepant findings of these two models, we assert the benefits of using contemporary approaches to handle big data in revisiting fundamental questions in entrepreneurship.

Platelet-Rich Plasma Monotherapies for Androgenetic Alopecia: A Network Meta-Analysis and Meta-Regression Study.

Platelet-rich plasma (PRP) is a commonly used therapeutic option for androgenetic alopecia (AGA). Evidence syntheses for the impact of PRP on AGA has been handicapped by non-standardized protocols for its administration. We quantitatively synthesized the evidence base to determine the relative efficacy of PRP regimens with different frequencies of administration. We defined frequency as a vector of the (i) number of sessions and (ii) time interval between the sessions. We systematically reviewed the peer-reviewed literature to obtain relevant data; we then conducted a multivariable meta-regression and network meta-analyses (NMAs). Twenty-five trials met our eligibility criteria; 10 unique PRP regimens were ultimately identified for use in our analyses. Our NMAs produced surface under the cumulative ranking curve (SUCRA) values that corroborated the findings of our multivariable meta-regression. The frequency of PRP sessions, chemical activation, number of centrifugations, the age and sex of the patient, and the design of PRP administration (ie, whole-head vs split-scalp) are correlated with the efficacy of PRP insofar as the mean change in total hair density at 6 months from baseline. For the most part, regimens’ SUCRA rankings and relative effects support that the efficacy of PRP administration increases when: (i) the number of sessions increases and (ii) the time interval between sessions decreases; we found that chemically-activated PRP (vs inactivated), double centrifugation (vs single), younger (vs older) age of treated patients, female (vs male) sex, and whole-head (vs split-scalp) administration is associated with improved PRP efficacy. Our approach rules out much confounding as the analysis of our outcome was exclusive to monotherapy at a singular timepoint. Our results may reconcile discrepant findings among previous studies and may be helpful in updating clinical practice guidelines. J Drugs Dermatol. 2022;21(9):943-952. doi:10.36849/JDD.6948.

CT findings of COVID-19-associated pulmonary aspergillosis: a systematic review and individual patient data analysis

PurposeCommon CT abnormalities of pulmonary aspergillosis represent a cavity with air-meniscus sign, nodule, mass, and consolidation having an angio-invasive pattern. This study aims to conduct a systematic review and an individual patient-level image analysis of CT findings of COVID-19-associated pulmonary aspergillosis (CAPA). MethodsA systematic literature search was conducted to identify studies reporting CT findings of CAPA as of January 7, 2021. We summarized study-level clinical and CT findings of CAPA and collected individual patient CT images by inviting corresponding authors. The CT findings were categorized into four groups: group 1, typical appearance of COVID-19; group 2, indeterminate appearance of COVID-19; group 3, atypical for COVID-19 without cavities; and group 4, atypical for COVID-19 with cavities. In group 2, cases had only minor discrepant findings including solid nodules, isolated airspace consolidation with negligible ground-glass opacities, centrilobular micronodules, bronchial abnormalities, and cavities. ResultsThe literature search identified 89 patients from 25 studies, and we collected CT images from 35 CAPA patients (mean age 62.4 ± 14.6 years; 21 men): group 1, thirteen patients (37.1%); group 2, eight patients (22.9%); group 3, six patients (17.1%); and group 4, eight patients (22.9%). Eight of the 14 patients (57.1%) with an atypical appearance had bronchial abnormalities, whereas only one (7.1%) had an angio-invasive fungal pattern. In the study-level analysis, cavities were reported in 12 of 54 patients (22.2%). ConclusionCAPA can frequently manifest as COVID-19 pneumonia without common CT abnormalities of pulmonary aspergillosis. If abnormalities exist on CT images, CAPA may frequently accompany bronchial abnormalities.

68Ga-PSMA-11 PET/MRI versus multiparametric MRI in men referred for prostate biopsy: primary tumour localization and interreader agreement

BackgroundMagnetic resonance imaging (MRI) is recommended by the European Urology Association guidelines as the standard modality for imaging-guided biopsy. Recently positron emission tomography with prostate-specific membrane antigen (PSMA PET) has shown promising results as a tool for this purpose. The aim of this study was to compare the accuracy of positron emission tomography with prostate-specific membrane antigen/magnetic resonance imaging (PET/MRI) using the gallium-labeled prostate-specific membrane antigen (68Ga-PSMA-11) and multiparametric MRI (mpMRI) for pre-biopsy tumour localization and interreader agreement for visual and semiquantitative analysis. Semiquantitative parameters included apparent diffusion coefficient (ADC) and maximum lesion diameter for mpMRI and standardized uptake value (SUVmax) and PSMA-positive volume (PSMAvol) for PSMA PET/MRI.ResultsSensitivity and specificity were 61.4% and 92.9% for mpMRI and 66.7% and 92.9% for PSMA PET/MRI for reader one, respectively. RPE was available in 23 patients and 41 of 47 quadrants with discrepant findings. Based on RPE results, the specificity for both imaging modalities increased to 98% and 99%, and the sensitivity improved to 63.9% and 72.1% for mpMRI and PSMA PET/MRI, respectively. Both modalities yielded a substantial interreader agreement for primary tumour localization (mpMRI kappa = 0.65 (0.52–0.79), PSMA PET/MRI kappa = 0.73 (0.61–0.84)). ICC for SUVmax, PSMAvol and lesion diameter were almost perfect (≥ 0.90) while for ADC it was only moderate (ICC = 0.54 (0.04–0.78)). ADC and lesion diameter did not correlate significantly with Gleason score (ρ = 0.26 and ρ = 0.16) while SUVmax and PSMAvol did (ρ = − 0.474 and ρ = − 0.468).ConclusionsPSMA PET/MRI has similar accuracy and reliability to mpMRI regarding primary prostate cancer (PCa) localization. In our cohort, semiquantitative parameters from PSMA PET/MRI correlated with tumour grade and were more reliable than the ones from mpMRI.

IL-33 biology in cancer: An update and future perspectives

Interleukin-33 (IL-33) is a member of the IL-1 family of cytokines that is constitutively expressed in the nucleus of epithelial, endothelial and fibroblast-like cells. Upon cell stress, damage or necrosis, IL-33 is released into the cytoplasm to exert its prime role as an alarmin by binding to its specific receptor moiety, ST2. IL-33 exhibits pleiotropic function in inflammatory diseases and particularly in cancer. IL-33 may play a dual role as both a pro-tumorigenic and anti-tumorigenic cytokine, dependent on tumor and cellular context, expression levels, bioactivity and the nature of the inflammatory environment. In this review, we discuss the differential contribution of IL-33 to malignant or inflammatory conditions, its multifaceted effects on the tumor microenvironment, while providing possible explanations for the discrepant findings described in the literature. Additionally, we examine the emerging and divergent functions of IL-33 in the nucleus, and aspects of IL-33 biology that are currently under-addressed.

Editors' Note: Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wild-Type Glioblastoma in Adults: An Observational Study

Dr. Pallud et al. investigated whether the duration of levetiracetam use during the standard chemoradiation protocol affected the overall survival of patients with IDH wild-type glioblastoma in an observational single-center cohort study of 460 patients. Levetiracetam use during the whole duration of the standard chemoradiation protocol independently predicted longer overall survival, and the authors concluded that levetiracetam should be considered in the antitumor strategy of future multicenter trials. In response, Dr. Mazzucchi et al. comment that because levetiracetam was likely initiated in these patients for new epilepsy or epilepsy resistant to other drugs, the study findings reinforce the hypothesis that uncontrolled epilepsy may be a risk factor for glioma progression. They also note that other antiseizure medications have been reported to display experimental antitumoral properties. Nevertheless, they caution against starting levetiracetam in patients without a prior history of seizures. Responding to these comments, the authors note that epilepsy was actually associated with improved survival in patients with glioblastomas and diffuse low-grade gliomas in their previous study. They emphasize that the discrepant findings among studies may relate to their focus on seizure control at the time of diagnosis rather than postoperatively. They also note that there were only a few patients without seizures who were on levetiracetam in their study. They agree that randomized controlled trials are needed to clarify the role of antiepileptic drugs in the treatment of diffuse gliomas. This exchange highlights both the promise and uncertainty presented by certain antiepileptic drugs such as levetiracetam in the treatment of patients with gliomas. Dr. Pallud et al. investigated whether the duration of levetiracetam use during the standard chemoradiation protocol affected the overall survival of patients with IDH wild-type glioblastoma in an observational single-center cohort study of 460 patients. Levetiracetam use during the whole duration of the standard chemoradiation protocol independently predicted longer overall survival, and the authors concluded that levetiracetam should be considered in the antitumor strategy of future multicenter trials. In response, Dr. Mazzucchi et al. comment that because levetiracetam was likely initiated in these patients for new epilepsy or epilepsy resistant to other drugs, the study findings reinforce the hypothesis that uncontrolled epilepsy may be a risk factor for glioma progression. They also note that other antiseizure medications have been reported to display experimental antitumoral properties. Nevertheless, they caution against starting levetiracetam in patients without a prior history of seizures. Responding to these comments, the authors note that epilepsy was actually associated with improved survival in patients with glioblastomas and diffuse low-grade gliomas in their previous study. They emphasize that the discrepant findings among studies may relate to their focus on seizure control at the time of diagnosis rather than postoperatively. They also note that there were only a few patients without seizures who were on levetiracetam in their study. They agree that randomized controlled trials are needed to clarify the role of antiepileptic drugs in the treatment of diffuse gliomas. This exchange highlights both the promise and uncertainty presented by certain antiepileptic drugs such as levetiracetam in the treatment of patients with gliomas.

Real-Time Monitoring of Cannabis and Prescription Opioid Co-Use Patterns, Analgesic Effectiveness, and the Opioid-Sparing Effect of Cannabis in Individuals With Chronic Pain

Despite a rapid expansion of cannabis use for pain management, how cannabis and prescription opioids are co-used and whether co-use improves analgesia and promotes reduction of opioid use in the daily lives of individuals with chronic pain is poorly understood. Based upon ecological momentary assessment (EMA), the present study examined 1) how pain and use of opioids and/or cannabis in the previous moment is associated with individuals’ choice of opioids and/or cannabis in the next moment, 2) the effects of co-use on pain severity and pain relief, and 3) whether daily total opioid consumption differs on days when people only used opioids versus co-used. Adults with chronic pain (N = 46) using both opioids and cannabis who were recruited online completed a 30-day EMA. Elevated pain did not increase the likelihood of co-use in subsequent momentary assessments. Switching from sole use of either opioids and cannabis to co-use was common. Neither co-use nor sole use of either cannabis or opioids were associated with reductions in pain in the next moment. However, participants reported the highest daily perceived pain relief from co-use compared to cannabis and opioid use only. Post hoc analysis suggested recall bias as a potential source of this discrepant findings between momentary versus retrospective assessment. Lastly, there was no evidence of an opioid-sparing effect of cannabis in this sample. The present study shows preliminary evidence on cannabis and opioid co-use patterns, as well as the effects of co-use on pain and opoid dose in the real-world setting. PerspectiveThis article presents the overall patterns and effects of co-using cannabis and prescription opioids among individuals with chronic pain employing ecological momentary assessment. There were conflicting findings on the association between co-use and analgesia. Co-use was not associated with a reduction in daily opioid consumption in this sample.

Does an increase in physiological indexes predict better cognitive performance: the PhyCog randomised cross-over protocol in type 2 diabetes

IntroductionThere has been a growing interest towards cognitive-training programmes to improve cognition and prevent cognitive impairment despite discrepant findings. Physical activity has been recognised in maintaining or improving cognitive ability....

Discrepancies between tumor genomic profiling and germline genetic testing

BackgroundTumor genomic profiling (TGP) often incidentally identifies germline pathogenic variants (PVs) associated with cancer predisposition syndromes. Methods used by somatic testing laboratories, including germline analysis, differ from designated germline laboratories that have optimized the identification of germline PVs. This study evaluated discrepancies between somatic and germline testing results, and their impact on patients.Patients and methodsChart reviews were carried out at a single institution for patients who had both somatic and designated germline genetic testing. Cases with discrepant results in which germline PVs were not detected by the somatic laboratory or in which variant classification differed are summarized.ResultsTGP was carried out on 2811 cancer patients, 600 of whom also underwent designated germline genetic testing. Germline PVs were identified for 109 individuals. Discrepancies between germline genetic testing and tumor profiling reports were identified in 20 cases, including 14 PVs identified by designated germline genetic testing laboratories that were not reported by somatic testing laboratories and six variants with discrepant classifications between the designated germline and somatic testing laboratories.Three PVs identified by designated germline laboratories are targets for poly adenosine diphosphate-ribose polymerase (PARP) inhibitors and resulted in different treatment options. Of the PVs identified by designated germline laboratories, 60% (n = 12) were in genes with established associations to the patients’ cancer, and 40% of the PVs were incidental. The majority (90%) of all discrepant findings, both contributory and incidental, changed management recommendations for these patients, highlighting the importance of comprehensive germline assessment.ConclusionsMethods used by somatic laboratories, regardless of the inclusion of germline analysis, differ from those of designated germline laboratories for identifying germline PVs. Unrecognized germline PVs may harm patients by missing hereditary syndromes and targeted therapy opportunities (e.g. anti-programmed cell death protein 1 immunotherapy, PARP inhibitors). Clinicians should refer patients who meet the criteria for genetic evaluation regardless of somatic testing outcomes.

Targeted genetic and epigenetic profiling of esophageal adenocarcinomas and non-dysplastic Barrett’s esophagus

BackgroundDespite the efforts to describe the molecular landscape of esophageal adenocarcinoma (EAC) and its precursor lesion Barrett’s esophagus (BE), discrepant findings are reported. Here, we investigated the prevalence of selected genetic (TP53 mutations and microsatellite instability (MSI) status) and epigenetic (DNA promoter hypermethylation of APC, CDKN2A, MGMT, TIMP3 and MLH1) modifications in a series of 19 non-dysplastic BE and 145 EAC samples. Additional biopsies from adjacent normal tissue were also evaluated. State-of-the-art methodologies and well-defined scoring criteria were applied in all molecular analyses.ResultsOverall, we confirmed frequent TP53 mutations among EAC (28%) in contrast to BE, which harbored no mutations. We demonstrated that MSI and MLH1 promoter hypermethylation are rare events, both in EAC and in BE. Our findings further support that APC, CDKN2A, MGMT and TIMP3 promoter hypermethylation is frequently seen in both lesions (21–89%), as well as in a subset of adjacent normal samples (up to 12%).ConclusionsOur study further enlightens the molecular background of BE and EAC. To the best of our knowledge, this is one of the largest studies addressing a targeted analysis of genetic and epigenetic modifications simultaneously across a combined series of non-dysplastic BE and EAC samples.

The beauty of diversity in cognitive neuroscience: The case of sex-related effects in language production networks.

Over the past few decades, several studies have focused on potential sex-related differences in the trajectories of language development and functioning. From a behavioral point of view, the available literature shows controversial results: differences between males and females in language production tasks may not always be detectable and, even when they are, are potentially biased by sociological and educational confounding factors. The problem regarding potential sex-related differences in language production has also been investigated at the neural level, again with controversial results. The current minireview focuses on studies assessing sex-related differences in the neural networks of language production. After providing a theoretical framework of language production, it is shown that the few available investigations have provided mixed results. The major reasons for discrepant findings are discussed with theoretical and methodological implications for future studies.

Parenting in context: A systematic review of the correlates of autonomy support

AbstractResearch has shown that autonomy‐supportive parenting is associated with positive academic and socioemotional outcomes across childhood. Many studies have examined the correlates of parental autonomy support to understand who is most likely to be autonomy‐supportive and under what conditions. The current systematic review synthesized findings from 63 studies that explored how sociodemographic, familial, parental, and situational factors are related to autonomy‐supportive parenting. Results indicated that sociodemographic factors did not reliably predict autonomy support across studies. Parental factors, including socialization goals, need satisfaction, and mental health, were consistently linked with autonomy support. We propose a contextual model of autonomy support in which the associations between distal factors and autonomy‐supportive parenting are mediated by parental factors, with situational factors moderating the relation between parental factors and autonomy support. Suggestions for future research include reconciling discrepant findings across different measurement approaches and considering how developmental timing influences the factors associated with autonomy‐supportive parenting.

CHEST CT VS RT-PCR FOR THE DETECTION OF COVID-19: SYSTEMATIC REVIEW AND META-ANALYSIS OF COMPARATIVE STUDIES

TYPE: Abstract TOPIC: Chest Infections PURPOSE: To compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) as the reference standard in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients. METHODS: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A search of electronic information was conducted using the following databases: MEDLINE, EMBASE, EMCARE, CINAHL and the Cochrane Central Register of Controlled Trials. Thirteen non-randomised studies enrolling 4092 patients were identified. Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcomes included other test performance characteristics and discrepant findings between both investigations. RESULTS: Chest CT had a median sensitivity, specificity and accuracy of 0.91 (range 0.82–0.98), 0.775 (0.25–1.00) and 0.87 (0.68–0.99), respectively, with RT-PCR as the reference. Importantly, early small, China-based studies tended to favour chest CT versus later larger, non-China studies. CONCLUSIONS: A relatively high false positive rate can be expected with chest CT. It is possible it may still be useful to provide circumstantial evidence, however, in some patients with a suspicious clinical presentation of COVID-19 and negative initial Severe Acute Respiratory Syndrome Coronavirus 2 RT-PCR tests, but more evidence is required in this context. In acute cardiorespiratory presentations, negative CT scan and RT-PCR tests is likely to be reassuring. CLINICAL IMPLICATIONS: This study provides useful information regardnig which reference standard in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients between chest CT versus RT-PCR DISCLOSURE: Nothing to declare. KEYWORD: COVID-19

Abnormal vasodilator stress electrocardiogram with normal myocardial perfusion: Clinical decision-making and review of literature

Ischemic electrocardiographic (ECG) changes during vasodilator stress testing in the presence of abnormal myocardial perfusion imaging (MPI) are associated with more severe coronary artery disease (CAD). However, significance of ECG changes during vasodilator stress test with normal MPI has been controversial. Here, we discuss two cases of significant ischemic ECG changes with vasodilator stress and normal MPI, whose subsequent workup revealed severe obstructive CAD. We also review the available literature on the occurrence and mechanism of these discrepant findings and propose recommendations for management.

Child maltreatment and asthma.

A growing body of evidence suggests a potential link between child maltreatment and asthma. Determining whether and how child maltreatment causes or worsens asthma would have major implications for disease prevention and treatment, as well as public health policy. In this article, we examine epidemiologic studies of child maltreatment and asthma and asthma-related outcomes, review the evidence for potential mechanisms underlying the child maltreatment-asthma association, and discuss future directions. To date, a child maltreatment-asthma link has been reported in most studies of children and adults, though the type of maltreatment associated with asthma has differed across studies. Such discrepant findings are likely explained by differences in study design and quality. All studies have been limited by potential under-reporting of child maltreatment and selection bias, and nonthorough assessment of asthma. Despite these limitations, the aggregate evidence from epidemiologic studies suggests a possible causal link between child maltreatment and asthma, though the relative contributions of various types of maltreatment (physical, sexual, emotional, or neglect) are unclear. To date, there is insufficient evidence of an association between child maltreatment and lung function in children or adults. Limited evidence further suggests that child maltreatment could influence the development or severity of asthma through direct effects on stress responses and anxiety- or depressive-related disorders, immunity, and airway inflammation, as well as indirect effects such as increased obesity risk. Future prospective studies should aim to adequately characterize both child maltreatment and asthma, while also assessing relevant covariates and biomarkers of stress, immune, and therapeutic responses.

0649 Objective and Subjective Sleep Patterns in Youth with Obsessive-Compulsive Disorder

Abstract Introduction Sleep disturbance commonly presents in youth with obsessive-compulsive disorder (OCD). However, studies elucidating the nature of sleep problems in OCD are limited and pose discrepant findings. The present study examines objective and subjective sleep disturbance in youth with OCD relative to healthy controls, and investigates the relationship between sleep disturbance and OCD symptom severity. Methods Participants were 61 youth aged 8 to 17 years (M = 12.18, SD = 2.64) with OCD (n = 26), and healthy controls (n = 35). An evaluator assessed psychiatric diagnosis through a diagnostic interview and rated OCD symptom severity (Children’s Yale-Brown Obsessive-Compulsive Scale). Objective sleep patterns, including sleep onset latency, wake after sleep onset, duration and number of awakenings, total sleep time, and sleep efficiency were assessed through 7-day sleep monitoring using the wActiSleep-BT actigraph. Youth rated sleep using the Sleep Self-Report (SSR), and parents rated youth sleep using the Children’s Sleep Habits Questionnaire (CSHQ). Results Independent samples t-tests were performed to compare youth with OCD and healthy controls on sleep measures. Findings revealed no significant differences between youth with OCD and healthy controls on the actigraphy measures (i.e., total sleep time, wake after sleep onset, duration and number of awakenings, and sleep onset latency, sleep efficiency). Youth with OCD had significantly greater self-reported, t(24) = 3.29, p < 0.01, and parent-reported sleep disturbance, t(41) = 2.94, p < 0.01, relative to healthy controls. OCD symptom severity was positively correlated with SSR scores, r = .53, p < 0.01, and CSHQ scores, r = .47, p = 0.03. There were no significant correlations between actigraphy measures and OCD symptom severity. Conclusion Youth with OCD exhibit sleep disturbance on subjective but not objective sleep measures relative to healthy controls. Findings are discrepant from objective-subjective sleep patterns found in other studies of youth with OCD, but consistent with those found in youth with anxiety disorders. Findings may suggest subjective measures capture forms of sleep disturbance (e.g., bedtime resistance, nighttime anxiety, etc.) not measured by actigraphy. Support (If Any)

Regression to the mean in latent change score models: an example involving breastfeeding and intelligence

BackgroundLatent change score models are often used to study change over time in observational data. However, latent change score models may be susceptible to regression to the mean. Earlier observational studies have identified a positive association between breastfeeding and child intelligence, even when adjusting for maternal intelligence.MethodIn the present study, we investigate regression to the mean in the case of breastfeeding and intelligence of children. We used latent change score modeling to analyze intergenerational change in intelligence, both from mothers to children and backward from children to mothers, in the 1979 National Longitudinal Survey of Youth (NLSY79) dataset (N = 6283).ResultsWhen analyzing change from mothers to children, breastfeeding was found to have a positive association with intergenerational change in intelligence, whereas when analyzing backward change from children to mothers, a negative association was found.ConclusionsThese discrepant findings highlight a hidden flexibility in the analytical space and call into question the reliability of earlier studies of breastfeeding and intelligence using observational data.