Greater Delay Research Articles

Differential access to neuropsychological evaluation in children with perinatal complications or autism spectrum disorder: Impact of sociodemographic factors

Objective Early childhood evaluation can identify deficits related to disruptions in early brain development and facilitate interventions. Access to care may differ by race/ethnicity or socioeconomic status. We explored neuropsychological evaluation access patterns and examined potential sociodemographic disparities in evaluation timing. Method: Participants were 213 children (age: M = 46.4 months, SD = 15.3 months) with a history of disrupted neural development due to perinatal complications (PC; n = 109) or autism spectrum disorder (ASD; n = 104). We used chi square tests of independence and one-way ANOVAs to compare groups on sociodemographics, referral sources, and cognition. Clinical sample means for cognitive and adaptive variables were compared to normative means to determine the presence of developmental delays. Differences in age at evaluation by race/ethnicity, caregiver education, and referral source, accounting for cognition, were explored with ANCOVAs. Results: The ASD group included significantly more White children and the PC group relatively more Black/African Americans. Children with ASD were referred by primary care physicians and caregivers/school staff; those with PC were referred by other medical providers. All participants performed more poorly than expected across all intellectual and adaptive domains, with greater delays in the ASD group. Children of caregivers with lower education were evaluated earlier in the PC group. For ASD, participants referred by primary care physicians were evaluated earlier. Conclusions: Children with PC and ASD exhibit cognitive delays and require neuropsychological evaluation. Disparities in access to care exist, particularly for minority children with ASD. Ways to promote equal access are discussed.

Retraso y velocidades de lectura en la subtitulación para personas sordas de los informativos

Este artículo surge de ITACA (Inclusión social, Traducción Audiovisual y Comunicación Audiovisual1), un proyecto de investigación interuniversitario e interdisciplinar sobre producción audiovisual accesible que pretende mejorar el acceso de las personas con limitaciones sensoriales a los medios audiovisuales. El estudio descriptivo que aquí presentamos se centra en la subtitulación para sordos (SPS) de los informativos, que suele elaborarse en directo o semidirecto. A tal fin, se seleccionaron once fragmentos de noticiarios emitidos en distintas cadenas públicas y privadas de televisión españolas. El retraso y la velocidad de lectura de los subtítulos, dos de los parámetros habituales para el análisis de la SPS, son la base de las hipótesis de trabajo y del marco analítico, cuyo objetivo es evaluar la SPS de los informativos desde una doble perspectiva, traductológica y fílmica. En líneas generales, los resultados muestran mayor retraso y menor velocidad de lectura en los subtítulos en directo respecto de los emitidos en semidirecto, lo que puede influir en la recepción por parte de los destinatarios finales.

Effects of tobacco addiction on links between early life adversities, sleep disturbance, and depression: A moderated mediation approach.

Despite the well-established relationship between early life adversities (ELA) and depression, the underlying mechanisms for this link remain less clear and need to be developed. The aim of this study was to advance our understanding of this link by testing the mediating role of sleep disturbances and the moderating role of tobacco use in this mediation. A total of 579 smokers and non-smokers were recruited in two US communities (Duluth and Minneapolis, MN). Simple and moderated mediation analyses were performed using the PROCESS macro for SPSS, with the number of ELA as an independent variable, depression symptoms assessed by the Patient Health Questionnaire-9 (PHQ-9) as a dependent variable, sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) as a mediator, and smoking status as a moderator variable. The study demonstrated that ELA and depressive symptoms were positively correlated; and sleep quality fully mediated this relationship. This mediation was moderated by tobacco use (index of moderated mediation = 0.10, 95%CI [0.03; 0.19]) and was more pronounced among smokers (b = 0.14, 95%CI [0.07; 0.23]) than non-smokers (b = 0.04, 95%CI [0.0002; 0.10]). Subsequent mediation analyses run separately for each component of the PSQI suggested that individuals who experienced ELA and who were smokers had greater delays in sleep onset and were more likely to sleep for a shorter duration, both of which predicted greater depressive symptoms. Sleep quality is therefore a promising ELA-related target for preventive and therapeutic interventions as well as for further research in depression and tobacco addiction.

S0302 Symptoms of Non-Hereditary Colorectal Cancer Before Age 45: Are We Listening to Our Patients?

INTRODUCTION: Colorectal cancer is the second leading cause of cancer death in the United States. Recent studies have led the American Cancer Society to recommend colorectal cancer screening begin at age 45 rather than 50 in the average risk patient. Patients often present with symptoms associated with colorectal cancer long before their diagnosis. Reasons for delays in diagnoses appear to be multifactorial. We aimed to further characterize the timing of diagnosis of colorectal cancer and factor contributing to its delay in patients younger than age 45. METHODS: We conducted a single quaternary center retrospective study of patients diagnosed with colon or rectal cancer between October 2007 and October 2018. We stratified patients by those diagnosed under age 45 and compared them to a control group of patients diagnosed above age 50. Patients with hereditary colorectal cancer or a family history of colorectal cancer were excluded. Time between symptom presentation and diagnosis, reasons for delay of diagnosis, demographics, comorbidities and family history and were recorded. Statistical analysis with chi-square and Wilcoxon sign-ranked tests were conducted using SPSS. RESULTS: Between October 2007 and October 2018, 122 cases of colorectal cancer were diagnosed at our institution in patients under the age of 45. The median age at diagnosis was 42 compared to 65 in patients above 50. Patients under 45 had a greater delay in diagnosis after initial report of symptoms compared to patients over 50 (15.4 vs 6.1 months, P < 0.0001). The most frequent cause of delayed diagnosis in both groups was found to be hesitation in presenting to a physician. Both patients diagnosed under the age of 45 and above 50 were predominantly male (55.1% and 51.6%). Patients diagnosed under the age of 45 had a lower prevalence of smoking compared to those above 50 (32.8% vs 56.8%, P < 0.0001). CONCLUSION: Our study demonstrates an alarming difference in the latency between presentation and diagnosis of colorectal cancer in those under 45 and above 50. Significant differences between the delay in diagnosis in patients below the age of 45 and those above 50 suggest that current guidelines may not be adequate in screening for colorectal cancer. Further studies aimed at risk stratification this younger age group are necessary. Additional efforts aimed at creating awareness on the risk of colorectal cancer in this population are necessary for both patients and providers.Table 1.: Comparison in patients diagnosed with colorectal cancer above age 50 and those diagnosed below age 45

37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery

Abstract Background Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished. Objectives To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at &amp;lt;37+0 weeks gestation) with CCHD and neonatal OHS. Design/Methods We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Results From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table). Conclusion For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.

Reaching movements are automatically redirected to nearby options during target split.

Motor behavior often occurs in environments with multiple goal options that can vary during the ongoing action. We explored this situation by requiring subjects to select between different target options during an ongoing reach. During split trials the original target was replaced with a left and a right flanking target, and participants had to select between them. This contrasted with the standard jump trials, where the original target would be replaced with a single flanking target, left or right. When participants were instructed to follow their natural tendency, they all tended to select the split target nearest the original. The near-target preference was more prominent with increased spatial disparity between the options and when participants could preview the potential options. Moreover, explicit instruction to obtain the "far" target during split trials resulted many errors compared with a "near" instruction, ~50% vs. ~15%. Online reaction times to target change were delayed in split trials compared with jump trials, ~200 ms vs. ~150 ms, but also highly automatic. Trials in which the instructed far target was correctly obtained were delayed by a further ~50 ms, unlike those in which the near target was incorrectly obtained. We also observed nonspecific responses from arm muscles at the jump trial latency during split trials. Taken together, our results indicate that online selection of reach targets is automatically linked to the spatial distribution of the options, though at greater delays than redirecting to a single target.NEW & NOTEWORTHY This work demonstrates that target selection during an ongoing reach is automatically linked to the option nearest a voided target. Online reaction times for two options are longer than redirection to a single option. Attempts to override the near-target tendency result in a high number of errors at the normal delay and further delays when the attempt is successful.

Optimization of workflow and screening panels for the detection of malignant monoclonal gammopathies.

Multiple myeloma (MM) is one of the hematologic malignancies with a greater delay in diagnosis. Laboratories receive numerous MM screening test requests without a specific suspicion, which entails a substantial workload and reduces the efficiency of laboratories. Objective: to increase the efficacy of MM screening protocols. The results of serum protein electrophoresis (SPEP), serum protein immunofixation electrophoresis (SIFE), urine protein immunofixation electrophoresis, and serum free light chain assays of 75 patients with MM, three with amyloidosis, and a patient with solitary plasmocytoma were collected. The frequency of a set of biochemical alterations in these patients was compared with that in controls (n=120). A validation of the screening algorithm was carried out in 261 consecutive patients with a clinical or analytical suspicion of MM. SPEP+SFLC or SIFE+SFLC (98% sensitivity) were the screening algorithms with the highest sensitivity. Prospectively, the SPEP+SFLC detected 27 of the 28 confirmed cases of MG and saved 15h of work. Alterations in five of the six parameters studied were more frequent in the study group, with a cumulative value of≥3 parameters altered (61.1 vs. 1.7%) (positive predictive value: 85%; negative predictive value: 94%). The SPEP+SFLC screening protocol demonstrated the highest sensitivity and was the least time-consuming protocol. In addition, this protocol improves diagnostic sensitivity and laboratory performance.

P0179ECULIZUMAB USE IN A TERTIARY CARE NEPHROLOGY CENTER

Abstract Background and Aims Practice patterns of Eculizumab use in patients with thrombotic microangiopathies (TMA) and C3-glomerulopathy (C3G) are not well described. Method We used the “Vienna TMA cohort” and the hospital pharmacy database at the Medical University of Vienna to identify adult patients with a history of eculizumab use between 2012 and 2019. We describe clinical characteristics, details of eculizumab use, and outcomes of patients with complement gene variant mediated TMA (cTMA), secondary TMA (sTMA) and C3G. Results As of December 2019, 212 individuals were enrolled in the Vienna TMA cohort comprising 51 cTMA, 144 sTMA, and 17 TTP patients. We included also our cohort of 14 patients with C3G for this analysis. 47 patients (22 TMA and 2 C3G, 23 other indications, i.e. paroxysmal nocturnal haemoglobinuria) received at least one dose of eculizumab at the Medical University of Vienna (Figure 1). Table 1 indicates demographic and clinical details of 15 cTMA (29.4% of all cTMA), 7 sTMA (4.9% of all sTMA) and 2 C3G (14.3% of all C3G) patients treated with eculizumab. 60% of cTMA patients showed a rare complement gene variant, while sTMA was ruled out in the remaining 40%. Causes of sTMA were bone marrow transplantation (BMT) (n=2), malignant hypertension, malignoma, systemic lupus erythematodes, antiphospholipid syndrome and lung transplantation (each n=1). One sTMA patient, a BMT recipient, had a donor with a thrombomodulin gene variant. Patients with cTMA had a greater delay from first diagnosis to treatment with eculizumab than the other groups and received maintenance therapy for a longer period of time. More female patients received eculizumab as compared to male patients. Chronic kidney disease stage improved in 60% and 43% of cTMA and sTMA patients, respectively. TMA relapses did not occur during administration of eculizumab. The 2 patients with C3G didn’t respond to eculizumab in our center. Eculizumab therapy was stopped in 66% of patients with cTMA and in all patients presenting with sTMA or C3G. In general, eculizumab was well tolerated and we did not observe life threatening infections of our patients. Three adverse drug reactions included exanthema, liver injury, and hypertensive emergency. Two patients died during therapy with eculizumab (1 cTMA, 1 C3G,) and two after cessation of eculizumab therapy (1 cTMA, 1 sTMA) resulting in a mortality of 16.7%. Conclusion Improvement of CKD stage was achieved in 60% of patients with cTMA and in 43% of patients with sTMA. In our patients with C3G, eculizumab did not improve kidney function. In general, therapy with eculizumab was well tolerated.

Delays in diagnosing pulmonary tuberculosis within a context of medium incidence, Medell\xedn, Colombia, 2017: an operational research

BackgroundDelay in tuberculosis (TB) diagnosis is one of the first obstacles for controlling the disease. Delays generate greater deterioration of the health of the patients and increase the possibilities of transmission and infection at home and in the community. The aim of the study was to identify profiles and individual variables associated with patient delays and health care system delays in patients with pulmonary tuberculosis (PTB) in Medellín, Colombia, a city that notifies 1400 new cases per year.MethodsA retrospective cohort study in adults with PTB was conducted from May to September of 2017. Sociodemographic, health care-seeking behaviour, and clinical variables were measured. The outcomes were patient delay and health care system delay. The data were obtained from records of the local TB program, and a questionnaire was applied by the health care team that performs routine field visits. Simple correspondence analysis was used to identify groups (profiles), and their characteristics. Cox’s proportional hazards model was carried out to identify the variables associated with the delays.ResultsThe study included 183 patients. The total delay median was 101 days (IQR: 64–163). Patient delay was of 35 days (IQR: 14–84), the profile with greater delay belonged to consumers of psychoactive substances. The health care system delay was of 27 days (IQR: 7–89), the attributes of the profile with greater delay were being a female, having more than two consultations before the diagnosis, and having prescribed antibiotics. Basic-medium educational level [HRa = 0.69; 95% CI (0.49–0.97)] and having a TB home contact [HRa = 0.68; 95% CI (0.48–0.96)] were associated with greater patient delay. Having negative acid-fast bacilli (AFB) smear [HRa = 0.64; 95% CI (0.45–0.92)] and more than two consultations before the diagnosis [HRa = 0.33; 95% CI (0.22–0.49)] was associated with greater health care system delay.ConclusionsData from epidemiological surveillance allowed locating risk groups with delays in TB diagnosis which requires the prioritisation of the local TB control program to promote early detection and prevention of adverse outcomes.

Interdisciplinary risk assessment and delay of chemotherapy.

e14033 Background: In 2015, in our outpatient clinic, we implemented a breast cancer interdisciplinary team with the goal of identifying risk factors for chemotherapy delay. Evaluation of individual cases and care plans were made by a medical oncologist, clinical pharmacologist, psychologist, dietician and oncology nurse. Methods: 81 patients with breast cancer in neoadjuvant/adjuvant chemotherapy were prospectively evaluated from July 2018 until July 2019 for clinical risk: age, anthracyckine use, presence of symptoms grade &gt;3, ASGPPP questionnaire for nutritional risk, psychological risk for pre existent issues or induce by treatment and IRPO questionnaire for screening, nursing evaluation for comunication, organization and understanding issues, and pharmacologist evaluation of polypharmacy and unknown drugs or routine use. Results: Of 81 patients evaluated and had finish treatment, 55 pts (67.9%) received adjuvant chemotherapy. Median age was 57.9 years (range:29-90.6y). We defined as risk factors for delay chemotherapy treatment: anthracycline-based chemotherapy (9.34 vs 2.58 d p:0.002), psychological risk (both risks combined) (8.1 vs 4.7 p:0.047), comunication, organization and understanding issues (15.25 vs 5.83 d p: 0.004), and unknown drugs that routinely uses (11 vs 5.34d p:0.012). Patients who needed extra nutritional and psychological appointment had greater delay in chemotherapy (Dietician: 9.636 vs 4.7 d P:0.01; Psyc: 9.1 vs 4.2d p:0.008). Conclusions: The chemotherapy scheme, psychological risk, difficulty in understanding and organizing, and unaware of the drugs used routinely uses were high risk factors for delayed chemotherapy and these patients should be handled more carefully.

Efficacy of immune checkpoint blockade alone or combined with chemotherapy and smoking status in NSCLC: A systematic review and meta-analysis.

e21661 Background: Tobacco smoking is a critical cause of mutational burden and immuno-microenvironmental alteration in non-small cell lung cancer (NSCLC). However, the association between tobacco consumption and the synergetic effect of chemotherapy on single-agent immunotherapy remains controversial. Methods: We systematically searched PubMed, the Cochrane Central library and Embase, for the RCTs of ICI in NSCLC with HR for both PFS and OS according to smoking status. Random-effects model were used to pool estimates of survival HR and 95%CI. Subgroup analysis and meta-regression were implemented to investigate the source of heterogeneity. Results: In total, 13 eligible RCTs of 8154 NSCLC patients (6800 ever-smokers and 1354 never-smokers) were included. PFS benefit from immunotherapy comparing standard treatment remarkably differed between ever-smokers and never-smokers (P = 0.005), where significant PFS benefit was observed in ever-smokers (pooled HR = 0.72, 95%CI 0.63-0.81, P &lt; 0.001) instead of never-smokers (pooled HR = 0.98, 95%CI 0.73-1.31, P = 0.90). In never-smokers, the choice of regimen (monotherapy vs. combination therapy) considerably impacted the benefit of PFS (HR = 2.21, 95%CI 1.35-3.61, P = 0.005) and OS (HR = 1.99, 95%CI 1.03-3.82, P = 0.041). Compared to standard treatment, monotherapy worsened PFS (HR = 1.39, 95%CI 1.01-1.90, P = 0.046) and did not improve OS (HR = 0.91, 95%CI 0.72-1.14) in never-smokers, while combination therapy dramatically delayed both progression (HR = 0.63, 95%CI 0.49-0.81, P &lt; 0.001) and death (HR = 0.45, 95%CI 0.25-0.82, P = 0.010). Conclusions: Tobacco smoke was associated with larger PFS, but not OS benefit from immunotherapy. In never-smokers, not ever-smokers, combination with chemotherapy compared to single-agent ICI might confer significantly greater delays of both progression and death. [Table: see text]

Dollar and Exports

The strength of the US dollar has attributes of a barometer of dollar credit conditions, whereby a stronger dollar is associated with tighter dollar credit conditions. Using finely disaggregated data on export shipments, we examine how dollar strength impacts exports through the availability of dollar financing for working capital - an issue of importance due to the greater working capital needs for exports arising from longer supply chains and greater delay in receiving payments. We find that exporters who are reliant on dollar-funded bank credit suffer a decline in exports, and that this decline is larger than any decline in domestic sales. Our findings shed light on the broad dollar index as a global financial factor with real effects on the economy.

Night eating syndrome and delay discounting

The aim of this study was to examine the frequency of night eating syndrome and its correlates with behavioral impulsivity measured by delay discounting. Three hundred five individuals from the general population were examined. All participants completed the delay discounting task with pairs of hypothetical choices and the Night Eating Questionnaire. Additionally, body mass index was objectively assessed. Prevalence of night eating syndrome was 6.6% in the current sample. Overall scores for the Night Eating Questionnaire showed significant association with greater delay discounting as well as elevated body mass index. Night eating syndrome is a problematic eating disorder, which is prevalent in young adults. Behavioral impulsivity might be of significance for night eating psychopathology.

Diagnostic Delays Lead to Greater Disability in Degenerative Cervical Myelopathy and Represent a Health Inequality.

Online survey. This study seeks to quantify delays faced, determine demographics of patients most likely to face delay, and determine whether delays affect surgical management and outcomes. Patients report significant delays in diagnosis of degenerative cervical myelopathy (DCM). Seven hundred seventy-eighty patients with self-reported DCM recruited via online survey hosted on myelopathy.org. A cumulative odds ordinal logistic regression was run to determine the effects of demographic (sex, country of residence, ethnicity, household income, and educational status) on the delay in diagnosis of DCM. Chi-square tests of homogeneity were run to determine the effects of delayed diagnosis on functional outcomes (patient-derived modified Japanese Orthopaedic Association disability score, support dependence, and employment status) and surgical management (anterior/posterior approach, single-/multilevel surgery). A Kruskal-Wallis H test was used to determine whether delayed diagnosis affected the number of operations undergone. The average delay in diagnosis faced was "1-2 years.' Greater delays in diagnosis were faced by Black or African American patients (P = 0.010). Delayed diagnosis was predictive of greater disability as assessed by patient-derived modified Japanese Orthopaedic Association score (P = 0.001), support dependence (P = 0.040), and employment status (P < 0.0005). Delayed diagnosis did not affect the likelihood of surgery, the number of operations undergone or perioperative characteristics. Patients continue to face significant delays in diagnosis of DCM. Ethnicity significantly influences length of delay experienced. Longer delays do not appear to affect surgical management but are associated with greater disability. 3.

Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment.

Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care.ObjectiveTo (a) compare history of abuse‐related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs.MethodWe analyzed data from 2,818 individuals treated at a large, US‐based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed‐effects models.ResultsSGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE‐Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE‐Q scores did not differ between SGMs and CHs.DiscussionOur main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs—possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.

Impact of hemp shiv extractives on hydration of Portland cement

When formulating materials containing an hydraulic binder and plant particles, the setting of the binder may be slowed or prevented by the compounds extracted from the plant. In this article, a methodology is fixed to analyse three types of hemp shiv and to study the variability of the composition of extractives and their influence on the hydration of cement. Isothermal calorimetric measurements have shown that one type of shiv caused a greater delay in the setting of the cement. Analysis of free compounds extracted from the plant has shown that this shiv has a higher content of extractives, and in particular, of sugar. By using the same quantities of standard sugars, it was found that the measured sugar content could not, in and of itself, account for the delay in hydration measured in the presence of shiv. Other extracted molecules, such as phenolic compounds, also play a part in the hydration of the cement.

Neurodevelopmental Delay in Premature Ecuadorian Children Born Weighing Less than 1500 g: a Follow-up Study

To determine neurodevelopmental disorders at 3 years of age in two cohorts of premature infants with at least two comorbidities and weigh less than 1500 g, applying the neurodevelopmental scales EDI and Brunet-Lezine. Epidemiological study, observational study, and cross-sectional study were performed at Neonatology Service of the Gynecological Obstetric Hospital Isidro Ayora, Quito, between 2015 and 2016. It analyzed 204 neonates, distributed in two cohorts, 102 premature newborns under 1500 g with two comorbidities and 102 under 1500 g with more than two comorbidities at birth. Mestizo mothers, between 25 and 39 years of age, with two or more comorbidities, including hypertension, preeclampsia, and HELLP syndrome, show children with greater neurodevelopmental delay. Children under 1500 g, born between 33 and 36 weeks of gestation and with moderate asphyxia or respiratory depression, whose mother had two more comorbidities are related with a greater delay in neurodevelopment, at 36 months of age when they were evaluated. The patent ductus arteriosus, connate infection, and hydrocephalus are the pathologies on admission which relates with preterm with neurodevelopment delay and with weight. Severe asphyxia, weight between 700 and 900 g, and presence of connate infection early sepsis and septic shock combined cause neurodevelopmental delay. Delay in neurodevelopment is present in the 11.8% of patients (24/204), at 3 years of age. Mestizo mothers between 25 and 39 years of age with two or more comorbidities, including hypertension, preeclampsia, and HELLP syndrome, with children born between 33 and 36 weeks of gestation, and born with severe asphyxia, show children with greater neurodevelopmental delay.

Opportunity knocks but once: delayed disclosure of financial items in earnings announcements and neglect of earnings news

We define a delayed disclosure ratio (DD) as the fraction of 10-Q financial statement items that are withheld at the earlier quarterly earnings announcement. We find that higher DD firms have a greater delay in investor and analyst response to earnings surprises: (i) the fraction of total market reaction to quarterly earnings news realized around the earnings announcement (after the 10-Q filing) is smaller (greater), and (ii) analysts are more likely to defer issuing forecasts from immediately after the earnings announcement to after the 10-Q filing. Consistent with our limited attention model predictions, the response catch-up associated with DD is incomplete, even after the delayed items are fully disclosed at the 10-Q filing date, and persists until the next earnings announcement date. The return reaction to earnings news over the entire quarter does not vary with DD, so differences in earnings informativeness do not explain the DD effect. Our findings suggest that, for limited attention effects to be mitigated, the timing of disclosures must be coincident with the focal periods—at earnings announcement dates—when investors and analysts are paying the most attention.

Pathways to care among patients with severe mental disorders attending a tertiary health-care facility in Puducherry, South India.

Introduction:Pathways to care can be defined as the pathway adopted by the patient to reach the appropriate health facility. In India, health workforce related to mental health care is inadequate. Persons with mental disorders approach different types of care providers. This study describes the number, sequence of care providers visited, and time gap between providers among individuals newly diagnosed with severe mental disorders.Materials and Methods:We conducted a facility-based descriptive study in the psychiatric outpatient department of a tertiary care center in South India between April and September 2017. All patients with any of the following diagnosis; acute psychosis, depression, bipolar disorder, or schizophrenia were included in the study. Information on number and sequence of care providers visited and the reasons for preference of providers were assessed using a validated World Health Organization questionnaire. Patients seeking care was summarized as numbers.Results:Of the total 150 participants, 86 (57%) were females and the mean (standard deviation) age was 35 (11.5) years. The first point of contact were traditional healers in 52 (34.7%) participants, general hospitals in 23 (15.3%), and psychiatric services in the remaining 75 (50%). The patients with schizophrenia and bipolar disorder had greater delays in accessing psychiatric care when compared to other disorders. Median (interquartile range) number of care providers visited till the diagnosis made was 2 (1–3). The availability and recommendation by close relatives were the major reasons for the preference of traditional healers.Conclusions:One-third of patients visited traditional healers as the first point of contact and about half visited the psychiatric facilities directly.

ВПЛИВ КОГНІТИВНОГО НАВАНТАЖЕННЯ НА ПРОЯВ ЕМОЦІЙНОГО ЕФЕКТУ СТРУПА

The Emotional Stroop Effect (ESE) is the result of a greater delay in naming colors of written emotional words than colors of written neutral words, because of shifting attention to emotionally meaningful information. ESE is mainly used in psychopathology surveys, but its application is also promising for solving applied psychophysiological problems, from professional screening and neuromarketing to detecting lies and detecting threats from emotionally unstable individuals. Because the ESE is sensitive to testing conditions, various modifications to the Emotional Stroop Test (EST) have been investigated. Within the subtests, neutral and emotional (negatively coloured) words were presented. The inclusion of distractors in subtests (target words, names of plants and animals that were not required to be answered by keystrokes) complicates the task, which manifests itself in a considerable extension of the reaction time. When performing a task with significant cognitive load, the left hand responds to emotional stimuli longer than the right. The results obtained may indicate the formation of a special system for processing emotional information in the right hemisphere, while the left hemisphere focuses on the cognitive task. It is likely that in the case of increased cognitive load, the subsystems for processing emotional and cognitive information operate relatively autonomously, inter-hemispheric interaction is enhanced, and functional asymmetry is reduced. As cognitive pressure decreases, functional asymmetry is likely to increase inter-hemispheric interaction, and ESE is not detected. The obtained values of latent periods of reaction to emotionally significant and neutral stimuli can be used to develop scales and criteria for evaluating a person's emotional reactions when it is needed.