Prospective Longitudinal Studies Research Articles

Ivabradine approved and other uses in clinical practice: a systematic review

Heart rate (HR) stands as a prognostic indicator of cardiovascular disease and a modifiable risk factor in heart failure (HF). Medication intolerance can curtail the application of conventional HR-lowering β-blockers to the optimum target dose. Ivabradine (IVA), a specific negative-chronotropic agent, selectively inhibits If current in pacemaker cells of the sinoatrial node without depressing myocardial contractility or comprising hemodynamics. This review summarized ivabradine’s clinical labeled and off-label uses, and mechanism of action focusing on the clinical outcomes. PubMed was searched up to January 2024 using the main keywords of IVA, coronary artery disease (CAD), HF, postural orthostatic tachycardia syndrome (POTS) and tachyarrhythmia. To comprehensively review IVA’s clinical indications, mechanisms, and therapeutic effects, all studies investigating treatment with IVA in humans were included, comprising different types of studies such as randomized controlled trials (RCTs) and longitudinal prospective observational studies. After screening, 141 studies were included in our review. A large number of reviewed articles were allocated to HFrEF and CAD, suggesting IVA as an alternative to β-blockers in case of contraindications or intolerance. The beneficial effects of IVA as premedication for coronary computed tomography angiography, HR lowering in POTS, and inappropriate sinus tachycardia constituted most studies among off-label uses. Promising results have been reported on the efficacy of IVA in controlling HR, especially in patients with inappropriate sinus tachycardia or POTS. Due to the unique mechanism of action, IVA has the potential to be used more frequently in future clinical practice.

Ivabradine approved and other uses in clinical practice: a systematic review

Heart rate (HR) stands as a prognostic indicator of cardiovascular disease and a modifiable risk factor in heart failure (HF). Medication intolerance can curtail the application of conventional HR-lowering β-blockers to the optimum target dose. Ivabradine (IVA), a specific negative-chronotropic agent, selectively inhibits If current in pacemaker cells of the sinoatrial node without depressing myocardial contractility or comprising hemodynamics. This review summarized ivabradine’s clinical labeled and off-label uses, and mechanism of action focusing on the clinical outcomes. PubMed was searched up to January 2024 using the main keywords of IVA, coronary artery disease (CAD), HF, postural orthostatic tachycardia syndrome (POTS) and tachyarrhythmia. To comprehensively review IVA’s clinical indications, mechanisms, and therapeutic effects, all studies investigating treatment with IVA in humans were included, comprising different types of studies such as randomized controlled trials (RCTs) and longitudinal prospective observational studies. After screening, 141 studies were included in our review. A large number of reviewed articles were allocated to HFrEF and CAD, suggesting IVA as an alternative to β-blockers in case of contraindications or intolerance. The beneficial effects of IVA as premedication for coronary computed tomography angiography, HR lowering in POTS, and inappropriate sinus tachycardia constituted most studies among off-label uses. Promising results have been reported on the efficacy of IVA in controlling HR, especially in patients with inappropriate sinus tachycardia or POTS. Due to the unique mechanism of action, IVA has the potential to be used more frequently in future clinical practice.

The risk and protective factors for entering organized crime groups and their association with different entering mechanisms: A systematic review using ASReview

The aims of the current systematic review are to provide an overview of the available evidence concerning the risk and protective factors for entering organized crime groups (OCGs), to explore which entry mechanisms for entering OCGs are distinguished in the literature, and to assess whether different sets of risk and protective factors could be identified for each of these entry mechanisms. To achieve these aims, a systematic literature search for qualitative, quantitative, and mixed method studies was performed up to 19 April 2021. To be included in the current review, studies had to be of empirical nature and published in either English or Dutch. ASReview was used to facilitate the inclusion process, a reference check of the included studies was performed, and all included studies in prior reviews on this topic were checked for inclusion. This process resulted in 51 included studies. Relevant study and sample characteristics, information on risk and protective factors, and indicated entry mechanisms were derived from the included studies. In line with earlier reviews, we find relatively strong evidence that being male, belonging to an ethnic minority group, committing certain crimes prior to entry at a young(er) age, committing multiple offenses without being specialized, and having a criminally involved family and/or friends are risk factors for entering OCGs. Entering OCGs occurs via four different entry mechanisms: active recruitment, soliciting for membership, growing into and self-setup. Based on the included studies, the risk and protective factors for entering OCGs that are associated with these different entry mechanisms into OCGs seem to overlap. Although the current review provides grounds to suggest that, in addition to a general set of risk and protective factors for entering OCGs, there might be different risk and protective factors associated with different entry mechanisms, longitudinal prospective studies are needed to substantiate this suggestion.

Defining "High Recurrence" of Depressive Episodes for Predicting Diagnostic Conversion from Major Depressive Disorder to Bipolar Disorder: A 5-year Retrospective Study.

This study determined the threshold for recurrent depressive episodes that predicted conversion from major depressive disorder (MDD) to bipolar disorder (BD). We retrospectively reviewed the medical records of 296 patients diagnosed with MDD for a minimum of 5 years in two university hospitals. We examined their the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnoses and detailed clinical information at the initial admission and yearly assessments after discharge to establish the threshold for recurrent depressive episodes indicating a risk of diagnostic conversion from MDD to BD. Optimal cut-offs were derived using receiver operating characteristic (ROC) curves. ROC curve analysis revealed that more than four recurrent depressive episodes was indicative of potential diagnostic conversion from MDD to BD (area under the curve, 0.604; sensitivity, 0.353; specificity, 0.855; positive predictive value, 0.421; negative predictive value, 0.816). These findings suggest that the best predictor of conversion from MDD to BD is more than four recurrent depressive episodes. Our findings have the potential to enhance diagnostic accuracy and treatment efficiency. To validate our results, longitudinal prospective studies are necessary.

E014 Migration of the large complex dataset of the UK Juvenile Dermatomyositis Cohort Biomarker Study: challenges and lessons

Abstract Background/Aims In rare disease research, longitudinal prospective cohort studies are important tools to generate invaluable real-world evidence to inform treatment choices and understand outcomes. The Juvenile Dermatomyositis Cohort Biomarker Study & Repository (JDCBS) is a multi-centre, prospective longitudinal cohort study with linked biobank, established in 2000, with 17 active UK-Centres contributing data and samples. It supported over 60 projects generating new evidence, treatments and biomarkers in the field of juvenile myositis. The database in use until March 2023 used aged technology which did not sufficiently meet current needs of the study. REDCap is secure web application for hosting online databases, able to support online longitudinal data capture for multi-centre research studies. The aim of this project was to build and deliver a future-proofed environment and migrate the large JDCBS dataset into the REDCap platform. Methods Clinical, laboratory and outcome data at clinic visits were previously captured through a web interface which loaded data into an MS-Access back-end database. In this project, an internationally agreed set of data elements for use in research in juvenile myositis was adopted and a new data entry platform built, using REDCap and a Trusted Research Environment hosted at Great Ormond Street Digital Research Environment. A multidisciplinary team was formed to deliver migration, including clinicians, study investigators, systems analysts, and health informatics data scientists. Careful comparison of fields in the existing database to those in the internationally agreed dataset before delivery of the new REDCap database and migration of the legacy data took place. Results Key steps to deliver the REDCap interface and migrate the data included: 1. Agreement of data elements to be included, dropped or added, compared to the legacy dataset; 2. Design of study forms and fields within REDCap; 3. Testing new interface; 4. Script design and testing for migration; 5. Data cleaning of legacy dataset; 6. Training 15 collaborators and REDCap accounts management for 63 collaborators; 6. Migration of legacy dataset and quality control of migrated data; 7. Post-migration data checking and feedback on use of the new platform; 8. Summary reports of process, data quality and audit trail of project. In total, 670 patient records and 7431 clinical forms, with data from 338 data fields, were successfully migrated to the new REDCap database. A median value of 11 clinical forms (IQR: 6-18), and 3,718 data points (IQR: 2,028-6084) were migrated per patient. Conclusion Migration of a multi-dimensional longstanding study data set is a complex multi-step task requiring multi-disciplinary engagement of stakeholders. Key elements to achieve success include early agreement of data fields for inclusion, strict definitions of fields, regular engagement with database users, providing robust training, enabling feedback, and acceptance that research datasets should strive to be parsimonious in fields collected. Disclosure D. Cancemi: None. R. Hamilton: None. S. Varakliotis: None. H.D. Nguyen: None. N. Sabire: None. N. Martin: None. L. McCann: None. C. Papadopoulou: None. L. Wedderburn: Other; LW has non-renumerated collaboration with Novartis Inc, relevant to this work.

Dental Caries and Salivary Immunoglobulin A in Down Syndrome

Down syndrome (DS) is defined as trisomy chromosome 21, which is observed to be the most prevalent autosomal genetic anomaly. Salivary immunoglobulin A (sIgA) plays an important role in defence mechanism against the microbial pathogens that can invade the surface of mucosa. In children with DS, raised sIgA levels cause an increase in immune mechanism against dental caries. The evidence about the salivary IgA levels in children suffering from Down syndrome is contradictory and limited in the literature. Thus, there is a terrible requirement to conduct more longitudinal prospective studies on saliva of DS patients taking large sample sizes to assess the molecular interactions. The present review is aimed to evaluate the association of Dental caries and salivary immunoglobulin A in Down syndrome individuals. The sources were searched from a database of PubMed from 2004 to 2023 (last 19 years). The inclusion criteria included key words of microdontia, delayed eruption, dental anomalies, retained teeth, anodontia, fissured lip and tongue, macroglossia, hypodontia in Down syndrome. The 22 articles that met the selection criteria (most of them were review article and some observational studies) were included to this review, of which some of the studies have been conducted to assess the role of sIgA in relation to dental caries and observed that increased sIgA levels decrease the rate of incidence of dental caries. The present review revealed that patients suffering with Down syndrome are at an increased risk of dental caries because of impaired motor activities, malocclusion and affected quality of life.

Maternal diabetes and fracture risk in offspring: a population-based analysis.

Factors affecting intrauterine environment exerts influence on skeletal health and fracture risk in later life. Diabetes during pregnancy is known to influence birth weight and is associated with fetal overgrowth. However, the effects of maternal diabetes on fracture risk in offspring is unknown. This study was aimed to evaluate the association between maternal diabetes and fracture risk in offspring. Using population-based administrative health data for Manitoba, Canada, we identified deliveries complicated by gestational diabetes and type 2 diabetes between April 1, 1980 and March 31, 2020. The cohort was followed for a median of 15.8years. The primary outcome was any incident fracture in offspring. Secondary outcomes were long bone upper extremity fracture, long bone lower extremity fracture, vertebral fracture, and any non-trauma fractures. Cox proportional hazard regression models were used to estimate fracture risk in offspring by maternal diabetes status adjusted for relevant covariates. Of 585 176 deliveries, 26 397 offspring were born to women with diabetes (3.0% gestational diabetes and 1.5% type 2 diabetes) and 558 779 were born to women without diabetes. The adjusted risk for any fracture was 7% (HR 1.07; 95% CI, 2.7-11.5%) higher in offspring of mothers with diabetes than offspring of mothers without diabetes. Types of fractures were similar between the two groups with a predominance of long-bone upper extremity fractures. In conclusion, maternal diabetes was associated with a modest increase in fracture risk in offspring. Longitudinal prospective studies are needed to understand intrauterine and post-natal factors that may influence fracture risk in offspring of mothers with diabetes.

Clinical and genetic contributions to medical comorbidity in bipolar disorder: a study using electronic health records-linked biobank data.

Bipolar disorder is a chronic and complex polygenic disease with high rates of comorbidity. However, the independent contribution of either diagnosis or genetic risk of bipolar disorder to the medical comorbidity profile of individuals with the disease remains unresolved. Here, we conducted a multi-step phenome-wide association study (PheWAS) of bipolar disorder using phenomes derived from the electronic health records of participants enrolled in the Mayo Clinic Biobank and the Mayo Clinic Bipolar Disorder Biobank. First, we explored the conditions associated with a diagnosis of bipolar disorder by conducting a phenotype-based PheWAS followed by LASSO-penalized regression to account for correlations within the phenome. Then, we explored the conditions associated with bipolar disorder polygenic risk score (BD-PRS) using a PRS-based PheWAS with a sequential exclusion approach to account for the possibility that diagnosis, instead of genetic risk, may drive such associations. 53,386 participants (58.7% women) with a mean age at analysis of 67.8 years (SD = 15.6) were included. A bipolar disorder diagnosis (n = 1479) was associated with higher rates of psychiatric conditions, injuries and poisonings, endocrine/metabolic and neurological conditions, viral hepatitis C, and asthma. BD-PRS was associated with psychiatric comorbidities but, in contrast, had no positive associations with general medical conditions. While our findings warrant confirmation with longitudinal-prospective studies, the limited associations between bipolar disorder genetics and medical conditions suggest that shared environmental effects or environmental consequences of diagnosis may have a greater impact on the general medical comorbidity profile of individuals with bipolar disorder than its genetic risk.

Thyroiditis and COVID-19: focus on pediatric age. A narrative review.

In light of the growing concern over the possible link between SARS-CoV2 infection and autoimmune diseases, we conducted a review to investigate the impact of the pandemic outbreak on thyroid diseases. We carried out a narrative review of all pediatric cases described in the literature, mainly focusing on the possible association of COVID-19 with the incidence of autoimmune and post-infective thyroid diseases (namely Hashimoto's Thyroiditis (HT), Grave's Disease (GD) and Sub-Acute Thyroiditis (SAT)). We also felt it was necessary to provide a brief review of Non-thyroidal Illness Syndrome (NTIS) and Multisystem Inflammatory Syndrome in Children (MIS-C) because of their overlap with thyroiditis. There is currently no conclusive evidence linking SARS-CoV-2 infection with an increased incidence of autoimmune thyroiditis (AT) in pediatric age. However, SAT may be a mild complication of SARS-CoV-2 infection, as is the case with other viral infections. SAT typically resolves on its own and does not require treatment. NTIS may be associated with inflammatory complications, such as MIS-C, and admission to intensive care. It may also be considered a prognostic risk factor for severe disease. The hypothesized pathogenetic mechanisms of thyroid damage in COVID-19 include direct damage due to the significant expression of angiotensin-converting enzyme 2 (ACE2) in the thyroid gland, which is a ligand for the virus, and indirect damage due to immune dysregulation, such as the overproduction of IL-6, which is thought to be part of the pathogenesis of thyroiditis. However, due to the limited evidence available, further prospective longitudinal studies are required to clarify the relationship between COVID-19 and thyroid disease in children and adolescents, as well as to investigate any potential long-term consequences.

Exercise as Treatment for "Stress-Related" Mental Disorders.

The beneficial impact of physical activity on preventing and treating mental disorders has captured growing (research) interest. This article aims to provide a concise overview of essential evidence regarding the effectiveness and underlying mechanisms of physical activity for individuals with mental disorders clustered as "stress-related" conditions. Empirical findings (e.g., longitudinalprospective studies, interventional randomized-controlled-trials, reviews, meta-analyses) regarding the effects of physical activity in the prevention and treatment of stress-related mental disorders are summarized. Furthermore, potential mechanisms underlying these effects are discussed, and recommendations regarding the use of physical activity are outlined. The majority of studies indicate good efficacy of physical activity in prospectively lowering the risk for the incidence of subsequent stress-related mental disorders as well as in the treatment of manifest disorders. Most evidence targets unipolar depressive disorder and, secondly, anxiety disorders. Research regarding posttraumatic stress disorder, obsessive-compulsive disorders, and somatoform disorders is promising but scarce. Physical activity seems to be useful as a stand-alone-treatment as well as in combination with other psychotherapeutic or pharmacological treatments. Multiple intertwined physiological, psychological, and social mechanisms are assumed to mediate the beneficial effects. Recommendations regarding physical activity can orientate on official guidelines but should consider the individual needs and circumstances of each subject. In summary, physical activity seems to be effective in the prevention and treatment of stressrelated mental disorders and, therefore, should be fostered in healthcare-settings. Future studies are needed to clarify partly inconsistent patterns of results and to close research gaps, e.g., concerning somatoform disorders.

Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies.

Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD. Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12months post hospital discharge. Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003). Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.

Assessing severity of COVID-19 and the development of multi system inflammatory syndrome in children (MIS-C) in pediatric patients with atopic disease.

Background: Research surrounding the coronavirus disease 2019 (COVID-19) pandemic and its impact on patients who are atopic has mainly focused on adults. After the delta variant showed increased rates of COVID-19 in children, the pediatric population needs to be assessed as well. Objective: The objective was to assess and report outcomes in patients with COVID-19 and with and without certain atopic diseases in our patient cohort at the University of Mississippi Medical Center. Methods: We conducted a retrospective review of patients by using a de-identified data base that allows querying via medical claims codes from the University of Mississippi Medical Center's Research Data Warehouse. We searched for patients who were COVID-19 positive and ages 0-21 years from January 1, 2020, to December 31, 2021. We then divided this population into two cohorts: an atopic population and a non-atopic population. The incidence of hospitalizations, intensive care unit (ICU) admissions, death, length of stay, inhaled corticosteroid prescription history, and the incidence of multi-system inflammatory syndrome in children (MIS-C) outcomes in the two populations were collected. Results: There were 5261 patients ages 0-21 years and with confirmed COVID-19. After exclusion criteria were applied, there were 1420 patients in the atopic cohort and 2525 patients in the non-atopic cohort. There were more hospitalizations and a longer length of stay in the atopic population. Mortality was equivalent in the atopic and non-atopic populations. There were more ICU admissions in the atopic population. There were 101 patients total with the diagnosis of MIS-C, and the incidence of MIS-C was similar in the atopic and non-atopic populations. There were more patients who were atopic on inhaled corticosteroid than were the patients who were non-atopic. Conclusion: This study sought to further elucidate whether asthma, atopic dermatitis, and allergic rhinitis in pediatric patients was associated with severe COVID-19. Our study showed increased hospitalizations, length of stay, and intensive care in the atopic population but similar outcomes in mortality and the development of MIS-C. Future longitudinal prospective studies are needed to assess the long-term effects on patient's atopic disease after COVID-19 infection.

A contemporary analysis of surgical ligation versus endovascular embolization in patients with intracranial dural arteriovenous fistulas: a propensity score-matched and mixed-effects model study.

Intracranial dural arteriovenous fistulas (dAVFs) are rare vascular lesions that can be asymptomatic or can lead to devastating hemorrhage based on the dAVF's aggressiveness. Several approaches can be taken to treat dAVFs, such as endovascular embolization and surgical ligation. However, very few studies have evaluated the influence of surgery compared to endovascular approaches on patient outcomes. This study was performed to analyze the clinical characteristics and outcomes of patients who underwent treatment for intracranial dAVF in which either endovascular embolization or microsurgical ligation was used. The Nationwide Readmissions Database was reviewed for all patients who underwent treatment for dAVFs (n = 18,152) between 2016 and 2019. Patients who received only surgical ligation or endovascular embolization (i.e., not both) were included. Variables regarding demographics, clinical outcomes, and healthcare utilization were queried. Primary outcome measures were nonroutine discharge, 1-year readmission, top quartile length of stay (LOS), and top quartile of inpatient all-payer cost. Propensity score matching was performed to evaluate the influence of either surgery or embolization on patient outcomes. Receiver operating characteristic (ROC) curves were created for each outcome measure. The area under the curve (AUC) of each ROC was used to estimate mixed-effects model performance. Following propensity score matching, 127 and 113 patients made up the surgical ligation and endovascular embolization cohort, respectively. There were no differences found in age (p = 0.16), sex (p = 0.57), or average Elixhauser Comorbidity Index (p = 0.32). Patients receiving surgical ligation had lower odds of readmission (OR 0.37, p = 0.028) and greater odds of nonroutine discharge (OR 2.21, p = 0.03) compared to patients who underwent endovascular embolization. The authors found no differences in the top quartile of LOS (p = 0.84), top quartile of cost (p = 0.38), or mortality (p > 0.99) between cohorts. ROC curves revealed that the mixed-effects models inclusive of approach outperformed models agnostic to approach with respect to nonroutine discharge (AUC with approach, 0.871; AUC without approach, 0.850; p = 0.018) and readmission (AUC with approach, 0.686; AUC without approach, 0.651; p = 0.019), but no differences were observed regarding top quartile of LOS (p = 0.17) and top quartile of cost (p = 0.40). Surgical approach may influence perioperative outcomes in patients treated for intracranial dAVF-most significantly discharge disposition and 1-year readmission. Future longitudinal prospective studies with more clinical detail will be required to fully capture the predictive utility of surgical approach in patients treated for intracranial dAVF, particularly for various dAVF subtypes.

Which factors may influence medium-term quality of life of patients with lower-limb loss? A systematic review of the literature.

The aim of this study was to systematically review the literature to identify factors that may influence quality of life in people with lower-limb amputation (all etiologies). Our primary focus was on identifying factors that can be modified, enabling a more concentrated integration of these aspects into the care and treatment of amputated patients. Medline (via Ovid) and Scopus were searched in January 2023 for studies assessing quality of life for people with lower-limb loss. Studies were included if they reported on factors that could influence quality of life. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies were identified and assessed independently by 2 reviewers. Data were extracted by 2 independent reviewers. After removing duplicates, the search yielded 2616 studies, of which 24 met our inclusion criteria (cross-sectional n = 13; prospective n = 9; retrospective n = 2). The most commonly used quality-of-life instruments were the Short Form 36, followed by the World Health Organization Quality of Life-BREF and the EuroQoL 5 dimension. Younger age, traumatic etiology, unilateral or below-knee amputation, presence of comorbidities, and social integration were found to influence quality of life in people with lower-limb amputation, whereas sex and socioeconomic context do not seem to have a clear influence. This systematic review of the literature identified several factors that influence quality of life in patients with lower-limb amputation. However, the results are not always consistent across studies and there is still no consensus on some factors. Conclusive findings regarding sex and socioeconomic status remain elusive, primarily because of substantial disparities observed across the literature. Future prospective longitudinal studies with clear a priori inclusion of a wide range of potential factors are needed to clarify the impact of the identified factors. Factors such as age, type of amputation, comorbidities and social integration should be considered in the management of patients with amputation.

Chikungunya seroprevalence, force of infection, and prevalence of chronic disability after infection in endemic and epidemic settings: a systematic review, meta-analysis, and modelling study

Chikungunya is an arboviral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes with a growing global burden linked to climate change and globalisation. We aimed to estimate chikungunya seroprevalence, force of infection (FOI), and prevalence of related chronic disability and hospital admissions in endemic and epidemic settings. In this systematic review, meta-analysis, and modelling study, we searched PubMed, Ovid, and Web of Science for articles published from database inception until Sept 26, 2022, for prospective and retrospective cross-sectional studies that addressed serological chikungunya virus infection in any geographical region, age group, and population subgroup and for longitudinal prospective and retrospective cohort studies with data on chronic chikungunya or hospital admissions in people with chikungunya. We did a systematic review of studies on chikungunya seroprevalence and fitted catalytic models to each survey to estimate location-specific FOI (ie, the rate at which susceptible individuals acquire chikungunya infection). We performed a meta-analysis to estimate the proportion of symptomatic patients with laboratory-confirmed chikungunya who had chronic chikungunya or were admitted to hospital following infection. We used a random-effects model to assess the relationship between chronic sequelae and follow-up length using linear regression. The systematic review protocol is registered online on PROSPERO, CRD42022363102. We identified 60 studies with data on seroprevalence and chronic chikungunya symptoms done across 76 locations in 38 countries, and classified 17 (22%) of 76 locations as endemic settings and 59 (78%) as epidemic settings. The global long-term median annual FOI was 0·007 (95% uncertainty interval [UI] 0·003-0·010) and varied from 0·0001 (0·00004-0·0002) to 0·113 (0·07-0·20). The highest estimated median seroprevalence at age 10 years was in south Asia (8·0% [95% UI 6·5-9·6]), followed by Latin America and the Caribbean (7·8% [4·9-14·6]), whereas median seroprevalence was lowest in the Middle East (1·0% [0·5-1·9]). We estimated that 51% (95% CI 45-58) of people with laboratory-confirmed symptomatic chikungunya had chronic disability after infection and 4% (3-5) were admitted to hospital following infection. We inferred subnational heterogeneity in long-term average annual FOI and transmission dynamics and identified both endemic and epidemic settings across different countries. Brazil, Ethiopia, Malaysia, and India included both endemic and epidemic settings. Long-term average annual FOI was higher in epidemic settings than endemic settings. However, long-term cumulative incidence of chikungunya can be similar between large outbreaks in epidemic settings with a high FOI and endemic settings with a relatively low FOI. International Vaccine Institute.

Sex Differences in ADHD: Review and Priorities for Future Research.

In childhood, attention-deficit/hyperactivity disorder (ADHD) is diagnosed three to 16 times more frequently in males compared to females, yet in adulthood, nearly equivalent numbers of males and females are diagnosed with ADHD. Relatively few studies have prioritized examination of sex differences in ADHD even though sex differences may have critical implications for the identification and treatment of ADHD in females and males. This review highlights current research on sex differences in ADHD across the lifespan that has emerged from cross-sectional and prospective longitudinal studies of youth, adult-ascertained samples, and registry studies. Accumulating research suggests that both males and females with ADHD experience widespread impairment across the lifespan. Some evidence of sex differences emerged, although effects have generally been modest in size. Continued research that includes females and males with ADHD is needed to clarify the nature of sex differences in ADHD. Research that focuses on equitable identification of ADHD in males and females, disentangles the effects of sex and gender, probes underlying mechanisms of sex differences, and addresses the clinical impact of sex differences in ADHD must be prioritized.

Relationship between periodontal disease and obstructive sleep apnea in adults: A systematic review

The purpose of this systematic review was to evaluate whether there are scientific evidence regarding the association between periodontitis and obstructive sleep apnea (OSA) in adults. An electronic search was performed on MEDLINE/PubMed for prospective and retrospective longitudinal studies, cohort studies, and case–control studies conducted in human adults affected by both OSA and periodontitis. Two reviewers extracted the data using a custom Excel spreadsheet. A methodological assessment of the quality of the studies was performed using the Newcastle–Ottawa Scale. Fourteen studies were included. All studies evaluated the association between periodontitis and OSA. None of the studies evaluated the cause–effect relationship. Eleven studies found a significant positive relationship between periodontitis and OSA, whereas three found no statistically significant association. Several study limitations were observed, such as lack of standardization of study groups, diagnosis of periodontitis and OSA, and differences in study design. Evidence of a plausible association between periodontitis and OSA was found. The possible relationship could be explained by systemic inflammation, oral breathing, and the comorbid relationship attributable to common risk factors. Observational and randomized controlled studies are needed to clarify the mechanism of interaction between the two conditions.

Influence of patients' preoperative expectations on postoperative outcomes after total knee or hip arthroplasty: a systematic review.

The association between preoperative expectations and treatment outcomes in total hip arthroplasty (THA) or total knee arthroplasty (TKA) is still unclear. Therefore the aim is to examine the association between preoperative outcome expectations, process expectations, and self-efficacy, and the postoperative outcomes overall outcome, pain, function, stiffness, satisfaction, and quality of life following THA/TKA. A systematic review with narrative synthesis was conducted. PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library were searched from inception to October 17, 2022. Included were prospective longitudinal cohort studies published in English, German, or Dutch, with an adult population undergoing THA/TKA, and including at least one measure of preoperative expectations and the postoperative outcomes mentioned earlier. Two independent reviewers screened the retrieved articles for eligibility, a third solved disagreements. Risk of bias (RoB) was assessed using the QUIPS tool. Of the 50 included studies, 38 had high RoB and 12 moderate RoB. Unadjusted results suggest a positive association between preoperative outcome expectations and overall outcome in the medium and long term, and between self-efficacy and change in 'overall outcome' in the long term. Adjusted results suggest positive associations between outcome expectations and function and between self-efficacy and overall outcome in the medium term, and for outcome expectations with pain and change in pain, respectively, and self-efficacy and stiffness in the long term. Preoperative expectations show a possible positive association with specific outcome measures, such as pain or function. For future research, it is advised to link matching specific expectations with specific outcomes.

Harmonisation of assessments of attention, social, emotional, and behaviour problems using the Child Behavior Checklist and the Strengths and Difficulties Questionnaire

AbstractObjectivesRetrospective harmonisation of data obtained through different instruments creates measurement error, even if the underlying concepts are assumed the same. We tested a novel method for item‐level data harmonisation of two widely used instruments that measure emotional and behavioural problems: the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ).MethodsItem content of the CBCL and SDQ was mapped onto four dimensions: emotional problems, peer relationship problems, hyperactivity/inattention and conduct problems. A diverse test sample was drawn from four prospective longitudinal birth cohort studies in Australia and Europe who used one or both instruments. The pooled sample included 5188 data points assessing children and adolescents aged 6–13 years (N = 257–704 participants per cohort). Measurement invariance was assessed using latent variable multi‐group confirmatory factor analysis.ResultsFifteen items from the CBCL and SDQ were mapped onto four dimensions allowing for measurement invariance testing as part of a stepwise process. Partial strict invariance between CBCL and SDQ assessments was established for all four dimensions.ConclusionsThe harmonised dimensions of emotional, peer relationship, hyperactivity/inattention and conduct problems are invariant across the CBCL and SDQ suggesting that these dimensions can be reliably compared with limited measurement error.

Mothers' recollections of parenting by their own mothers and fathers and maternal and infant outcomes

AbstractObjectiveUsing a family network approach, we examined patterns of remembered parental rearing by both parents and associations with maternal and infant outcomes.BackgroundWomen's memories of how they were cared for by their own mothers in childhood are associated with important outcomes in the perinatal period. However, few studies assess women's recollections of caregiving by their fathers, despite fathers' influence on the larger family context and child adjustment.MethodWe combined data from two prospective longitudinal studies of mothers and their infants (N = 468) in the perinatal period to identify profiles of remembered parental rearing by both parents using latent profile analysis and examined how these profiles were associated with maternal depressive symptoms, mothers' perceived romantic relationship satisfaction, parenting, and infant socioemotional problems.ResultsFour distinct profiles of remembered parental rearing emerged: two supportive parents, two unsupportive parents, a supportive mother but unsupportive father, and a supportive father but unsupportive mother. Results document the differential effects of these profiles on parenting and other maternal and infant outcomes.ConclusionRemembering two supportive parents confers the most benefit for mothers and their infants.ImplicationsFor mothers with nonsupportive childhood experiences, processing that legacy within a therapeutic relationship may bolster multiple perinatal domains.