Subtypes of adverse childhood experiences and depression among adult cancer survivors: Evidence from a population-based study.

Antibiotics for the uncomplicated acute sore throat to prevent invasive group A Streptococcus - a critical analysis of current evidence.

Effects of an imagery-enhanced behavioral activation intervention on depressive symptoms and activation levels: Results from the WIMBA-trial.

Resting-state burst features within alpha and beta oscillations are differentially associated with autogenous and reactive obsessions.

A pilot randomized controlled trial of prolonged exposure therapy vs. psychoeducation for psychogenic nonepileptic seizures and comorbid post-traumatic stress disorder.

Exploring Unexplained Gaps: Prospective Observational Cohort Study of Factors Influencing Core Surgical Training Success.

Thought-fusion beliefs' independent causal effects on obsessive-compulsive symptoms: Evidence from experimental manipulations.

The impact of timing on bright light therapy: Alleviating anhedonia and circadian rhythm disturbances in depression patients: a randomized controlled trial.

The glucose monitoring comparison in primary care study (GluCoCare): Study design, methods, recruitment success, and baseline characteristics of study participants.

Quantitative analysis of clonic upper limb movements in bilateral Tonic-Clonic seizures and Functional/Dissociative seizures using optical flow.

Nonspecific low back pain is extremely common, with clinical symptoms mainly characterized by pain and functional impairment. Moreover, pain can further induce anxiety, depression, and sleep disorders. Although there are many existing rehabilitation methods, their therapeutic effects are limited and the recurrence rate is high. Therefore, we plan to conduct a clinical efficacy evaluation of extracorporeal radial shock wave therapy combined with repetitive transcranial magnetic stimulation for nonspecific low back pain and also explore the potential therapeutic mechanisms. This study employed a randomized, double-blind, parallel-controlled trial design (allocation ratio: 1:1:1:1). A total of 160 patients were enrolled and randomly assigned to four groups (n=40 per group): Extracorporeal Shock Wave Therapy group (Active ESWT+Sham rTMS), Repetitive Transcranial Magnetic Stimulation group (Sham ESWT+Active rTMS), Combined Treatment group (Active ESWT+Active rTMS), Placebo group (Sham ESWT+Sham rTMS). Outcome assessments were performed at baseline and after 4weeks of intervention, including the Visual Analog Scale (VAS), Short-Form McGill Pain Questionnaire (SF-MPQ), lumbar Range of Motion (ROM), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), Zung Self-Rating Depression Scale (SDS Index), multimodal magnetic resonance imaging (MRI), and inflammatory factors. All participants were followed up for 3months. The primary outcome measure was the VAS score. Data were collected after treatment and subjected to statistical analysis. This study will verify the clinical intervention efficacy of ESWT combined with rTMS for nonspecific low back pain and explore the potential therapeutic mechanisms.

Perioperative anxiety plays a key role in patients, particularly for postoperative recovery. Immersive virtual reality (VR), which has been developed in recent years for use in regional anesthesia, may help reduce this anxiety and limit intraoperative sedative consumption. The aim of this study was to objectively assess the impact of VR distraction on perioperative anxiety by evaluating sedative use during total knee arthroplasty (TKA) under spinal anesthesia (SA). A retrospective, single-center cohort study was conducted in patients receiving SA with a VR headset (group 1), compared to those receiving SA alone (group 2). The primary outcome measure was intraoperative sedative consumption. Secondary outcomes included perioperative complications (oxygen administration, hypotension) and analgesic consumption within five postoperative days (nefopam and oral morphine equivalent). Pearson's Chi-square and Wilcoxon-Mann-Whitney tests were used to assess categorical and continuous variables, respectively. There were 30 patients (group 1) who used a VR headset during the procedure, while 30 patients (group 2) received SA alone. The mean age was 71 years. There was a significant reduction in intraoperative sedative consumption in patients undergoing TKA under SA with VR (95% confidence interval [0.13 to 0.87], P = 0.018). A reduction in nefopam consumption within the five postoperative days was also observed (95% confidence interval [-0.1 to 33.7], P = 0.005). There were no significant differences found regarding oxygen administration, intraoperative hypotension, and length of hospital stay or oral morphine equivalent consumption within five postoperative days. The use of VR is an innovative approach that appears effective in reducing sedative consumption without increasing perioperative complications in patients undergoing TKA under SA. This promising study encourages further large-scale research to better assess the impact of VR in surgeries performed under SA. IV.

Community integration is a key outcome for individuals with a history of homelessness after they attain permanent housing. The goals of finding purpose, meaning, and belonging in one's community-despite their importance in predicting mental well-being and housing stability-are frequently elusive for recently housed individuals. This study aimed to evaluate a novel psychosocial intervention that combines two evidence-based practices, motivational interviewing (MI) and cognitive-behavioral therapy (CBT), to improve motivation and functional outcomes related to community integration. Sixty veterans with a recent history of homelessness who were admitted to a U.S. Department of Veterans Affairs supportive housing program in the past year were included in a randomized controlled trial comparing the 12-session MI-CBT treatment with treatment as usual. Participants were assessed at four time points during the study period, which included 24 weeks of active treatment and 12 weeks of follow-up. The primary outcome measures were motivational deficits (negative symptoms), level of behaviors consistent with motivational change, and social and work functioning. Compared with participants in the control group, participants who received MI-CBT showed significantly greater improvement (p<0.05) in motivational deficits over the 12-week acute treatment period. Their gains relative to baseline were maintained at follow-up. MI-CBT yields improvements in motivational deficits. Implications for future studies and for improving generalizability of the motivational negative symptom gains to daily functioning domains are discussed.

APOE genotype and astrocyte activity collectively influence AD biomarkers and Aβ burden.

The Gaylord Occupational Therapy Cognitive screen (GOT-Cog™) is a novel cognitive screening tool developed to support inpatient occupational therapy treatment planning. It has demonstrated excellent content, construct, and criterion validity, as well as good internal consistency. To assess GOT-Cog rater reliability and responsiveness. Repeated-measures design. GOT-Cog was administered to participants twice at admission and once at discharge. When different investigators collected the first two assessments, interrater reliability was tested; when collected by the same investigator, intrarater reliability was tested. The first and final GOT-Cog scores were used to assess responsiveness. Single long-term acute care hospital (LTACH). 192 participants, recruited from inpatients admitted with an order for occupational therapy services. GOT-Cog total score was the primary outcome measure. Rater reliability was evaluated using interclass correlation coefficients (ICCs); responsiveness was calculated using effect size and score change. Scale-level interrater reliability of GOT-Cog was moderate to good, ICC(2, 1) = .80 (95% confidence interval [CI] [.71, .87], r = .81, n = 87); intrarater reliability was good to excellent, ICC(2, 1) = .84 (95% CI [.76, .90], r = .86, n = 89). Domain-level rater reliability ranged from poor to excellent. A small effect size was demonstrated from admission to discharge (d = .37, n = 149) over a mean length of stay of 24.06 d (95% CI [20.70, 27.41]; n = 192). Previous findings are supported, which indicates that GOT-Cog has the validity and reliability needed to support its use in the LTACH setting with a mixed medically complex inpatient population. Plain-Language Summary: Conducted in the long-term care setting, this study explains how consistent the Gaylord Occupational Therapy Cognitive screen (GOT-Cog™) is when given to the same person, multiple times, and by the same or different people, as well as how sensitive it is to change over time. To test this, GOT-Cog was given to participants twice at inpatient admission and once at discharge. GOT-Cog was found to have moderate to good consistency when delivered by different people and good to excellent consistency when used by the same person. Over an average of 24 days, GOT-Cog showed a small level of change in participants who were tested admission and again at discharge.

The burden of health-care costs on society continues to grow. U.S. health-care expenditures reached $4.9 trillion in 2023, accounting for 17.6% of the U.S. gross domestic product1. In a world of limited resources, alternative treatment options need to be evaluated for their cost-effectiveness in addition to their comparative safety and effectiveness. The article by Suter et al. provides a useful cost-effectiveness analysis of the 2 alternative treatments for displaced, closed humeral shaft fractures, with practical implications for shared decision-making at the individual patient level. The practicing traumatologist must consider 2 reasonable options when treating displaced, closed humeral shaft fractures: (1) nonoperative treatment with functional bracing and (2) open reduction with internal fixation (ORIF). Nonoperative management of closed humeral shaft fractures was the established norm during the 20th century, especially after functional bracing was introduced by Sarmiento in 19772. ORIF, developed to decrease the period of immobilization and to quicken the return to function, has since become the predominant treatment modality in the U.S., with utilization increasing from 47.2% of humeral shaft fractures in 2002 to 60.3% of humeral shaft fractures in 20113. A recently published analysis found that patients who were on Medicare or Medicaid or who were self-paying were significantly less likely to undergo operative treatment for humeral shaft fractures4. Outside the U.S., functional bracing remains recommended as the first treatment of choice. Clearly, economic resource limitations continue to drive ongoing disparities in the treatment of displaced, closed humeral fractures. The prespecified economic analysis by Suter et al. compares ORIF and functional bracing in the Finnish health-care system with use of prospectively collected economic and outcome data from a pragmatic randomized clinical trial (RCT) for which 1-, 2-, and 5-year clinical results have already been published5–7. These published reports found significantly improved DASH (Disabilities of the Arm, Shoulder and Hand) and Constant-Murley shoulder function scores for the surgery group compared with the bracing group at 6 weeks and 3 months of follow-up but no significant differences at 1 year (the primary outcome measure) or at 2 and 5 years, suggesting that the ultimate trajectory of recovery was similar regardless of the allocated treatment group. In their comparison of societal versus health-care perspectives, Suter et al. identified patient-specific factors that influenced the cost-effectiveness of these 2 treatment alternatives. The base-case analysis, prespecified as the societal perspective, found that ORIF was more effective than functional bracing and yielded a cost-saving incremental net monetary benefit (INMB) of €9,423. Surgery was also clinically favored for health-related quality of life measured using the 15D utility instrument. This result was considered a cost-effectiveness win-win for society, with all bootstrapped estimates overwhelmingly found in the lower right (win-win) quadrant of the standard cost-effectiveness plane. This societal cost-saving was primarily driven by the inclusion of the indirect cost of time away from work for employed patients. Conversely, when the analysis considered only direct health-care costs, ORIF became markedly more expensive than functional bracing, with an INMB of +€4,087. Despite the solid evidence of the cost-effectiveness of ORIF from the societal perspective and the finding that 32% of patients who were randomized to functional bracing still required surgery, policy-makers might still tend to favor functional bracing because of health-care resource limitations. Simply put, humeral fracture is just 1 of many “buckets” of societal costs related to injury or degenerative conditions. Policy-makers must allocate available funds among buckets corresponding to multiple disease states and treatments. Randomized health economic trials are the gold-standard tool for guiding the allocation of funds among disease and/or treatment-specific health-care buckets at the societal level. Suter et al. also provide pragmatic evidence to inform treatment decisions for individual patients. This report should be of interest to both practicing clinicians and health economists. Cost-effectiveness was primarily calculated as an INMB in simple € terms that are easy for clinicians to understand. The incremental cost-effectiveness ratio (ICER) favored by health economists was included in the Appendix to facilitate comparison across multiple disease states and treatments. The societal cost-effectiveness of ORIF also has relevant implications for shared decision-making at the individual patient level, establishing a useful framework for patient-physician discussions. This analysis highlights the importance of taking multiple clinical and socioeconomic factors into consideration when making patient-specific decisions. Moreover, it suggests the need for patient-specific flexibility in health-care policy, rather than the typically rigid reliance on treatment guidelines imposed by payers who are forced to deal with group-level effects and resource limitations.

The present study investigates the feasibility and initial efficacy of the Unified Protocol (UP) as a pilot trial for anxiety and depressive symptoms in Turkish university students with a pretest-posttest control group research design. Thirty-four undergraduate students with high levels of depressive and/or anxiety symptoms were randomly assigned to one of two study conditions: an intervention group based on the UP (n = 17) or a waitlist control group (n = 17). To determine the effectiveness of treatment, a 2 (intervention-control group) x 2 (pre-post test) mixed measures variance analysis was applied for the primary outcome measures: degree of anxiety and depressive symptoms as well as positive and negative affect and psychological well-being. The analyses revealed a significant difference between pre- and post-treatment scores on all outcome measures in the intervention group; these improvements were also significantly greater than those in the control group. These outcomes included participants receiving the Unified Protocol reported lower levels of anxiety and depressive symptoms, decreased negative affect, higher levels of positive affect, and improved psychological well-being compared to the control condition. The findings of this study provide preliminary support for the efficacy of the Unified Protocol in a Turkish sample. The study findings are evaluated in light of the relevant literature and within the scope of the study's limitations, and suggestions for academic and clinical applications are presented.

Systemic corticosteroids are playing an increasingly important role in elective total knee arthroplasty (TKA) to aid in postoperative recovery. Corticosteroids reduce inflammation that can cause pain, limit range of motion (ROM), and prolong narcotic use following TKA. Dexamethasone and methylprednisolone are corticosteroids used perioperatively during TKA, but, to our knowledge, a comparative analysis assessing pain and narcotic use has not been done. We sought to determine if a difference exists between these two medications in reducing pain and narcotic usage while also assessing clinical outcomes and complications. A nonrandomized prospective cohort study was performed of 350 patients undergoing primary unilateral TKA; 200 patients received an oral dexamethasone, and 150 patients received an oral methylprednisolone taper. The primary outcome measures included pain levels and narcotic consumption recorded by patients over the first 30 days after surgery. Pain scores were implemented utilizing the visual analog scale. Narcotic usage was converted to oral morphine milligram equivalents (MMEs). Lengths of hospital stay, knee ROMs, complications, and hospital readmissions were collected. Patients taking methylprednisolone reported significantly lower pain than patients taking dexamethasone on postoperative days three to seven and nine (all P < 0.05), with no significant differences through day 30. There were no statistically significant differences in MMEs between groups during the first postoperative month. There were no differences in lengths of stay, ROMs, complications, or hospital readmissions. A novel prospective study is presented comparing dexamethasone versus methylprednisolone, assessing narcotic usage and pain scores following TKA. Patients who received methylprednisolone taper reported statistically significantly lower postoperative pain scores compared to those receiving dexamethasone. Narcotic MMEs and complication rates were similar. Methylprednisolone demonstrated similar clinical outcomes and may be preferred for its more controlled tapering profile and greater ease of prescription and patient compliance than dexamethasone.

The additional pharmacological effects of ipratropium bromide, a short-acting anticholinergic agent, remain controversial within the context of standardized stress-oriented management (SOM). To evaluate the effects of SOM combined with ipratropium bromide nebulization therapy on oxygenation status, respiratory mechanics, inflammatory stress responses and clinical outcomes in patients with severe pneumonia (SP) complicated with respiratory failure (RF) (SP+RF). This study retrospectively analyzed 168 patients with SP and RF admitted between March 2024 and August 2025 were enrolled and divided into an observation group (n = 81) and a control group (n = 87) based on whether they received ipratropium bromide nebulization therapy. Primary outcome measures included: oxygenation status, respiratory mechanics parameters, incidence of multiple organ dysfunction syndrome (MODS) and organ function indicators, inflammatory and stress markers, and clinical outcomes. Regarding oxygenation status, the observation group demonstrated superior PaO2/FiO2, SpO2 and blood lactate results compared to the control group at 24 hours post-treatment (T1) and 48 hours post-treatment (T2) (p<0.05). Respiratory mechanics parameters showed that airway resistance (Raw), peak airway pressure (Ppeak) and plateau pressure (Pplat) were lower in the observation group than in the control group at T1 (p<0.05); static lung compliance (Cst) showed more pronounced improvement at T2. Additionally, the incidence of MODS was lower in the observation group (p<0.05). Regarding inflammatory markers, the observation group exhibited lower levels of CRP and cortisol (p<0.05). Clinical outcomes demonstrated shorter DMV and length of hospital stay in the observation group (p<0.05), but no statistically significant difference was observed between the two groups in 28d-M (p>0.05). In patients with SP+RF, SOM plus ipratropium bromide nebulization significantly improves oxygenation status, respiratory mechanics, and inflammatory stress responses, shortens the duration of mechanical ventilation and the length of hospital stay, and reduces the risk of MODS.

Assessment of a standard dietitian evaluation in pediatric patients with celiac disease.