Adult Population Research Articles

Association Between Early Childhood P300 Deficits and Risk for Preadolescence Depressive Disorder Mediated by Responsiveness to PCIT-ED Treatment.

Preschool-onset major depressive disorder (PO-MDD) is an impairing pediatric mental health disorder that impacts children as young as three years old. There is limited work dedicated to uncovering neural measures of this early childhood disorder which could be leveraged to further understand both treatment responsiveness and future depression risk. Event-related potentials (ERPs) such as the P300 have been employed extensively in adult populations to examine depression-related deficits in cognitive and motivational systems. Few studies examine the prospective relationships between depression and P300, especially in young children. Moreover, limited research examines the relationship between P300 with psychotherapy treatment responsiveness in youths. The current study sought to examine the prospective relationships between pre-intervention P300 (i.e., choice-locked) elicited from the doors task in depressed preschool children (i.e., PO-MDD; ages 3-to-6) with reductions in depressive symptoms after completing an 18-week long dyadic psychotherapy intervention (n = 59). We also explored relations to risk for depression assessed at a follow-up visit during preadolescence (ages 8-to-12; n = 82). Those with PO-MDD exhibiting reduced choice (doors)-locked P300 demonstrated worse treatment response to psychotherapy and were more likely to meet criteria for depression during preadolescence. Moreover, the relationship between pre-intervention P300 and later preadolescence depression was significantly mediated by response to treatment. These findings suggest that deficits in brain systems linked to the choice-locked P300 component (i.e., cognitive and motivational) might be indicative of non-responsiveness to early dyadic psychotherapeutic intervention efforts for depression which impacts risk for recurrent patterns of depression in youths.

Association Between Symptoms of Body Dysmorphia and Social Media Usage: A Cross-Generational Comparison.

Background: The rise of social media parallels a mental health epidemic. The effect of social media usage on rates and severity of body dysmorphic disorder is not well-understood. Objective: To determine if an association exists between social media engagement, body dysmorphia symptoms, and/or interest in cosmetic surgery in a demographically diverse cross-section of the U.S. adult population. Methods: In a Qualtrics platform-based survey study of the general U.S. adult population, responses to demographic information, social media activity questionnaire and the body dysmorphic disorder screening questionnaire, and interest in cosmetic surgery were collected. Descriptive statistics and a multivariate logistic regression model were carried out. Results: A total of 1,013 respondents completed the survey. The average age was 40.9 (SD, 14.8) years, 72% were women. Median time spent on social media (IQR) was 4 (2-7) h/day. Respondents who screened positive for symptoms of body dysmorphia had higher daily mean social media usage time (odds ratio [OR] 1.49), tend to be female (OR 2.17), younger (OR 0.97), identify as Caucasian (OR 1.65), and are more likely considering a cosmetic procedure in the next year (OR 2.98). Conclusion: This study demonstrates a positive association between daily social media usage, self-reported symptoms of body dysmorphia, and interest in cosmetic procedures.

The role of diagnostic modalities in differentiating hypertensive heart disease and hypertrophic cardiomyopathy: strategies in adults for potential application in paediatrics.

Hypertensive heart disease and hypertrophic cardiomyopathy both lead to left ventricular hypertrophy despite differing in aetiology. Elucidating the correct aetiology of the presenting hypertrophy can be a challenge for clinicians, especially in patients with overlapping risk factors. Furthermore, drugs typically used to combat hypertensive heart disease may be contraindicated for the treatment of hypertrophic cardiomyopathy, making the correct diagnosis imperative. In this review, we discuss characteristics of both hypertensive heart disease and hypertrophic cardiomyopathy that may enable clinicians to discriminate the two as causes of left ventricular hypertrophy. We summarise the current literature, which is primarily focused on adult populations, containing discriminative techniques available via diagnostic modalities such as electrocardiography, echocardiography, and cardiac MRI, noting strategies yet to be applied in paediatric populations. Finally, we review pharmacotherapy strategies for each disease with regard to pathophysiology.

Lipoprotein(a) Atherosclerotic Cardiovascular Disease Risk Score Development and Prediction in Primary Prevention From Real-World Data.

Lp(a; Lipoprotein[a]) is a predictor of atherosclerotic cardiovascular disease (ASCVD); however, there are few algorithms incorporating Lp(a), especially from real-world settings. We developed an electronic health record (EHR)-based risk prediction algorithm including Lp(a). Utilizing a large EHR database, we categorized Lp(a) cut points at 25, 50, and 75 mg/dL and constructed 10-year ASCVD risk prediction models incorporating Lp(a), with external validation in a pooled cohort of 4 US prospective studies. Net reclassification improvement was determined among borderline-intermediate risk patients. We included 5902 patients aged ≥18 years (mean age 48.7±16.7 years, 51.2% women, and 7.7% Black). Our EHR model included Lp(a), age, sex, Black race/ethnicity, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking, and hypertension medication. Over a mean follow-up of 6.8 years, ASCVD event rates (per 1000 people-years) ranged from 8.7 to 16.7 across Lp(a) groups. A 25 mg/dL increment in Lp(a) was associated with an adjusted hazard ratio of 1.23 (95% CI, 1.10-1.37) for composite ASCVD. Those with Lp(a) ≥75 mg/dL had an 88% higher risk of ASCVD (hazard ratio, 1.88 [95% CI, 1.30-2.70]) and more than double the risk of incident stroke (hazard ratio, 2.55 [95% CI, 1.54-4.23]). C-statistics for our EHR and EHR+Lp(a) models in our EHR training data set were 0.7475 and 0.7556, respectively, with external validation in our pooled cohort (n=21 864) of 0.7350 and 0.7368, respectively. Among those at borderline/intermediate risk, the net reclassification improvement was 21.3%. We show the feasibility of developing an improved ASCVD risk prediction model incorporating Lp(a) based on a real-world adult clinic population. The inclusion of Lp(a) in ASCVD prediction models can reclassify risk in patients who may benefit from more intensified ASCVD prevention efforts.

The Management of Chronic Kidney Disease not Requiring Renal Replacement Therapy in General Practice.

Chronic kidney disease (CKD) is common in the German adult population, with a prevalence of 10%. This guideline, updated on the basis of current scientific evidence, contains recommendations for the management of CKD in general practice. The updated guideline is based on a review and assessment of source guidelines and systematic reviews concerning individual questions. The recommendations were agreed upon in a moderated two-stage nominal group process by the mandate holders of the participating specialist societies, along with patient representatives. The risk of progression to renal failure requiring renal replacement therapy should be assessed with a risk score. Assessing this risk and determining the indication for treatment with SGLT2 inhibitors both require measurement of the urinary albumin-to-creatinine ratio. Pharmacotherapy is not recommended for asymptomatic hyperuricemia. An initial ultrasonographic examination of the kidneys and urogenital system is now recommended for all patients. The vaccination recommendations that differ for people with CKD have been integrated into the guideline. The risk assessment of CKD and the treatment options have been expanded. The updated guideline can improve primary care for patients with CKD and the selection of patients for interdisciplinary care.

Cracking the Code of Calcification: How Presence and Burden among Intracranial Arteries Influence Stroke Incidence and Recurrence.

Intracranial atherosclerosis accounts for about 8% of all strokes in Western societies but the influence of arterial calcification on plaque instability is a topic on ongoing debate. Explore the association between the presence and burden of calcium in atherosclerotic plaques among intracranial arteries with the risk of clinical or silent stroke events through a systematic review and meta-analysis. Adhering to PRISMA guidelines, studies from PubMed and Embase were analyzed up to May 2024. Adult populations undergoing CT/CTA scans for symptomatic and asymptomatic atherosclerosis among intracranial vessels. Statistical analyses were performed to identify the impact of calcium presence and relative burden on stroke incidence or recurrence. Risk of bias was evaluated with QUADAS-2 criteria while GRADE system was used to assess quality of evidence. The study synthesized data from 8 longitudinal studies, creating two different models: Calcium presence (heterogeneity: Q 9.19; I2 42.61%) and calcium burden (heterogeneity: Q 6.01; I2 0.01%). As for calcium presence and stroke events, 6839 patients were considered, and two statistical models were made. Our analysis established a significant association between the presence of calcium and stroke events. [OR= 1.54, 95% CI 1.06, 2.24, p=0.001]. A subsequent effect size analysis showed a similar correlation's strength [OR = 1.56, 95% CI 1.11, 2.19, p = 0.001]. As for calcium burden and stroke events, 4885 patients were considered with effect size analysis establishing a positive correlation [OR = 1.31, 95% CI, 1.17, 1.46, p =< 0.001). A decrease in correlation strength was found between calcium presence [OR = 1.56] and burden [OR = 1.31] with stroke events. Despite strict exclusion criteria, heterogeneity across studies and between different statistical models of the present study persisted. Valuable data loss among excluded studies could have affected the findings of this meta-analysis. Unified calcium scoring pattern and individual arterial segment analysis was not widely adopted by included literature. Our meta-analysis showed a weak, yet present association between presence and burden of calcification among intracranial arterial vessels and clinical or silent stroke events. Considering the high prevalence of intracranial calcification in the general population, widespread intracranial calcium assessment for stroke prediction has currently poor evidence. Investigation on specific intracranial vessels or exploration of newer calcium patterns could be essential to enhance the predictive accuracy of calcification in stroke incidence or recurrence. IAC = Intracranial Arterial Calcification; HU = Hounsfield Unit; RE = Random Effect.

Optimizing orthobiologic therapies with exercise, diet, and supplements.

Orthobiologic injections including platelet-rich plasma (PRP) and cell-based injections are becoming increasingly popular. Evidence suggests that these therapies can be effective in certain situations. The efficacy of these injections may be more dependent on the quality of the injectate, which given their autologous nature, may be dependent on lifestyle choices like exercise, diet, and supplements. The literature describing PRP injections shows that the number and activity of platelets can improve their efficacy. A multitude of lifestyle modifications can affect those factors. Exercise intensity appears to increase platelet count and increases adhesion as well as release of growth factors. Low inflammatory diets increase platelet counts and activity overall. Stress, some supplements, high cholesterol, or processed sugar diets can increase inflammation and potentially decrease platelet counts as well as quality of PRP injectate. Similarly, cell-based therapies can be affected by mesenchymal stromal cell (MSC) number and quality. Cell-based therapy is based upon limiting cellular senescence and increasing replication and differentiation. Exercise may limit senescence and improve replication and differentiation of these cell-based therapies, especially in older adult populations. There are a multitude of supplements that may potentiate these types of injections and patients should discuss the potential benefits and concerns when starting a supplement regimen. Certain foods as well as changes in oxygenation may limit cellular senescence and lower calorie intake may affect MSC viability and function as well. Overall, the current state of literature describes biologic plausibility of how exercise, diet and supplements might affect orthobiologic injection efficacy. Further translational research needs to be completed to describe the effect size and improve recommendations for clinical implementation.

Parental Mental Health and Child Maltreatment in the COVID-19 Pandemic: Importance of Sampling in a Quantitative Statistical Study.

Results on parental burden during the COVID-19 pandemic are predominantly available from nonrepresentative samples. Although sample selection can significantly influence results, the effects of sampling strategies have been largely underexplored. This study aimed to investigate how sampling strategy may impact study results. Specifically, we aimed to (1) investigate if outcomes on parental health and child maltreatment during the COVID-19 pandemic from a convenience sample differ from those of a specific representative sample and (2) investigate reasons for differences in the results. In 2020, we simultaneously conducted 2 studies: (1) a web-based survey using a convenience sample of 4967 parents of underage children, primarily recruited via social media, and (2) a study using a quota sample representative of the German adult population with underage children (N=1024), recruited through a combination of telephone interviews and computer-assisted web interviews. In both studies, the same questionnaire was used. To evaluate the impact of sampling, we compared the results on outcomes (parental stress, subjective health, parental mental health, general stress, pandemic-related stress, and the occurrence of child maltreatment) between the 2 samples. To explain differences in the results between the 2 studies, we controlled for sociodemographic data, parent-related risk factors, and COVID-19-related experiences. Compared to parents from the quota sample, parents from the convenience sample reported significantly more parental stress (η2=0.024); decreased subjective health (η2=0.016); more anxiety and depression symptoms (η2=0.055); more general stress (η2=0.044); more occurrences of verbal emotional abuse (VEA; φ=0.12), witnessing domestic violence (WDV; φ=0.13), nonverbal emotional abuse (NEA; φ=0.03), physical abuse (φ=0.10), and emotional neglect (φ=0.06); and an increase of child maltreatment (VEA: exp(B)=2.95; WDV: exp(B)=3.19; NEA: exp(B)=1.65). Sociodemographic data, parent-related risk factors, and COVID-19-related experiences explained the differences in parental stress (remaining difference between samples after controlling for covariates: η2=0.002) and subjective health (remaining difference between samples after controlling for covariates: η2=0.004) and partially explained differences in parental mental health (remaining: η2=0.016), general stress (remaining: η2=0.014), and child maltreatment (remaining: VEA: exp(B)=2.05 and WDV: exp(B)=2.02) between the 2 samples. The covariates could not explain the difference in NEA (exp(B)=1.70). We discuss further factors that may explain the unexplained differences. Results of studies can be heavily impacted by the sampling strategy. Scientists are advised to collect relevant explaining variables (covariates) that are possibly related to sample selection and the outcome under investigation. This approach enables us to identify the individuals to whom the results apply and to combine findings from different studies. Furthermore, if data on the distribution of these explanatory variables in the population are available, it becomes possible to adjust for sample selection bias.

Topographical anatomy of the vermiform appendix within a select adult and fetal South African population

One of the intra-abdominal structures that is considered vestigial, yet highly potent, is the appendix, which can vary in position, length, and diameter due to differences among sexes, population groups, and embryological variations. These variations have been documented in various adult and fetal populations; however, few have investigated these variations within a South African population. The present study therefore aimed to describe the topographical anatomy of the vermiform appendix within a select adult and fetal South African population. The appendicular position, length, outer diameter (at the base, midpoint, and tip), distance of the spino-umbilical line, and the relation to the spino-umbilical line were determined in 20 adult (subset A) and 45 fetal (subset B) embalmed cadavers obtained from the Department of Clinical Anatomy, University of KwaZulu-Natal, South Africa. There was a high incidence of the retrocecal position in subset A, and the pre-ileal position in subset B. The average distance of the spino-umbilical line, length, and diameter in subset A were 216.54 ± 36.51 mm, 75.56 ± 19.45 mm, and 5.99 ± 1.64 mm, respectively. The average length, diameter, and distance of the spino-umbilical in subset B were 21.99 ± 5.38 mm, 1.47 ± 0.36 mm, and 29.02 ± 5.70 mm, respectively. The appendicular base was frequently found along the spino-umbilical line in subset A, and cephalically in subset B. The present study’s findings may assist in diagnosing appendicitis and appendectomy within this select adult and fetal South African population.

Multimodal strategies for the implementation of infection prevention and control (IPC) interventions - update of a systematic review for the WHO guidelines on core components of IPC programmes at the facility level.

Healthcare-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the World Health Organization (WHO) to enhance infection prevention. To update the systematic review on facility-level infection prevention and control (IPC) interventions on the WHO Core Component of using multimodal strategies. Data Sources: Medline (via PubMed), EMBASE, CINAHL, and the Cochrane library. Randomized controlled studies (RCTs), interrupted time series (ITS), and before-after studies in acute care settings, from 24 November 2015 to 30 June 2023. Both paediatric and adult populations. IPC interventions implemented with at least three WHO multimodality elements. HAI, HAI caused by antimicrobial-resistant microorganisms, and hand hygiene (HH) compliance.Assessment of Risk of Bias: Effective practice and organisation of care (EPOC) and integrated quality criteria for review of multiple study designs (ICROMS) tools.Methods of data Synthesis: Descriptive data synthesis. Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies (NCBA) were excluded due to an insufficient ICROMS score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to AMR and six on HH compliance. Eleven were controlled studies (RCTs or controlled before-after studies (CBAs)), nine ITS and seven NCBA studies. Twenty-two of the studies originated from high-income countries and the overall quality was medium to low. Twenty studies showed either significant HAI-reductions or HH improvement. Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate with few studies from low- or middle-income countries. Future research should focus on higher quality studies in resource limited settings.

Screening and Referral for Social Needs Among Veterans: A Randomized Controlled Trial.

Healthcare-based social need screening and referral (S&R) among adult populations has produced equivocal results regarding social need resource connection. Assess the efficacy of S&R on resource connection (primary outcome) and unmet need reduction (secondary outcome). Intention-to-treat randomized controlled trial. Analyses adjusted for demographics (e.g., age, race), comorbidity (Elixhauser), and VA priority group (PG). Veterans with and at-risk for cardiovascular disease and one of more (hereafter " ≥ 1") social needs receiving healthcare at one of three Veterans Healthcare Administration (VHA) medical facilities. Study arms represented referral strategies of varying intensity. Arm 1 (control) received generic resource information; Arm 2 (low intensity) received generic and tailored resource information; Arm 3 (high intensity) received all the above plus social work navigation assistance. Post index surveys at 2-months assessed resource connection (connection to ≥ 1 new resources) and 6-months assessed need reduction (≥ 1 needs at the index screen no longer identified). A total of 479 Veterans were randomized: 50% were minoritized Veterans, mean age was 64, and 91% were male. Arm 3 was associated with greater resource connection but differences across study arms were not statistically significant. For example, compared to the control arm, participants in Arm 3 had higher but non-statistically significant odds of connecting to ≥ 1 resources (OR = 1.60, CI [.96, 2.67]). Among VHA-enrolled Veterans, a high-intensity S&R intervention was associated with a non-statistically significant increase in connection to social need resources. Further study needed to establish S&R efficacy. NCT04977583.

Outcomes of Concentrated Bone Marrow Aspirate with Extracellular Matrix in Pediatric and Adolescent Patients with Capitellar Osteochondritis Dissecans.

Humeral capitellar osteochondritis dissecans (OCD) lesions can be challenging to treat. Past studies have demonstrated grafting with extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) to be a viable technique for treatment of talar dome OCD, though little literature exists regarding application of this technique to the capitellum. This study aimed to report patient-reported outcomes (PROs) and return to sport (RTS) of pediatric patients at ≥1-year postoperatively who underwent ECM-BMAC grafting for capitellar OCD lesions. A consecutive, single surgeon series of patients aged <18 years with unstable, contained humeral capitellum OCD who underwent ECM-BMAC grafting and had ≥1-year of clinical follow-up were included. Elbow range of motion (ROM), RTS time, postoperative sport level, and complications were recorded at follow-up visits. PROs, including Hospital for Special Surgery (HSS) Pedi-FABS, QuickDASH, Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility, PROMIS Pain Interference, and PROMIS Upper Extremity, were obtained at baseline and ≥1-year postoperatively. Both PROs and ROM were compared pre- and postoperatively using Wilcoxon Signed-Rank tests based on normality testing with Shapiro-Wilk tests. Twenty patients were included (mean age 12.8 ± 1.4 years) with an average 22.2 ± 13.0 months follow-up. Fifteen (75%) patients were female. The most common primary sports were gymnastics, baseball/softball, and racquet sports. Flexion improved significantly at ≥1-year postoperative, while extension remained close to full pre- and postoperatively. PROs improved from pre- to postoperative for all assessed instruments except for the HSS Pedi-FABS. Eighteen patients returned to their primary sport at the same competitive level or higher at a mean 5.8 ± 1.2 months. The two patients who did not return to their primary sport changed sports due to preferences unrelated to their elbow. There were no complications (e.g. infection, stiffness, revision surgery). This study demonstrated that ECM-BMAC grafting is a viable treatment strategy for pediatric patients with unstable, contained capitellar OCD lesions. We observed favorable PROs with a ∼90% RTS rate ≥1-year postoperatively, supporting the results of this technique that has demonstrated success in other anatomic regions and adult populations. These findings suggest ECM-BMAC grafting to be a viable treatment option for contained capitellar OCD lesions. Although these early results are promising, longer-term research studies are paramount in determining the outcomes of patients with capitellum OCD lesions treated with ECM-BMAC grafting.

How Do Personality Dysfunction and Maladaptive Personality Traits Predict Time to Premature Discontinuation of Pharmacological Treatment of ADHD?

Non-adherence to medication is common in the adult ADHD clinical group. The goal of this pre-registered study was to examine whether the DSM-5 Alternative Model of Personality Disorder (AMPD), generality personality dysfunction (LPFS-BF 2.0) or maladaptive personality traits (PID-5), can predict time to premature discontinuation of pharmacological treatment beyond other known factors. A sample of 284 adult patients with ADHD (60.6% female; Mage = 32.31 years) were investigated for medication adherence from 2018 to 2023, using time-to-event analytic methods. Of the sample, 54 were found to have discontinued treatment prematurely without consulting their physician. Interestingly this group was prescribed considerably lower doses before discontinuation than adhering patients. General personality dysfunction and maladaptive antagonistic personality traits are implicated in varying degrees, with the specific maladaptive personality facets Intimacy Avoidance and Deceitfulness (PID-5) significantly predicting time to premature discontinuation of ADHD medication beyond other known reasons for non-adherence. The broader implication is that the emerging personality pathology models hold promise to predict non-adherence in the adult ADHD population.

Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study.

Nearly 3% of adults have attention-deficit and hyperactivity disorder (ADHD), although in the UK, most are undiagnosed. Adults with ADHD on average experience poorer educational and employment outcomes, worse physical and mental health and are more likely to die prematurely. No studies have yet used mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD in the UK or worldwide. This study used the life-table method to calculate the life-expectancy deficit for people with diagnosed ADHD using data from UK primary care. A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000-2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD. Around 0.32% of adults in the cohort had an ADHD diagnosis, ~1 in 9 of all adults with ADHD. Diagnoses of common physical and mental health conditions were more common in adults with diagnosed ADHD than the comparison group. The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females. Adults with diagnosed ADHD are living shorter lives than they should. We believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions. This study included data from adults with diagnosed ADHD; the results may not generalise to the entire population of adults with ADHD, the vast majority of whom are undiagnosed.

Seroprevalence of Borrelia burgdorferi sensu lato antibodies in English adult blood donors: A nationwide cross-sectional study, 2021-2022.

Estimates of Lyme disease incidence in England are based on reporting of cases with a laboratory-confirmed diagnosis only, underestimating total cases. In 2017 - 2018, two independent reviews commissioned by the UK Government highlighted the lack of official data on Lyme disease prevalence and incidence as a critical knowledge gap. To estimate the prevalence of IgG antibodies in the English adult population specific for Borrelia burgdorferi sensu lato (Bbsl), the causative agent of Lyme disease. The prevalence of Bbsl-specific antibodies in the English population was estimated in a cross-sectional cohort, selected from an archive of residual NHS blood donor plasma samples (age range 17 - 84, collected between 2021 - 2022). 10,000 samples were randomly selected proportionate to the population size of each of the nine English administrative regions. 9,994 samples were tested using a standard two-tiered testing strategy, with an IgG/IgM ELISA followed by an IgG immunoblot (array) test for any sera with positive or indeterminate reactivity in the ELISA. Out of the 9,994 samples tested, 482 were seroreactive by screening ELISA. After two-tier testing, 49 were confirmed positive. Regional and demographic differences in seroprevalence were observed after two-tier testing, but due to the low overall seroprevalence, were not significant upon multivariable analysis. The seroprevalence of Borrelia burgdorferi sensu lato-specific IgG in the English adult population (2021 - 2022), determined using two-tier testing was estimated at 0.49 % (95 % CI 0.36 - 0.65). This is lower than neighbouring UK nation Scotland and other northern European countries.

Cutaneous Intertriginous Langerhans Cell Histiocytosis in Adults: A Case Report and Systematic Review.

Authors characterized all published adult cases of cutaneous, intertriginous Langerhans cell histiocytosis (LCH) to bring this clinical presentation to the attention of clinicians. We emphasize the morphology, histopathology, immunohistochemical profiles, and genetic mutations associated with these cases. A systematic review of the National Center for Biotechnology Information's PubMed was conducted, utilizing the following specific key words to identify all adult LCH patients with cutaneous intertriginous involvement: "Intertriginous Langerhans," "Vulvar Langerhans," "Genital Langerhans," "Perineal Langerhans," "Perianal Langerhans," "Intergluteal Langerhans," "Inguinal Langerhans," "Axillary Langerhans," and "Inframammary Langerhans." Reports were subjected to strict inclusion criteria: case reports, case series, or meta-analyses documenting case(s) of biopsy-proven LCH with cutaneous, intertriginous involvement in adult patients (>18 years of age at the time of diagnosis). This systematic review identified 1 original and 121 published cases of biopsy-proven, cutaneous, intertriginous LCH in adult patients. Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata). This systematic review encompasses the largest compilation of adult cutaneous intertriginous LCH cases in the medical literature to our knowledge to date. This study identifies an important clinical presentation of this rare, commonly pediatric diagnosis; highlights trends among these cases and important clinical mimickers; and serves as a reminder to clinicians to maintain suspicion for LCH in adult populations, particularly in the setting of intertriginous cutaneous involvement.

Estimating mortality attributable to alcohol or tobacco – a cohort study from Germany

BackgroundLittle is known about mortality from four disorder combinations: fully attributable to alcohol or tobacco, partly attributable to both alcohol and tobacco, to tobacco only, to alcohol only.AimTo analyze whether residents who had disclosed risky alcohol drinking or daily tobacco smoking had a shorter time to death than non-risky drinkers and never daily smokers twenty years later according to the disorder combinations.MethodsA random adult general population sample (4,075 study participants) of a northern German area had been interviewed in the years 1996–1997. Vital status and death certificate data were gathered 2017–2018. The data analysis included estimates of alcohol- or tobacco-attributable mortality using all conditions given in the death certificate and alternatively the underlying cause of death only.ResultsAmong 573 deaths, 71.9–94.1% had any alcohol- or tobacco-attributable disorder depending on the estimate. Risky alcohol consumption and daily tobacco smoking at baseline were related to disorders in the death certificate according to the combinations. Deaths with an alcohol- and tobacco-attributable disorder were related to risky alcohol consumption (subhazard ratio 1.57; 95% confidence interval 1.25–1.98) and to daily tobacco smoking at baseline (subhazard ratio 1.85; 95% confidence interval 1.42–2.41).ConclusionFirst, more than 70% of the deceased persons had one or more alcohol- or tobacco-attributable disorders. This finding suggests that total mortality seems to be the suitable outcome if potential effects of alcohol or tobacco consumption in a general population are to be estimated. Second, the relations of risky alcohol consumption and tobacco smoking with time to death speak in favor of the validity of alcohol- and of tobacco-attributable disorders in death certificates and of considering both alcohol consumption and tobacco smoking if attributable deaths are to be estimated.

Factors associated with dental care utilization among Iranian adult populations based on Anderson model

BackgroundThe utilization of dental care is affected by different factors. Despite the importance of dental care, there are significant disparities in its utilization among various population groups. The aim of this study was to identify the main factors of dental care utilization and the influences of the Health Transformation Plan (HTP) in Iran based on the Anderson model.Methods and materialsThis cross-sectional house-by-house study was conducted during Aug-Nov 2022 among 704 adult people in two cities under the coverage of the HTP and two cities out-side the plan using a multi-stage sampling method. Dental visit in the last year was considered as the utilization of the dental services. Independent Factors included the contextual, individual enabling, individual predisposing and individual need factors based on the Andersen model. Personal health behaviors were also assessed. Statistical analysis was conducted using Chi-square tests, simple and multivariable logistic regression models (α < 0.05).ResultsThe 63.1% of the participants covered by the HTP and 57.7% of the population outside the plan sought dental care in the past year. In the final model individuals in the 35–44 age group (OR = 1.5, 95% CI = 1.02–2.2), males (OR = 1.7, 95% CI = 1.2–2.5), single individuals (OR = 1.4, 95% CI = 1.01-2) and those with the perception of need for dental treatment (OR = 2.1, 95% CI = 1.3–3.4) had higher chance of dental visit. Better perceived oral health status was associated with lower chance of visiting the dentist (OR = 0.9, 95% CI = 0.8–0.9). Being covered by the HTP was not significantly in association with the chance of dental visit in the last year (p value = 0.19, OR = 0.78, 95%CI = 0.55–1.12).ConclusionThe predisposing factors including age, gender, marital status, and perceived oral health status and perceptions of dental need were the main factors in association with the dental utilization behavior among adults and the coverage by the HTP did not have significant effect on it.

Diagnostic impact of DNA methylation classification in adult and pediatric CNS tumors

Over the past decade, neuropathological diagnosis has undergone significant changes, integrating morphological features with molecular biomarkers. The molecular era has successfully refined neuropathological diagnostic accuracy; however, a substantial number of CNS tumor diagnoses remain challenging, particularly in children. DNA methylation classification has emerged as a powerful machine learning approach for clinical decision-making in CNS tumors. The aim of this study is to share our experience using DNA methylation classification in daily routine practice, illustrated through clinical cases. We employed a classification system to evaluate discrepancies between histo-molecular and DNA methylation diagnoses, with a specific focus on adult versus pediatric CNS tumors. In our study, we observed that 40% of cases fell into Class I, 47% into Class II, and 13% into Class III among the “matched cases” (≥ 0.84). In other words, DNA methylation classification confirmed morphological diagnoses in 63% of adult and 23% of pediatric cases. Refinement of diagnosis was particularly evident in the pediatric population (65% vs. 21% for the adult population, p = 0.006). Additionally, we discussed cases classified with low calibrated scores. In conclusion, our study confirms that DNA methylation classification provides significant added-value for CNS tumors diagnosis, particularly in pediatric cases.

Perceived financial hardship and sleep in an adult population-based cohort: The mediating role of psychosocial and lifestyle-related factors.

Social inequalities in sleep have been reported, but there is less research on the mechanisms underlying this association. This study investigates the relationship between financial hardship and sleep within the general adult population, focusing on the mediating effects of psychosocial and lifestyle-related factors. We used data from the Specchio cohort, a population-based study in Geneva, Switzerland, initiated in December 2020. Perceived financial hardship and sleep outcomes (insomnia, sleep quality, and sleep duration) were assessed by questionnaire in 2020 to 2021. Counterfactual mediation analysis was conducted to examine the extent to which perceived financial hardship impacts sleep through psychosocial (psychological distress and loneliness) and lifestyle-related (weight, smoking, and physical inactivity) pathways. Models were adjusted for age, sex, education, living alone, and chronic disease. Among 4388 participants, those experiencing financial hardship had a greater risk of insomnia (odds ratio: 2.11; 95% confidence interval: 1.70-2.61), poor sleep quality (odds ratio: 1.69; 95%confidence interval: 1.41-2.02), and not meeting sleep duration guidelines (odds ratio: 1.40; 95%confidence interval: 1.18-1.66) compared to those without financial difficulties. Psychosocial factors explained 40% of the relationship of financial hardship with insomnia, 35% of the relationship with poor sleep quality, and 10% of the association with suboptimal sleep duration. The contribution of lifestyle-related factors was 8%, 12%, and 17%, respectively. Perceived financial hardship is a significant predictor of poor sleep, and this association is mediated by psychosocial and, to a lesser extent, lifestyle-related factors. These findings highlight the need for integrative approaches addressing social inequalities in sleep.