Improvement In Functioning Research Articles

Appraising Jackson-based unrestorability to competence to stand trial: The demonstration model.

Under United States law, criminal prosecution may not proceed against a defendant who is incompetent to participate in this process. The vast majority of defendants who are adjudicated incompetent to stand trial (IST) will subsequently regain sufficient capacities to be adjudicated competent to stand trial (CST). However, a small subgroup of defendants do not show sufficient improvement in clinical functioning and functional-legal capacities to regain CST. Under Jackson v. Indiana (1972), such individuals should be adjudicated unrestorably IST, with associated actions (e.g., dropping of criminal charges, civil commitment, transfer to a less restrictive environment or released) specified under the particular jurisdictional statutes. But the present practices associated with the evaluation of unrestorability do not appear well supported by research. In particular, statutorily specified evaluative procedures are overly dependent on prediction in some instances and allow an unnecessarily long restoration period in others. In the present article, we propose and describe an alternative approach-the Demonstration Model-that would address both challenges, providing a more consistent and standard approach to assessing CST and the possibility that a defendant may not recover needed capacities within the foreseeable future. Implementation of this approach can potentially guide restoration planning and intervention, decrease unsupported reliance upon prediction in favor of observing and documenting the results of selected interventions, and provide legal decision-makers with clearer and more transparent evidence, while acknowledging the liberty interests of IST defendants set forth in Jackson. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of exercise mode specificity on quality of life in prostate cancer patients undergoing androgen suppression.

72 Background: Androgen deprivation therapy (ADT) is accompanied by a range of adverse effects including those of the musculoskeletal, metabolic, and cardiovascular systems, as well as compromised functioning and quality of life (QoL). Exercise has been shown to be an effective countermeasure to a number of these toxicities, although the effects of different modes or prescriptions on self-report QoL is unclear. Here we report the effects from a yearlong trial of 3 different exercise prescriptions involving aerobic, resistance, and impact loading modes on QoL in men with prostate cancer undergoing ADT. Methods: One hundred and fifty-four prostate cancer patients (43-90 yrs, BMI 28.7 ± 4.1) on ADT (Mdn 3 mths, IQR 2.0-4.0 mths) were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training; ILRT, n=57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training; ART, n=50) supervised for 6 months followed by a 6-month home program, or delayed aerobic exercise (DelAer, n=47) receiving exercise information for 6 months followed by 6 months supervised stationary cycling exercise. Supervised exercise was undertaken twice weekly at a moderate intensity. QoL domains were assessed at baseline, 6, and 12 months using the Short Form-36 questionnaire. Results: There were no significant differences among groups in QoL domains at baseline. Following exercise there was a significant group x time interaction (p < 0.05) for the domain role physical and the physical health composite score with increases at 12 months for ILRT and DelAer. There was also a significant time effect (p < 0.001) for improvements in physical functioning, general health, vitality, and mental health, and also bodily pain (p = 0.037), with no between-group differences. Patients in the lowest tertile for QoL at baseline improved the most with exercise (Ptrend < 0.001). Conclusions: Different exercise modes had similar effects on improving QoL in patients with prostate cancer undergoing ADT. Importantly, those with the lowest QoL derived the greatest benefits from exercise. Recommending patients on ADT to undertake exercise, regardless of mode, will help to preserve or improve quality of life. Clinical trial information: ACTRN12609000200280 .

Efficacy of Psychosocial and Psychological Interventions in Addition to Drug Therapy to Improve Global Functioning of Inpatients with Schizophrenia Spectrum and Mood Disorders: A Real-World Observational Study.

Psychotic and mood disorders are associated with significant functional impairment, premature mortality, physical morbidity, and great social and economic burden. The aim of this study is to evaluate the effectiveness of psychosocial, psychological, and rehabilitative interventions implemented in an Italian psychiatric inpatient facility, with a focus on patients with schizophrenia spectrum versus those with mood disorders. A retrospective observational study was conducted in the psychiatric hospital Villa Maria Pia in Rome, Italy, during 2022. Patients with an established diagnosis of schizophrenia spectrum and mood disorder (ICD-9-CM) were assessed on admission (T0) and at the end of treatment (T1), using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Interventions involved a multidisciplinary team and included individual and group activities. The t-test for independent samples was used to compare continuous variables between groups and Spearman correlation coefficient to calculate correlations between variables. The study sample consisted of 141 patients, the majority of them being adults (51.3 years ± 12.4) men (F/M= 68/73). Among them, 85 patients (60.3%) actively engaged in psychosocial and rehabilitative interventions and, compared to non-participating individuals, they showed lower functioning and symptoms at discharge (delta GAF was significantly higher among patients who had taken part in the psychosocial activities, t = -2.095; p = 0.038). Considering the index computed (n of interventions/days of hospitalization), the number of psychosocial activities was positively correlated with the improvement in patients' functioning in the sample taking part in activities (r = 0.272, p = 0.012), especially with psychotherapy and support groups (r = 0.202, p = 0.017 and r = 0.188, p = 0.025, respectively). Splitting the total sample into schizophrenia-spectrum disorder (N = 37) and mood disorder (N = 48) groups, the positive correlations between GAF improvement and participation in psychosocial activities were confirmed only in the schizophrenia-spectrum group. These correlations were not significant for symptomatology (BPRS) either in the total or the individual group. Evidence from our study suggests that inpatient rehabilitation can be effective and useful for people with severe mental disorders. Further investigations are needed to better understand its effectiveness on improving quality of life and social functioning in the long term.

Women achieve equivalent health-related quality of life benefits to men from attending cardiac rehabilitation: a matched case-control study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SOLVE-CHD NHMRC Synergy Grant Background/Introduction Coronary heart disease (CHD) is the leading cause of death in women globally; and women have worse health outcomes from CHD than men, including poorer health-related quality of life (HRQL). Comprehensive cardiac rehabilitation (EBCR) has well-established benefit for patients with CHD in improving HRQL. These benefits have rarely been distinguished separately for women despite known differences to men. Purpose The aim of this study was to compare women and men’s HRQL outcomes after accounting for differences in age, partnership status and diagnosis. Methods A secondary analysis of a larger prospective observational study of CR outcomes using a matched case-control study of women and men. The sample included patients enrolled in four CR programs following admission for CHD (myocardial infarction [MI], percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]). Women were matched to men based on age (within 0-2 years), marital status (single, or partnered), and diagnosis (MI, PCI, or CABG). Sociodemographic data were collected from the participants and clinical information (diagnosis, comorbidities) from the medical record. HRQL was measured using the Short Form-12 Health Survey (SF-12). Results Thirty-seven matched women and men were included in this study at baseline, of whom 27 completed the study (72.9%). There were no significance differences in sociodemographic and clinical characteristics between men and women at baseline. Both women and men improved HRQL substantially from pre-post CR, with no significant differences in change scores in any domain between the sexes despite women having worse scores at baseline in Physical Functioning (mean score 41.59 vs 44.15), Bodily Pain (mean score 47.78 vs 48.71) and overall physical summary score (mean score 44.14 vs 45.29). Women had clinically meaningful improvements in Physical Functioning (MD 6.51, 95% CI 2.59-10.44) and Role Physical (MD 6.42, 95% CI 2.81-10.03), Mental Health (MD 4.35, 95% CI 2.05-6.66) and Bodily Pain (MD 4.97, 95% CI 1.36-8.60) and in the overall physical summary score (MD 5.67, 95% CI 1.98-9.38). Men achieved clinically meaningful improvements in the same domains as women plus Vitality (MD 5.11, 95% CI 0.87-9.36) and Social Function (MD 8.54, 95% CI 3.98-13.09). Conclusion(s) When matched to men for age, partnership status, and diagnosis, women achieve clinically meaningful and equivalent HRQL outcomes following CR. Women significantly improved in overall physical and mental health HRQL, as well as in the majority of HRQL domains. These findings could be used to strengthen advocacy in supporting women with CHD to participate and complete CR programs.

Effect of sex differences and time of oxytocin administration on treatment of rat model of autism spectrum disorder: Focused on necroptosis markers.

Autism is a neurodevelopmental disorder. A variety of molecular and cellular abnormalities leads to behavioral deficits in autism. Nevertheless, its etiology and treatment strategy are not completely understood. Oxytocin has recently shown improvements in social functioning. This study aimed to evaluate the necroptosis pathway for the neuroprotective effects of oxytocin in the valproic acid-induced autism spectrum disorder model. The autism spectrum disorder was induced by valproic acid on gestational day 12.5 (600 mg/kg, intraperitoneally). Offspring received intranasal oxytocin (1μg/μL) on the 21st and 40th days after birth. The offspring behaviors were scrutinized by self-grooming, marble-burying, three-chamber, and Morris water maze tests. Western blot was performed on the hippocampus and amygdala tissues to investigate the expression of RIP3 and MLKL markers. The valproic acid group demonstrated more anxiety, repetitive behaviors, and expression of RIP3 and MLKL markers, and less social interaction and spatial memory compared with the control group. Oxytocin considerably improved social interactions, preference for social novelty, and memory. The elevated expression of RIP3 and MLKL markers in valproic acid-induced autistic rats were alleviated after treatment with oxytocin. We also highlighted the importance of age and gender in autism spectrum disorder interventions. Our findings suggested that oxytocin administration was as an effective treatment in two areas of repetitive/stereotyped behaviors, social interactions/cognitive function. Notably, early administration of oxytocin resulted in better therapeutic responses in autism-like behaviors. The molecular tests introduce oxytocin as a potential candidate for reducing the expression of necroptosis mediators in the brain. This reinforced our hypothesis that the necroptosis pathway takes part in autism spectrum disorder.

Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD

ABSTRACT Objective We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD). Method Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation. Results Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress. Discussion CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.

Overnight olfactory enrichment using an odorant diffuser improves memory and modifies the uncinate fasciculus in older adults.

Cognitive loss in older adults is a growing issue in our society, and there is a need to develop inexpensive, simple, effective in-home treatments. This study was conducted to explore the use of olfactory enrichment at night to improve cognitive ability in healthy older adults. Male and female older adults (N = 43), age 60-85, were enrolled in the study and randomly assigned to an Olfactory Enriched or Control group. Individuals in the enriched group were exposed to 7 different odorants a week, one per night, for 2 h, using an odorant diffuser. Individuals in the control group had the same experience with de minimis amounts of odorant. Neuropsychological assessments and fMRI scans were administered at the beginning of the study and after 6 months. A statistically significant 226% improvement was observed in the enriched group compared to the control group on the Rey Auditory Verbal Learning Test and improved functioning was observed in the left uncinate fasciculus, as assessed by mean diffusivity. Minimal olfactory enrichment administered at night produces improvements in both cognitive and neural functioning. Thus, olfactory enrichment may provide an effective and low-effort pathway to improved brain health.

Outcomes for young people in out of home care accessing tiered mental health services in Sydney, Australia.

Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8-17years accessing mental health services across SWSLHD from January 2020-December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity.

Comparing trauma-focused cognitive-behavioral therapy to commonly used treatments in usual care for children with posttraumatic stress disorder.

Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based treatment; however, few studies have examined the use of TF-CBT as part of routine clinical care, outside of research trials. This study used administrative data from a statewide system of care to examine differences in pretreatment characteristics and outcomes between children with posttraumatic stress disorder (PTSD) who received TF-CBT and those who received non-TF-CBT treatments. The sample consisted of 1,861 children (59% female, 43% Hispanic, 35% White, and 14% Black) ages 3-17 with a primary diagnosis of PTSD who received outpatient psychotherapy at 25 clinics in Connecticut. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity and functioning using the Ohio Scales. Approximately one-third of children received TF-CBT. There were some differences at intake between children who received TF-CBT and those who received another type of usual care treatment; children who experienced sexual victimization and more types of trauma as well as non-Hispanic White children were more likely to receive TF-CBT. Propensity score matching was used to balance intake differences between treatment groups, and results indicated that children who received TF-CBT had significantly greater improvements in problem severity and functioning than children who received other types of usual care treatments (effect size = 0.21-0.24), including generic cognitive-behavioral therapy (CBT). These findings reinforce the evidence for providing TF-CBT to children with PTSD in outpatient settings and suggest that supporting clinicians in implementing TF-CBT can result in greater improvements than usual care treatments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Older age bipolar disorder.

Older age bipolar disorder (OABD) refers to patients with bipolar disorder aged 50 years and over. There is a paucity of evidence-based guidelines specific to OABD, but in recent years, several studies have been published on OABD. The current review synthesizes previous literature (up to January 1, 2021) as well as most recent literature on OABD (since January 1, 2021). This review covers the following themes: diagnosis and specifiers, clinical course, psychosocial functioning, cognition, physical comorbidities, and pharmacotherapy. On the basis of the latest data, specific clinical recommendations are proposed for each theme. OABD forms a more complex subgroup of bipolar disorder, with an increased risk of cognitive deficits, physical comorbidities, impaired psychosocial functioning, and premature death. The distinctions between BD-I and BD-II and between EOBD and LOBD do not clinically represent relevant subtypes for OABD patients. Mental healthcare professionals should treat all OABD patients with an integrative care model that takes into account cognitive and physical comorbidities and that contains elements aimed at improvement of psychosocial functioning and quality of life. Older age itself should not be a reason to withhold lithium treatment. Future research should collect data on essential data domains using validated measurement scales.

Outcomes among youth attending inpatient treatment for co-occurring disorders.

An emerging body of research is identifying effective outpatient integrated treatment approaches for youth with co-occurring psychiatric and substance use disorders, though few studies exist examining inpatient treatment. The current study aimed to address this gap by examining response to treatment during admission to, and in the year following discharge from, a specialized inpatient program for youth with co-occurring disorders. A single-cohort longitudinal design examined change in adaptive functioning, mental health symptoms, and substance use frequency among N = 142 youth (69.1% female) aged 14-21 (M = 16.9, SD = 1.5) attending the program. Participants completed self-report measures at admission, discharge, and 1-, 6- and 12-months post-discharge. Analyses indicated significant improvements in adaptive functioning, internalizing and externalizing symptoms, and substance use frequency during admission. There was some loss of gains in adaptive functioning over the 12-months post-discharge. Improvements were maintained in internalizing symptoms and substance use frequency, and improvements in externalizing symptoms continued over the 12-months post-discharge. There was no significant interaction between change in functioning and internalizing symptoms at admission or type of substance use disorder diagnosis. There was a significant interaction with externalizing symptoms, such that those with clinically significant levels of externalizing symptoms at admission experienced greater improvement in functioning, though the groups ended treatment with comparable functioning scores. The results provide preliminary support for integrated treatment for co-occurring disorders delivered in an inpatient setting. However, the results also reflect the significant needs of youth with co-occurring disorders and the importance of ongoing care post-discharge from intensive treatment settings.

Difficulties in Addressing Diagnostic, Treatment and Support Needs in Individuals with Intellectual Disability and Persistent Challenging Behaviours: A Descriptive File Study of Referrals to an Expertise Centre.

Service providers may experience difficulties in providing appropriate care to optimize the functioning of individuals with intellectual disability and challenging behaviour. External consultation to identify and address the unmet support needs underlying the behaviour may be beneficial. Applying the multidimensional American Association Intellectual and Developmental Disabilities (AAIDD) model may facilitate this approach. We aimed to describe the content and outcomes of consultation for individuals with intellectual disability and challenging behaviour referred to the Dutch Centre for Consultation and Expertise in relation to the AAIDD model. Interventions were based on the clients' diagnostic, treatment, and support needs and were categorized according to the five dimensions of the AAIDD model. Outcomes of the consultations were assessed based on reports in the file and rated as 'clear improvement', 'improvement' or 'no improvement or deterioration'. In two-thirds of the 104 studied files, consultees were satisfied with the improvement in functioning. Interventions targeted the difficulties of the service providers in supporting their clients and were most often applied within the Health and Context dimensions of the AAIDD model. We may conclude that consultation of an expert team may be valuable to support the care providers, and the use of the AAIDD model may be helpful to address the unmet needs to improve the functioning of individuals with challenging behaviour.

Exercise knowledge, barriers and motivators among LRRK2 G2019S mutation carriers

IntroductionPeople with a Gly2019Ser mutation in the leucine-rich repeat kinase 2 (LRRK2 G2019S) are at increased risk of developing Parkinson's disease (PD). Recent evidence suggests that exercise may delay or prevent the development of clinically overt symptoms of PD in people at risk of PD. We determined whether LRRK2 G2019S mutation carriers with and without manifest PD are aware of the relationship between exercise and PD and how they differ in awareness, barriers and motivators to exercise. MethodsWe deployed a survey among 4422 LRRK2 G2019S mutation carriers. In total, 505 (11.4%) of them completed the survey, of whom 105 had self-reported manifest PD. ResultsNinety-two percent of the LRRK2 G2019S mutation carriers with manifest PD and 63% of those with non-manifest PD were aware of the relationship between exercise and PD. Lack of motivation was the top barrier for those without manifest PD, while having an injury/disability was the most common barrier for those with manifest PD. Improvement of body functioning was the top motivator for both. ConclusionThe fact that many at-risk individuals are not aware of the importance of exercise and would exercise more with fewer barriers creates opportunities for trials using exercise as a possible prevention strategy for PD.

Phase 4 Multinational Multicenter Retrospective and Prospective Real-World Study of Nivolumab in Recurrent and Metastatic Squamous Cell Carcinoma of the Head and Neck.

This study examined the real-world use of nivolumab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). This was a multinational retrospective study (VOLUME) assessing treatment effectiveness and safety outcomes and a prospective study (VOLUME-PRO) assessing HRQoL and patient-reported symptoms. There were 447 and 51 patients in VOLUME and VOLUME-PRO, respectively. Across both studies, the median age was 64.0 years, 80.9% were male, and 52.6% were former smokers. Clinical outcomes of interest included real-world overall survival (rwOS) and real-world progression-free survival (rwPFS). The median rwOS was 9.2 months. Among patients with at least one assessment, 21.7% reported their best response as 'partial response', with 3.9% reporting 'complete response'. The median duration of response (DoR) and median rwPFS were 11.0 months and 3.9 months, respectively. At baseline, VOLUME-PRO patients reported difficulties relating to fatigue, physical and sexual functioning, dyspnea, nausea, sticky saliva, dry mouth, pain/discomfort, mobility, and financial difficulties. There were improvements in social functioning and financial difficulties throughout the study; however, no other clinically meaningful changes were noted. No new safety concerns were identified. This real-world, multinational, multicenter, retrospective and prospective study supports the effectiveness and safety of nivolumab for R/M SCCHN patients.

The impact of liver transplantation on health-related quality of life in (acute) intoxication-type inborn errors of metabolism.

Organic acidurias (OAs), urea-cycle disorders (UCDs), and maple syrup urine disease (MSUD) belong to the category of intoxication-type inborn errors of metabolism (IT-IEM). Liver transplantation (LTx) is increasingly utilized in IT-IEM. However, its impact has been mainly focused on clinical outcome measures and rarely on health-related quality of life (HRQoL). Aim of the study was to investigate the impact of LTx on HrQoL in IT-IEMs. This single center prospective study involved 32 patients (15 OA, 11 UCD, 6 MSUD; median age at LTx 3.0 years, range 0.8-26.0). HRQoL was assessed pre/post transplantation by PedsQL-General Module 4.0 and by MetabQoL 1.0, a specifically designed tool for IT-IEM. PedsQL highlighted significant post-LTx improvements in total and physical functioning in both patients' and parents' scores. According to age at transplantation (≤3 vs. >3 years), younger patients showed higher post-LTx scores on Physical (p = 0.03), Social (p < 0.001), and Total (p =0.007) functioning. MetabQoL confirmed significant post-LTx changes in Total and Physical functioning in both patients and parents scores (p ≤ 0.009). Differently from PedsQL, MetabQoL Mental (patients p = 0.013, parents p = 0.03) and Social scores (patients p = 0.02, parents p = 0.012) were significantly higher post-LTx. Significant improvements (p = 0.001-0.04) were also detected both in self- and proxy-reports for almost all MetabQoL subscales. This study shows the importance of assessing the impact of transplantation on HrQoL, a meaningful outcome reflecting patients' wellbeing. LTx is associated with significant improvements of HrQol in both self- and parent-reports. The comparison between PedsQL-GM and MetabQoL highlighted that MetabQoL demonstrated higher sensitivity in the assessment of disease-specific domains than the generic PedsQL tool.

Number, Duration, and Distribution of Wake Bouts in Patients with Insomnia Disorder: Effect of Daridorexant and Zolpidem.

Daridorexant, a dual orexin receptor antagonist approved in early 2022, reduces wake after sleep onset without reducing the number of awakenings in patients with insomnia. The objective of this post hoc analysis was to explore the effect of daridorexant on the number, duration, and distribution of night-time wake bouts, and their correlation with daytime functioning. Adults with insomnia disorder were randomized 1:1:1:1:1:1 to placebo, zolpidem 10mg, or daridorexant 5, 10, 25, or 50mg in a phase II dose-finding study, and 1:1:1 to placebo or daridorexant 25 or 50mg in a pivotal phase III study. We analyzed polysomnography data for daridorexant 25 and 50mg, zolpidem 10mg, and placebo groups. Polysomnography was conducted at baseline, then on Days 1/2, 15/16, and 28/29 in the phase II study, and Months 1 and 3 in the phase III study. The number, duration, and distribution of wake bouts (≥ 0.5min) were assessed. Data from 1111 patients (phase II study: daridorexant 50mg [n = 61], zolpidem 10mg [n = 60], placebo [n = 60]; phase III study: daridorexant 25mg [n = 310], daridorexant 50mg [n = 310], placebo [n = 310]) were analyzed. Long wake bouts were defined as > 6min. Compared with placebo, daridorexant 50mg reduced overall wake time (p < 0.05; all time points, both studies), the odds of experiencing long wake bouts (p < 0.001; Months 1 and 3, phase III study), and the cumulative duration of long wake bouts (p < 0.01; all time points, both studies). Reductions in long wake bouts were sustained through the second half of the night and correlated with improvements in daytime functioning. An increase in the cumulative duration of short wake bouts was observed with daridorexant 50mg (p < 0.01 vs placebo, Months 1 and 3, phase III study); this was uncorrelated with daytime functioning. Daridorexant reduced the number and duration of longer wake bouts throughout the night compared with placebo, corresponding with improved daytime functioning. Clinicaltrials.gov NCT02839200 (registered July 20, 2016), NCT03545191 (registered June 4, 2018).

Effects of traditional Chinese exercise on physiological indicators and quality of life in patients with coronary heart disease: A systematic review and meta-analysis.

The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of physiological indicators and quality of life in patients with coronary heart disease (CHD) is controversial. Five databases were systematically searched for relevant articles published from inception to February 2023. Controlled trials examining TCE intervention in patients with CHD. The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges g). The categorical and continuous variables were used to conduct moderator analyses. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence based on the Grading of Recommendations Assessment, Development and Evaluation approach. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42023401934). Ten studies involving a total of 718 participants were included in the final analysis. In the physiological indicators outcomes, the meta-analytic findings revealed large and significant improvements in systolic blood pressure (g = 0.78, 95% confidence interval [CI] = 0.51-1.05, P = .00, I2 = 98%), diastolic blood pressure (g = 0.90, 95% CI = 0.61-1.20, P = .00, I2 = 98%) and body mass index (g = 1.05, 95% CI = 0.75-1.34, P = .00, I2 = 99%), small and significant improvements in heart rate (g = 0.28, 95% CI = 0.01-0.54, P = .04, I2 = 98%) and ventilatory equivalents/carbon dioxide (g = -1.10, 95% CI = -1.47 to -0.74, P = .00, I2 = 96%).In the quality of life outcomes, the findings revealed small and significant improvements in physical functioning (g = -3.01, 95% CI = -3.45 to -2.57, P = .00, I2 = 96%), bodily pain (g = -2.16, 95% CI = -2.57 to -1.74, P = .00, I2 = 98%), vitality (g = -3.67, 95% CI = -4.16 to -3.16, P = .00, I2 = 97%) and mental health (g = -1.23, 95% CI = -1.771 to -0.692, P = .00, I2 = 99%). The moderator shows that the effects of TCE on physiological indicators and quality of life were moderated by PEDro score, type of exercise, exercise frequency, exercise duration, and number of sessions. TCE intervention is a beneficial nonpharmacological approach to improving physiological indicators in patients with CHD, especially in systolic blood pressure, diastolic blood pressure, and body mass index. However, there was no significant effect on quality of life. Our findings require broader clinical trials and higher-quality study designs to strengthen the evidence.

The role of posttraumatic cognitions in integrated treatments for co-occurring posttraumatic stress disorder and alcohol use disorder.

Posttraumatic cognitions are a mechanism of posttraumatic stress disorder (PTSD) symptom reduction in trauma-focused interventions for PTSD. It is unclear how changes in posttraumatic cognitions are associated with important clinical correlates of PTSD, including drinking and psychosocial functioning. This study examined if changes in posttraumatic cognitions during integrated treatment for co-occurring PTSD/alcohol use disorder (AUD) were associated with concurrent improvements in PTSD severity, heavy drinking, and psychosocial functioning. One hundred nineteen veterans (65.5% white and 89.9% men) with PTSD/AUD randomized to receive Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure or Seeking Safety completed assessments of posttraumatic cognitions (Posttraumatic Cognitions Inventory), PTSD severity (Clinician-Administered PTSD Scale for DSM-5), drinking (Timeline Followback), and psychosocial functioning (Medical Outcomes Survey SF-36) at baseline, posttreatment, 3- and 6-month follow-up. Structural equation models indicated that posttraumatic cognitions improved significantly during treatments for PTSD/AUD with no significant treatment differences. Reductions in posttraumatic cognitions during treatment were associated with concurrent improvements in PTSD severity and functioning, and differentially associated with drinking. Findings suggest that changes in posttraumatic cognitions in integrated treatments for PTSD/AUD are not solely important for symptom change but are implicated in improvements in functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patient-reported outcomes with hypoglossal nerve stimulation for treatment of obstructive sleep apnea: a systematic review and meta-analysis.

Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated substantial changes in OSA with this therapy by reducing respiratory events and improving symptoms such as daytime sleepiness and quality of life. The objective of this review was to conduct a systematic review and meta-analysis to evaluate patient-reported outcomes and experience with HNS therapy. A systematic literature search of MEDLINE, Cochrane, and Web of Science was performed to identify randomized controlled and observational studies reporting subjective outcomes with different HNS systems in patients with OSA. Abstracts of 406 articles were screened and a subset of 55 articles were reviewed for eligibility. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis using RevMan was performed when > 2 studies were identified that reported data on a specific outcome. Thirty-four publications reporting data on 3785 patients with a mean follow-up of 11.8 ± 12.2months were identified and included in the meta-analysis. The analysis revealed a pooled effect of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z = 42.82, p < .001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z = 28.38, p < .001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z = 2.53, p = .010). Patient-reported experience was consistently positive and revealed additional relevant aspects from this perspective. HNS therapy significantly improves quality of life in patients with OSA and reliably produces clinically meaningful effects on daytime sleepiness, daytime functioning, and sleep quality. Treatment regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Additional research is needed to further investigate effects on quality of life beyond improvements in daytime sleepiness and daytime functioning.

Evaluation of the efficacy and tolerability of alendronate versus denosumab in kidney transplant patients with reduced bone mineral density.

To compare the effect of denosumab and alendronate on bone mineral density (BMD) in renal transplant recipients (RTRs) with low bone mass. Patients were randomized to receive either denosumab subcutaneously (60 mg/6 months), oral alendronate (70 mg/week), or no treatment for 1 year. The three groups were prescribed daily calcium and vitamin D. Primary outcome was BMD assessed at lumbar spine, hip, and radius and measured by dual-energy X-ray absorptiometry (DEXA) at baseline and after 6 and 12 months. Adverse events and laboratory assessments (calcium, phosphate, vitamin D, renal functions, and intact parathyroid hormone) were monitored for all patients. Quality of life was assessed at baseline and after 6 and 12 months for all patients. Ninety RTRs were included in the study (30 in each group). Baseline clinical characteristics and BMD values were comparable in the three groups. After 12 months, lumbar spine T-score of patients treated with denosumab and alendronate showed a median increase of 0.5 [95% confidence interval (CI): 0.4-0.6] and 0.5 (95% CI: 0.4-0.8), respectively, and patients in the control group showed a decrease of -0.2 (95% CI: -0.3 to -0.1), p < 0.001. Denosumab and alendronate showed a significant comparable gain in T-scores at hip and radius versus a significant decrease in the control group. Adverse events and laboratory values were similar in the three groups. Both treatments resulted in comparable significant improvement in physical functioning, physical role limitations, vitality, and pain scores. Denosumab and alendronate showed comparable efficacy in improving BMD at all measured skeletal sites and were safe and well-tolerated, with no serious adverse effects reported in RTRs with low bone mass. The study was registered on ClinicalTrials.gov, number NCT04169698.