Individualized Treatment Programs Research Articles

Experiences with Take it Personal!+ from People with Mild Intellectual Disability or Borderline Intellectual Functioning and Substance Use Disorder and Their Confidants: A Qualitative Study

ABSTRACT Introduction Take it Personal!+ is a treatment program for individuals with Mild Intellectual Disability or Borderline Intellectual Functioning (MID-BIF) and Substance Use Disorder (SUD). It is supported by a mobile health application (mHealth), and researchers found it can reduce Substance Use (SU). Aims: This study aimed to explore the usability of the treatment program in as experienced by clients and their confidants. Methods We conducted post-treatment, semi-structured interviews with clients (n = 8) and their confidants (n = 8). We coded transcripts according to thematic analysis and using inductive and deductive methods. Subsequently, we analyzed connections between the codes and grouped them into themes using axial coding. Results Overall clients and confidants experienced the treatment program as usable, and most mentioned the program helped to reduce SU. The clients and confidants reported the presence of a confidant was helpful. Some clients and confidants reported the mHealth application was helpful. Components that were perceived as effective were self-control skills, daily registration exercise and discussing quantity of SU non-judgingly. Perceived impeding factors were video calling and a non-supportive network. Conclusion This study shows that Take it Personal!+ is an useable treatment program for individuals with MID-BIF and SUD, that helps to decrease their self-reported SU. Nevertheless, there is room for improvement for further adapting the treatment, which will be discussed.

Model Assessment of Supervised Machine Learning Techniques for Predicting Heart Disease

Abstract: Stroke is a leading cause of death and permanent disability, making it a serious global health concern. Cell death is the result of impaired blood flow to the brain. Patient outcomes are ultimately impacted by prompt and precise stroke type identification, which is essential for efficient management and treatment. The potential of machine learning algorithms to categorize stroke subtypes and forecast the probability of stroke occurrence is examined in this project. A thorough dataset that included clinical features, medical imaging results, and patient demographics was put together. To guarantee compatibility with machine learning algorithms, this dataset was preprocessed, fixing missing values and transforming categorical variables into a numerical format. To find the most pertinent variables for prediction, feature selection was done. Four machine learning algorithms were used: Random Forest (an ensemble learning technique), k-NN (a nearest-neighbor method), J48 (a decision tree algorithm), and Naive Bayes. A 10-fold cross-validation technique was used to thoroughly assess the model's performance, guaranteeing solid and trustworthy outcomes. The Random Forest algorithm proved to be effective in predicting stroke, as evidenced by its highest accuracy. The potential of machine learning to help medical professionals prevent, diagnose, and treat strokes is highlighted by this finding. The knowledge gathered from this research could improve patient care and guide the creation of individualized treatment programs. This project highlights the wider application of machine learning in healthcare beyond stroke. Machine learning has the potential to revolutionize healthcare delivery by utilizing data analysis and predictive modeling, which could result in better patient outcomes, more individualized treatments, and better diagnostics.

Cognitive functioning in children and adolescents with cerebral palsy: protocol for the Danish CPCog-Youth study

BackgroundMany children and adolescents with cerebral palsy (CP) experience cognitive difficulties, impacting their academic, social, and emotional well-being. A Danish study from 2023 revealed that merely 40% of individuals with CP complete their elementary school education, and previous neuropsychological studies have found that most children and adolescents with CP experience cognitive difficulties. Yet, cognitive functioning is often assumed rather than assessed, and CP follow-up programs focus predominantly on physical functioning. Recognizing this gap, we aim to investigate cognitive functioning in children and adolescents with CP in mainstream schools in Denmark, using standardized neuropsychological tests. Our objective is to provide valuable insights to guide clinical practice on cognitive assessment and intervention, ultimately fostering a more effective support system for individuals with CP.MethodsThe study employs a cross-sectional design, involving 100 children and adolescents with CP aged 11–15 years attending mainstream schools in Denmark. Cognitive assessment includes the core battery from a proposed Nordic test protocol for children and adolescents with CP – the CPCog – encompassing general cognitive functioning (intelligence), executive functions, and visuo-motor skills. Supplementary tests cover verbal and nonverbal short-term memory, attention, fatigue, and mental health. The assessment protocol will also be evaluated by parents of participating children and adolescents with CP. The project is conducted collaboratively by the neuropsychological teams at three assessment sites, in conjunction with the Center for Cerebral Palsy, Rigshospitalet, Aarhus University Hospital, and Aalborg University Hospital. The study benefits from an external advisory board comprising leading international CP experts.DiscussionCognitive difficulties in children and adolescents with CP are often overlooked. Few cognitive studies exist, with some providing only estimated cognitive functioning. The CPCog-Youth study will help advance our understanding of the cognitive challenges experienced by children and adolescents attending mainstream schools. The findings will contribute to the development of targeted cognitive assessment and intervention programs for individuals with CP, addressing this commonly neglected aspect of care. By also seeking feedback from participating families and the involved neuropsychologists, we aim to investigate whether the proposed cognitive assessment is feasible and beneficial in real-world settings.Trial registrationThe study was registered on ClinicalTrials.gov on June 27, 2023 (ID: NCT05921422).

Analysis of the types of social activity participation of older adults living in the community and the health level and quality of life by types: Applying Latent Class Analysis

AbstractBackgroundParticipation in various social activities of elderly has a significant impact on overall health and quality of life, including physical and metal health. Therefore, in this study, we aim to analyze the types of social activity participation among community‐dwelling elderly and examine differences in characteristics, health status, and quality of life according to these types of participation of social activities. Thus, we purpose to utilize the findings of this study as a foundation basis for research aimed at promoting services and intervention related to social activities of elderly in community.MethodThis study utilized the 9th wave (2022) panel data from the Korean Longitudinal Study of Elderly Employment(KLoSA). Latent class analysis was utilized to explore types of social activities. To assess the goodness of fit of the latent model, χ² (Chi‐square) test, Akaike Information Criteria (AIC), Bayesian Information Criteria (BIC), Sample‐Size Adjusted Bayesian Information Criteria (SABIC) indices, and Lo‐Mendell‐Rubin adjusted Likelihood Ratio Test (LMR‐LRT) were employed. One‐way ANOVA was conducted to examine characteristics across different types.ResultThe study included a total of 6,057 elderly individuals aged 60 and above residing in the local community for analysis. The results demonstrate four distinct types of social activity participation among the elderly. These four groups were named based on the types of social activities they engaged in: “Religious and Social Activity Centered,” “Social and Leisure Activity Centered,” “Social Activity Centered,” and “Inactive.” The analysis of characteristics across these types showed statistically significant differences in demographic factors such as age, marital status, and religion. In terms of health‐related aspects, subjective health and overall quality of life indices exhibited statistically significant differences among the types.ConclusionSocial activities among the elderly were analyzed into four distinct types based on the activities they engaged in. The participation of elderly individuals in various social activities is considered a crucial indicator for improving health and quality of life. It is hoped that this study will serve as a foundational basis for developing services and intervention programs for elderly individuals in the community, aimed at facilitating their participation in diverse social activities.

The Atypical Neural Processing of Reward in Bipolar Disorder

Abstract: There are still many unanswered questions regarding bipolar disorder among researchers. Understanding the characteristics of a particular area and neuroeconomics can aid in a more thorough examination of reward dysfunction and the reward process. Because changes in reward are undoubtedly one of the most prevalent signs of psychopathology in humans, researchers try to understand the prevalence of these diseases as well as the importance of reward in the manifestation of these conditions. Research indicates that different biological entities with comparable phenotypic symptoms make up bipolar illness. Finding the primary and secondary rewards connected to the functioning resting-state of bipolar illness patients' brain circuits is the goal of another investigation. On the other hand, using a reward task that begins with the expectation and consumption of rewarding and nonrewarding outcomes and progresses through fixation point, target, and outcome screen, researchers hope to better understand the connections between healthy individuals and BD patients' reward processing and striatal responses. This review can provide some suggestions to the development of prevention and intervention programs for individuals at risk of BD.

Impaired Social Attention and Cognitive Empathy in a Paediatric Sample of Children with Symptoms of Anxiety

Impairments in social cognition, in particular empathy, have been associated with childhood psychopathology, though previous investigations have yielded inconsistent results. Measures of social attention can reveal processes involved in responses to emotional stimuli and highlight deficits in empathy, or emotional biases in those with anxiety. The current study examined symptoms of anxiety, cognitive and affective empathy scores, and eye-gaze patterns in a pediatric sample of children (n = 178; 51–98 months-old) referred by their teachers for emerging psychopathology symptoms at school. We used eye-tracking metrics to capture gaze patterns during a dynamic video task designed to elicit empathic responses. Anxiety symptomology was reported by parents using the Screen for Child Anxiety Related Disorders scale (SCARED). Associations between eye-tracking variables, cognitive and affective empathy, and anxiety scores were analysed dimensionally in accordance with the Research and Domain Criteria (RDoC) framework. Higher levels of anxiety were associated with lower cognitive empathy and shorter first and total fixation durations to the eyes, across emotions (happiness, sadness, fear). No such associations were found between affective empathy and anxiety. Hierarchical multiple regression analyses revealed that across emotion conditions, first fixation duration negatively predicted anxiety scores. Our results indicate that children high in anxiety display cognitive empathy impairments and shorter attention to the eyes. These findings could inform early intervention programs for individuals at risk of developing anxiety disorders, as educating those high in anxiety on ways to identify emotions in others through changes in social attention could help to reduce anxiety.

Promoting Resilience in Stress Management for Adolescents With Type 1 Diabetes

Type 1 diabetes (T1D) requires demanding self-management health behaviors, and adolescents with T1D are at risk for poor psychosocial and medical outcomes. Developing resilience skills may help adolescents with T1D and elevated distress navigate common stressors and achieve positive outcomes. To test the efficacy of the Promoting Resilience in Stress Management (PRISM) intervention on levels of hemoglobin A1c (HbA1c), diabetes distress, self-management behaviors, resilience, and quality of life among adolescents. This phase 3, parallel, 1:1 randomized clinical trial that followed up 172 participants for 12 months was conducted from January 1, 2020, to November 30, 2022, at each of 2 children's hospitals, in Seattle, Washington, and Houston, Texas. Participants were ages 13 to 18 years with T1D for at least 12 months and elevated diabetes distress. PRISM, a manualized, skills-based, individual intervention program that teaches stress management, goal setting, reframing, and meaning-making, facilitated by a coach and accompanied by a digital app, was delivered in three 30- to 60-minute sessions approximately 2 weeks apart. The 2 primary outcomes, diabetes distress and HbA1c levels, and 3 secondary outcomes, resilience, quality of life, and engagement in self-management behaviors, were assessed at baseline and 6 and 12 months after baseline. Linear mixed-effects regression models were used to evaluate associations between PRISM or usual care (UC) and these outcomes at both time points for the intention-to-treat population. Among 172 adolescents (mean [SD] age, 15.7 [1.6] years), 96 were female (56%), and their baseline mean (SD) HbA1c level was 8.7% (2.0%). No differences were evident between PRISM and UC recipients in HbA1c levels (β, -0.21 [95% CI, -0.65 to 0.22]; P = .33) or diabetes distress (β, -2.71 [95% CI, -6.31 to 0.90]; P = .14) or any participant-reported outcome (eg, β, 2.25 [95% CI, -0.30 to 4.80]; P = .08 for self-management behaviors) at 6 months. At 12 months, there was no statistically significant difference between arms in HbA1c levels (β, -0.26 [95% CI, -0.72 to 0.19]; P = .25); however, PRISM recipients reported significantly greater amelioration of diabetes distress (β, -4.59 [95% CI, -8.25 to -0.94]; P = .01) and improvement in self-management behaviors (β, 3.4 [95% CI, 0.9 to 5.9]; P = .01) compared with UC recipients. The findings in this randomized clinical trial of psychosocial and behavioral improvements associated with PRISM at 12 months illustrate the value of a strengths-based intervention. Integrating resilience skills-building with traditional diabetes care may be a promising approach for improving outcomes among adolescents with T1D and elevated diabetes distress. ClinicalTrials.gov number: NCT03847194.

Current trends in antimicrobial resistance of ESKAPEEc pathogens from bloodstream infections – Experience of a tertiary care centre in North India

IntroductionBloodstream infections (BSI) due to ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli), cause significant mobility and mortality worldwide and are among the most common healthcare associated infections. Rising rates of antimicrobial resistance (AMR) in India are alarming, because of the high infection rates and poor control of antibiotic use. This single-centre, retrospective study was undertaken to identify the patterns of distribution and antimicrobial resistance of ESKAPEEc pathogens in bloodstream infections. MethodologyBlood samples from patients with suspected BSI were cultured and antimicrobial susceptibility testing was performed on automated systems (BD Bactec Fx/BactAlert 3D and Vitek2). The microbiological data on bacterial BSI was retrieved from the laboratory records and antimicrobial resistance profiles were analysed. Results10.7% of the blood culture samples showed bacterial growth during the study period (adult > paediatric and intensive care unit (ICU) > ward > outpatient department (OPD)). E. coli (24%) and K. pneumoniae (20.5%) were the predominant species isolated, followed by S. aureus (9.5%) and A. baumanni (9%). High rates of resistance to third generation cephalosporins, β-lactam-β-lactamase inhibitor combinations (BL-BLI) and carbapenems was observed, in Gram-negative isolates, especially from ICU patients. Methicillin-resistant S. aureus (MRSA) isolates increased from 67% to 88% over the five-year period. Vancomycin-resistance among Enterococcus isolates also escalated to 40% in 2022 with 11% linezolid resistance. ConclusionThe study revealed that more than 77% of bloodstream infections were caused by ESKAPEEc pathogens, with high rates of resistance to most antimicrobials. This reinforces the importance of monitoring the frequency of bacteria and antibiograms in individual treatment and hospital infection control programs.

Effectiveness of Biologic Therapy in Controlling Inflammation and Achieving Disease Remission in Patients with Rheumatoid Arthritis: A Systematic Review

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder characterized by joint pain, swelling, and potential systemic complications. The usefulness of biological treatments in reducing inflammation and helping RA patients achieve clinical remission is assessed in this systematic narrative review. Using PubMed, Scopus, and Google Scholar, a thorough literature search was carried out with an emphasis on research published in the last five years. The inclusion criteria were English-language human subject research that contributed significantly to our understanding of biological therapies for RA. Despite concerns over long-term drug withdrawal, TNF-alpha inhibitors, including certolizumab, adalimumab, and infliximab, have shown considerable effectiveness in lowering disease activity and inducing remission. Tocilizumab and other IL inhibitors have shown strong anti-inflammatory properties and increased rates of medication retention. Certain patient profiles have shown success with other biologics, such as rituximab and abatacept, especially those who have not responded to previous therapies. Empirical evidence demonstrates that tofacitinib, a JAK inhibitor, is just as effective as conventional biologics. The study emphasizes how important it is to create individualized treatment programs depending on the medical history and response to the condition. Even with encouraging findings, improving RA care requires ongoing observation of safety profiles and long-term effects. This study offers a thorough synthesis of the available data to help physicians choose the best biologic therapy for patients with RA.

Risk factors for dropout from psychological substance use disorder treatment programs in criminal justice settings

BackgroundSubstance use disorders are highly prevalent in people within the criminal justice system. Psychological programs are the most common type of treatment available and have been shown to decrease recidivism, but dropping out of treatment is common. Risk factors associated with treatment dropout remain unclear in this setting, and whether the risk factors differ by treatment form (group-based vs. individual). MethodsOutcome (treatment dropout) was defined as not finishing the program due to client’s own wish, misbehavior, no-shows, or because program leader found client to be unsuitable. Predictors of treatment dropout included a comprehensive set of individual-level clinical, socioeconomic, and crime-related pre-treatment characteristics. Multivariable regression models were used to estimate the associations between predictors and dropout. FindingsThe study cohort included 5239 criminal justice clients who participated in a psychological treatment program (group-based or individual). Multivariable logistic regression models showed that female sex (OR=1.64, 95% CI 1.20–2.25), age (0.99, [0.97–1.00]), sentence length (0.98, [0.97–0.98]), higher education (0.54, [0.28–1.00]), number of violent offenses (1.03, [1.01–1.05]), and anxiety disorders (1.32, [1.01–1.72]) were associated with dropout from the individual treatment program. For the group-based program, age (OR=0.98, 95% CI 0.96–1.00), sentence length (OR=0.96, 95% CI 0.94–0.98), stimulant use disorder (OR=1.48, 95%, 1.00–2.19), and self-harm (OR 1.52, 95% CI 1.00–2.34) were associated with dropout. ConclusionsWe identified certain sociodemographic, crime-related, and clinical characteristics that were particularly important in predicting dropout from psychological treatment. Further, we find that there are similarities and differences in predictors of dropout from group-based and individual treatment forms.

Social and Language Development Interventions Regarding Adolescents with Autism Spectrum Disorder.

Every person with autism spectrum disorder (ASD) is unique and faces challenges with communication, repetitive behaviors, and social interaction. Speech and language development are among the key areas affected by ASD. Speech therapy plays a crucial role in the lives of individuals with autism. Communication is central to human interaction, and people with ASD often struggle to effectively express their needs, thoughts, and feelings. This paper explores the importance of speech language and social skills improvement for adolescents on the autism spectrum, focusing on the goals and techniques that help them overcome communication barriers. The improvements in these areas enhance social interactions, boost academic performance, and increase independence. The paper also discusses considerations for designing intervention programs for individuals with autism and provides recommendations for practice. Moreover, recommendations for future research are provided.

Interplay Between Diabetes Mellitus and the Occurrence of Osteoarthritis and Associated Conditions in Women of Menopausal Age.

Osteoarthritis (OA) and diabetes mellitus (DM) have long-term deleterious chronic effects and are among the most prevalent chronic disorders. DM and its associated factors, such as hyperglycemia, have a significant contribution to the pathophysiology of OA, particularly in post-menopausal women. Women who have uncontrolled diabetes (DM) are more prone to develop osteoarthritis (OA), which may be exacerbated by poor glycemic control. Furthermore, this category of female patients with DM has an increased risk of developing fractures, even in those with initially normal bone density scores, further illustrating the correlation between DM and bone health. Additionally, multiple risk factors, including obesity, metabolic syndrome, hypertension, estrogen-based hormone therapy, and hyperuricemia, in menopausal women can lead to the development and exacerbation of OA. It is discovered that these variables have a direct or indirect impact, frequently causing inflammation and hormonal changes, which contribute to the intricate interaction between DM and OA. The management of OA and DM in womenthus calls for a multi-faceted management plan including glycemic control, weight control, exercise, and specialized pain management methods catering to the specific requirements of the patients. Regularly screening for OA should be implemented for menopausal women with DM and utmost care should be provided by healthcare professionals. Regular monitoring of joint health and early management, encouraging interdisciplinary cooperation, putting preventative measures into place, and creating individualized treatment programs are essential. A thorough understanding of the link between DM and OA will ultimately lead to improved health outcomes and a better future for these individuals.

Efforts to stimulate PWMD patients through psychotherapy based on media craft activities

People with mental disorders often face health challenges and are at risk of social isolation, highlighting the importance of appropriate treatment to enhance their quality of life. The objective of this initiative is to improve the quality of life and foster independence among patients with mental disorders (ODGJ) through psychotherapy in the form of handicraft activities. The program is conducted collaboratively by the community service team and the Omben Sampang Community Health Center team. It involves providing hands-on training and direct guidance to ODGJ patients in creating tote bag paintings and shibori batik. As a result of this activity, ODGJ patients exhibit positive developments in both their quality of life and their ability to engage in daily activities independently. These outcomes serve as a foundation for the development of effective treatment programs for individuals with mental disorders.

The relationship and relevant factors between sleep disturbance and depressive symptoms in adolescents

Depression and sleep difficulties have a strong association. Depression may coexist with long-term sleep difficulties in some people, and vice versa for those who already have depression, they are more likely to develop sleep disturbance. In other words, the development of one symptom can trigger the development of another. Patients must therefore pay close attention to their sleep difficulties. Numerous psychiatric illnesses that are related to sleep difficulties might worsen a patient's overall condition. If the issue of sleep difficulties is not resolved in a timely manner, it may eventually lead to the appearance of other connected psychiatric illnesses, which may make the patient's condition worse overall. Depression is a prevalent mental illness. Clinical symptoms of depression commonly include tiredness, delayed thinking, and diminished volitional activity. Sleep disturbances can arise for a variety of reasons, including physical illnesses and psychological issues. This review can provide some suggestions for the development of prevention and intervention programs for individuals with depression and sleep disturbance.

Exploring a multiparameter MRI-based radiomics approach to predict tumor proliferation status of serous ovarian carcinoma.

To develop a multiparameter magnetic resonance imaging (MRI)-based radiomics approach that can accurately predict the tumor cell proliferation status of serous ovarian carcinoma (SOC). A total of 134 patients with SOC who met the inclusion and exclusion criteria were retrospectively screened from institution A, spanning from January 2016 to March 2022. Additionally, an external validation set comprising 42 SOC patients from institution B was also included. The region of interest was determined by drawing each ovarian mass boundaries manually slice-by-slice on T2-weighted imaging fat-suppressed fast spin-echo (T2FSE) and T1 with contrast enhancement (T1CE) images using ITK-SNAP software. The handcrafted radiomic features were extracted, and then were selected using variance threshold algorithm, SelectKBest algorithm, and least absolute shrinkage and selection operator. The optimal radiomic scores and the clinical/radiological independent predictors were integrated as a combined model. Compared with the area under the curve (AUC) values of each radiomic signature of T2FSE and T1CE, respectively, the AUC value of the radiomic signature (T1CE-T2FSE) was the highest in the training set (0.999 vs. 0.965 and 0.860). The homogeneous solid component of the ovarian mass was considered the only independent predictor of tumor cell proliferation status among the clinical/radiological variables. The AUC of the radiomic-radiological model was 0.999. The radiomic-radiological model combining radiomic scores and the homogeneous solid component of the ovarian mass can accurately predict tumor cell proliferation status of SOC which has high repeatability and may enable more targeted and effective treatment strategies. The proposed radiomic-radiological model combining radiomic scores and the homogeneous solid component of the ovarian mass can predict tumor cell proliferation status of SOC which has high repeatability and may guide individualized treatment programs. • The radiomic-radiological nomogram may guide individualized treatment programs of SOC. • This radiomic-radiological nomogram showed a favorable prediction ability. • Homogeneous slightly higher signal intensity on T2FSE is vital for Ki-67.

The effect of robotic surgery on low anterior resection syndrome in patients with lower rectal cancer: a propensity score-matched analysis

BackgroundMany patients experience anorectal dysfunction after rectal surgery, which is known as low anterior resection syndrome (LARS). Robotic systems have many technical advantages that may be suitable for functional preservation after low rectal resection. Thus, the study aimed to explore whether robotic surgery can reduce the incidence and severity of LARS.MethodsPatients undergoing minimally invasive sphincter-sparing surgery for low rectal cancer were enrolled between January 2015 and December 2020. The patients were divided into robotic or laparoscopic groups. The LARS survey was conducted at 6, 12 and 18 months postoperatively. Major LARS scores were analysed as the primary endpoint. In order to reduce confounding factors, one-to-two propensity score matches were used.ResultsIn total, 342 patients were enrolled in the study. At 18 months postoperatively, the incidence of LARS was 68.7% (235/342); minor LARS was identified in 112/342 patients (32.7%), and major LARS in 123/342 (36.0%). After matching, the robotic group included 74 patients, and the laparoscopic group included 148 patients. The incidence of major LARS in the robotic group was significantly lower than that in the laparoscopic group at 6, 12, and 18 months after surgery. In multivariate logistic regression analysis, tumour location, laparoscopic surgery, intersphincteric resection, neoadjuvant therapy, and anastomotic leakage were independent risk factors for major LARS after minimally invasive sphincter-sparing surgery for low rectal cancer. Furthermore, a major LARS prediction model was constructed. Results of model evaluation showed that the nomogram had good prediction accuracy and efficiency.ConclusionsPatients with low rectal cancer may benefit from robotic surgery to reduce the incidence and severity of LARS. Our nomogram could aid surgeons in setting an individualized treatment program for low rectal cancer patients.

Clinical application of CT-based radiomics model in differentiation between laryngeal squamous cell carcinoma and squamous cell hyperplasia.

To evaluate the clinical application of the CT-based radiomics prediction model for discriminating SCC and SCH. A total of 254 clinical samples were selected from 291 patients with larynx-occupying lesions who underwent primary surgery. All lesions were validated via histopathological examination at The Second Hospital of Jilin University between June 2004 and December 2019. All patients were randomly allocated to the training (n = 177) and validation (n = 77) cohorts. After the acquisition of CT images, manual 3D tumor segmentation was performed using the CT images of the arterial, venous, and non-contrast phases via ITK-SNAP software. Subsequently, radiomics features were extracted using A.K. software. Based on the above features, three different diagnostic models (CTN, CTA+CTV, and CTN+CTA+CTV) were constructed to classify squamous cell carcinoma (SCC) and squamous cell hyperplasia (SCH). Additionally, receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were measured to evaluate the diagnostic characteristics and clinical safety of the proposed three prognostic models. In the radiomic prediction Model 1 (CTN), the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the training cohorts in differentiating SCC and SCH were 0.883, 0.785, 0.645, 1.000, 1.000, and 0.648, while in the testing cohorts, these values were 0.852, 0.792, 0.66, 1.000, 1.000, and 0.652, respectively. In the radiomic prediction Model 2 (CTA+CTV), the AUC, accuracy, sensitivity, specificity, PPV, and NPV values of the training cohorts were 0.965, 0.91, 0.916, 0.9, 0.933, and 0.875, respectively, while in the testing cohorts, the corresponding values were 0.902, 0.805, 0.851, 0.733, 0.833, and 0.759, respectively. In the radiomic prediction Model 3(CTN+CTA+CTV), the AUC, accuracy, sensitivity, specificity, PPV, and NPV values of the training cohorts were 0.985, 0.944, 0.953, 0.929, 0.953, and 0.929, while in the testing cohorts, the corresponding values were 0.965, 0.857, 0.894, 0.8, 0.875, and 0.828, respectively. The radiomic prediction Model 3, based on the arterial-venous-plain combined scan phase of CT, achieved promising diagnostic performance, expected to be regarded as a preoperative imaging tool in classifying SCC and SCH to guide clinicians to develop individualized treatment programs.

Understanding COVID-19 vaccination decisions during pregnancy and while breastfeeding in a Canadian province

ABSTRACTBackgroundVaccination in pregnancy is important for preventing illness for mothers and babies; however, vaccine uptake in pregnant individuals is lower than non-pregnant females of fertile age. Given the devastating effects of COVID-19 and the increased morbidity and mortality risk for pregnant individuals, it is important to understand the determinants of vaccine hesitancy in pregnancy. The focus of our study was to explore COVID-19 vaccination among pregnant and breastfeeding individuals and its association with their reasons (psychological factors) for vaccination using the 5C scale and other factors.MethodsAn online survey investigating prior vaccinations, level of trust in healthcare providers, demographic information, and the 5C scale was used for, pregnant and breastfeeding individuals in a Canadian province.ResultsPrior vaccinations, higher levels of trust in medical professionals, education, confidence, and collective responsibility predicted increased vaccine uptake pregnant and breastfeeding individuals.ConclusionsThere are specific psychological and socio-demographic determinants that affect COVID-19 vaccine uptake in pregnant populations. Implications of these findings include targeting these determinants when informing and developing intervention and educational programs for both pregnant and breastfeeding individuals, as well as healthcare professionals who are making vaccine recommendations to patients. Study limitations include a small sample and lack of ethnic and socioeconomic diversity.

Geriatric cardiology: general provisions

The increase in life expectancy, thanks not least to the success of disease prevention and treatment, has led to a global restructuring of the population structure with a dramatic increase of the elderly and long-livers. Characteristics for elderly patients are the spectrum of age-associated types of pathology, disease-nonspecific symptoms and syndromes, polypharmacy, and functional in capacity which require a fundamentally different approach from the «disease-centered» approach in modern medicine. The review examines the history of geriatric cardiology and its demographic factors, the tasks of geriatric cardiology at the current stage of the development of clinical medicine, focuses on a number of specific geriatric conditions such as multimorbidity, polypharmacy, geriatric syndromes, and the limited representation of geriatric aspects of cardiovascular diseases in the recommendations of the European Society of Cardiology. It is emphasized that the organic incorporation of principles and methods of comprehensive geriatric assessment into the traditional cardiological diagnostic and treatment process using methods of geriatric screening, geriatric diagnosis, creation of individual treatment and recovery programs will allow to improve the quality of life, functional status, to prevent traumatic events and acute conditions in of elderly patients, to reduce the burden on the medical and social security system.

Assessment of the quality of life in complex medical rehabilitation of patients at the stage of chemoradiotherapy for head and neck cancer

BACKGROUND: At the stage of chemoradiotherapy of malignant neoplasms of the head and neck, in 90% of cases, the development of radiation dermatitis and mucositis is observed. The resulting acute radiation reactions negatively affect not only the quality of life of the patient, but also the planned treatment. A multidisciplinary approach with the inclusion of basic treatment, physical therapy, physical factors, psychological correction, and nutritional support is an effective strategy for improving the patient's quality of life at this stage of treatment. AIM: To assess the quality of life of patients in complex medical rehabilitation who underwent chemoradiotherapy for malignant neoplasms of the head and neck. MATERIALS AND METHODS: An interventional prospective randomized study was conducted with the participation of 60 patients with malignant neoplasms of the oral cavity, larynx, oropharynx, larynx undergoing chemoradiotherapy. The main group (n=30) received a course of medical rehabilitation: exposure to low-temperature argon plasma, general magnetic therapy, physical therapy, training on the support reaction on a barefoot platform, nutritional support and classes with a medical psychologist. In patients of the comparison group (n=30), plasma exposure was not included in the rehabilitation course. The effect of chemoradiotherapy for head and neck cancer on the patient's quality of life was assessed by the severity of pain syndrome, physical functioning, and limitations of daily activities using Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS) techniques, a questionnaire developed by C.D. Spielberger and adapted by Y.L. Khanin, the SF-36 questionnaire. RESULTS: After a course of chemoradiotherapy, patients began to complain of pain, burning in the mouth, complaints of dry mouth, pain when swallowing, eating, limited mouth opening, redness and peeling of the skin, voice changes, difficulty falling asleep, frequent awakenings at night, embarrassment of one’s appearance. In patients of both groups, there was a decrease in the level of reactive and personal anxiety, the increased level of anxiety and depression decreased by the end of the course of chemoradiotherapy with a decrease in indicators after 6 months. Despite the increase in pain intensity during chemoradiation treatment, an increase in vital activity indicator was recorded, as well as an indicator of self-assessment of one’s health by the end of the course of chemoradiation treatment. CONCLUSION: The resulting radiation mucositis and epidermitis at the stage of chemoradiotherapy for head and neck cancer lead to physical and psychological limitations, worsening the patient's quality of life, which determines the need to accompany this stage of treatment with comprehensive medical rehabilitation. The study of the dynamics of the parameters of the quality of life of patients is the basis for the selection of individual rehabilitation treatment programs.