Risk Of Poor Outcome Research Articles

Frail patients require Longer Fusions for Success following Adult Cervical Deformity Surgery.

Adult cervical deformity (ACD) surgery is more frequently being performed in frail patients. Although surgical outcomes are largely successful, there remains significant risk of poor outcomes. The ideal length of fusion constructs in these patients remains debatable. Patients undergoing cervical fusion for ACD with lower instrumented vertebra (LIV) at T4-or-above, with clinical and radiographic data from baseline (BL) to 2years (2Y) were stratified by CD-modified frailty index into not frail (NF), frail (F) and severely frail (SF) categories. Deformity was classified by Kim et al. criteria. Means comparisons tests were used to assess differences between both groups. Logistic regression analyses were used to analyze associations between frailty categories, lower instrumented vertebra (LIV) and outcomes. 286 patients (Age: 57.3 ± 10.9years, BMI: 28.9 ± 6.4kg/m2, CCI: 0.84 ± 1.26). 47% of patients were female. 32.2% of patients were NF, 50.3% F and 17.5% SF. By deformity, 66% were focal kyphosis (FK), 12% were flatneck, and 22% were cervicothoracic. Only FK type differed between NF and F/SF patients (39.2 vs 73.6%, p = 0.005). At baseline (BL), differences in age, BMI, CCI and deformity were not significant. F/SF patients had longer LOS (p = 0.018) and higher rates of distal junctional kyphosis/failure (DJK/F) at 2years. Controlling for baseline disability, F and SF patients were more likely to experience poor outcomes at 2years with C7 compared with more distal LIVs. The risk for poorer outcomes was not significant when comparing LIVs within the upper thoracic spine. Similar trends were seen performing sub-analyses specifically comparing F vs SF patients. Frail patients are at risk for poor outcomes following ACD surgery due to their comorbidities. These patients appear to be at even greater risk for poor outcomes with a lower instrumented vertebra proximal to T1.

Survival Outcomes Among Patients With Hepatocellular Carcinoma in a Large Integrated US Health System

Hepatocellular carcinoma (HCC) is the leading oncologic cause of death among patients with cirrhosis, but large studies examining mortality trends are lacking. To evaluate survival among patients with HCC in one of the largest integrated health care systems in the US. This retrospective cohort study included 3441 adult patients who received a diagnosis of HCC between January 1, 2006, and December 31, 2019, with end of follow-up on December 31, 2020. The study period was further categorized as era 1, defined as 2006 to 2012, and era 2, defined as 2013 to 2019. Statistical analysis was conducted from January 2021 to June 2024. Patient demographic characteristics and disease factors. All-cause and HCC-specific mortality were used as primary end points, and survival probabilities were estimated using the Kaplan-Meier method. Cox proportional hazards regression analyses were adjusted for age at diagnosis, sex, race and ethnicity, cause of disease, Barcelona Clinic Liver Cancer (BCLC) stage, alpha-fetoprotein level, and treatment type. Of 3441 patients with HCC, 2581 (75.0%) were men, and the median age was 65 years (IQR, 58-73 years). A total of 1195 patients (34.7%) received curative treatment, 1374 (39.9%) received noncurative treatment, and 872 (25.3%) received no treatment. During the study period, 2500 patients (72.7%) experienced all-cause mortality, and 1809 (52.6%) had HCC-specific mortality. In multivariable analysis, being 70 years of age or older (adjusted hazard ratio [AHR], 1.39; 95% CI, 1.22-1.59), male sex (AHR, 1.20; 95% CI, 1.07-1.35), BCLC stage C or D (AHR, 2.40; 95% CI, 2.15-2.67), increasing alpha-fetoprotein level (vs <20 ng/mL; 20-99 ng/mL: AHR, 1.20; 95% CI, 1.04-1.38; ≥1000 ng/mL: AHR, 2.84; 95% CI, 2.45-3.25), noncurative treatment (AHR, 2.51; 95% CI, 2.16-2.90), and no treatment (AHR, 3.15; 95% CI, 2.64-3.76) were associated with higher all-cause mortality, while Asian or Other Pacific Islander race and ethnicity (vs non-Hispanic White; AHR, 0.76; 95% CI, 0.65-0.88) was associated with lower all-cause mortality. Survival improved in diagnosis era 2 (2013-2019; n = 2007) compared with diagnosis era 1 (2006-2012; n = 1434). This large, racially and ethnically diverse cohort study of patients with HCC found improving survival over time, especially among individuals with early-stage HCC receiving potentially curative treatments. This study highlights the importance of surveillance for detection of HCC at early stages, particularly among groups at risk for poorer outcomes.

Health-Related Quality of Life of Adolescents and Children With Type 1 Diabetes in the Jazan Region of Saudi Arabia.

Type 1 diabetes mellitus (T1DM) is increasingly prevalent among Saudi Arabian youth, particularly in the Jazan region. This chronic condition necessitates lifelong insulin therapy and poses significant daily management challenges for affected adolescents. Despite the high incidence rates, there is a notable lack of research into how T1DM impacts the health-related quality of life (HRQoL) of these individuals. This study aimed to assess HRQoL and its demographic correlates in T1DM patients in the Jazan region of Saudi Arabia. In this cross-sectional study, 236 T1DM patients completed the Pediatric Quality of Life Inventory Diabetes Module 3.0 (PedsQL DM). The HRQoL across domains of diabetes symptoms, treatment barriers, adherence, worry, and communication was compared by gender, nationality, age, education, residence, and healthcare follow-up using t-tests and ANOVA. Multivariate regression identified predictors of overall HRQoL. Most respondents were female (51.3%), 42.8% were between the ages of seven and 12 years, and 94.5% were Saudi nationals. Males reported better HRQoL than females, with fewer symptoms, treatment barriers, and better communication (all p<0.05). Non-Saudis had better treatment adherence, communication, and overall HRQoL than Saudis (all p<0.05). Older children (13-18 years) reported lower treatment barriers than younger children (three to six years) (p<0.05). Those with intermediate education had lower treatment barriers than those with preliminary education (p = 0.038). Only the female gender (-0.171, p = 0.009) independently predicted poorer overall HRQoL. This study revealed disparities in HRQoL among T1DM children and adolescents. Males, non-Saudis, older children, and those with more education had better HRQoL. Females were at particular risk for poorer outcomes. Targeted interventions are needed to address this region's demographic disparities in diabetes-related HRQoL.

Social and language regression: characteristics of children with autism spectrum disorder in a community-based sample.

This study investigated the prevalence, and the developmental, behavior and emotional outcomes of 675 preschoolers with ASD with or without a history of regression, who participated in the Study to Explore Early Development (SEED). The SEED project is a cross-sectional case-control study that collected data between 2007 and 2011. Children's history of regression, adaptive skills, and behavior problems were assessed using the Autism Diagnostic Interview-Revised (ADI-R), the Vineland Adaptive Behavior Scales-Second Edition (Vineland-2), and the Child Behavior Checklist (CBCL), respectively; and children's developmental levels were assessed using the Mullen Scales of Learning (MSEL). Findings from this study indicated that 26% of children experienced social and language regression, and of those with regression, 76% had regained lost skills upon completion of the study. Compared to children without a history of regression, children with social regression demonstrated increased internalizing problems and decreased fine motor skills, and children with language regression demonstrated poorer language skills. Also, children with language and social regression displayed poorer adaptive communication skills than children without regression. Children who experienced regression in one area of development demonstrated better outcomes than those who experience regression in multiple areas. To conclude, children with regression are at risk for poorer outcomes during their preschool years.

Affective Disturbance and Neurocognitive Variability in College Athletes.

Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous research found that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed (A/PS) at baseline compared to healthy controls. However, this work solely examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance. 835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into four groups (Healthy Mood [n = 582], Depression Alone [n = 137], Anxiety Alone [n = 54], and Co-Occurring Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined globally and within composites of A/PS and memory via intraindividual standard deviation, with higher scores indicating greater variability. Linear regression results revealed that the Co-Occurring Depression/Anxiety group exhibited greater variability within the memory composite compared to the Healthy Mood group, as well as the Depression Alone and Anxiety Alone groups. The Depression Alone and Anxiety Alone groups did not differ from the Healthy Mood group on memory IIV. None of the groups differed on A/PS or global IIV. Athletes with co-occurring depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that neuropsychological performance is interpreted beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance, as these factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.

The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis.

Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. We aimed to examine whether family members' participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient's treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample's baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families.

The quality of antiretroviral medicines: an uncertain problem

ObjectivesSubstandard and falsified (SF) antiretrovirals (ARVs) risk poor outcomes and drug resistance, potentially affecting millions of people in need of treatment and prevention. We assessed the available evidence on SF...

Almost 2 years into the COVID-19 pandemic: an update on parental stress, parent mental health, and the occurrence of child maltreatment

Increased parental stress, poorer mental health, and an increase in the occurrence of child maltreatment (CM) have been reported in earlier phases of the COVID-19 pandemic. However, data from later phases of the pandemic are not yet available. We conducted a cross-sectional, representative survey among 1087 parents (48.8% female; mean age 41.72 years, SD = 9.15) in Germany in December 2021. Data were compared to a previous representative sample, assessed in August 2020 (N = 1024), and to normative scores of the outcome measures. Predictors for the occurrence of CM were analyzed by logistic regression. Pandemic-related stress and general stress were higher and physical and mental health were poorer in the December 2021 sample than in the August 2020 sample. Occurrence rates of CM varied between 5 and 56%. Verbal emotional abuse (n = 607, 56%), witnessing domestic violence (n = 446, 41%), and emotional neglect (n = 435, 40%) were most frequently reported. For these subtypes, parental risk for alcohol abuse (OR 2.1–2.7) and parental recent experience of violence (OR 2.1–5.1) were the strongest predictors. Across all subtypes of CM, parents reporting child maltreatment showed poorer scores on all stress outcomes, with medium–large-effect sizes. Results confirm a high burden within the families, almost 2 years into the pandemic. Occurrence rates of a broad spectrum of CM subtypes raise further concerns for the well-being of children. Family-oriented intervention efforts are needed to stabilize families and provide targeted support. Longitudinal studies are needed for a description of families at risk for poorer outcomes.

Sepsis-Associated DIC with Decreased Levels of Antithrombin and Fibrinogen is the Target for Combination Therapy with Thrombomodulin Alfa and Antithrombin.

Background Disseminated intravascular coagulation (DIC) is not a homogeneous condition, but rather includes heterogeneous conditions, and its pathophysiology and outcome vary considerably depending on the background. Although anticoagulant therapy is expected to be of benefit in the treatment of DIC, previous studies have suggested that the benefits are limited only to a specific subtype. Objects The purpose of this study was to identify the group that would benefit from combination therapy using thrombomodulin/antithrombin. Methods The data from 2,839 patients registered in the postmarketing surveillance of thrombomodulin were evaluated. The patients were divided into four groups depending on antithrombin and fibrinogen levels, and the additive effects of antithrombin on thrombomodulin were examined in the groups. Results The DIC score, Sequential Organ Failure Assessment score, and mortality were significantly higher in the DIC group with low-antithrombin/low-fibrinogen than in the DIC groups without either low antithrombin or low fibrinogen. The survival curve was significantly higher in DIC patients with combination therapy than in patients treated with thrombomodulin monotherapy, but this effect was seen only in patients with infection-based DIC. Conclusion DIC patients with low-antithrombin/low-fibrinogen risk poor outcomes, but they can be the target of combination therapy with antithrombin and thrombomodulin as long as the DIC is due to infection.

A-47 Affective Comorbidity Neurocognitive Variability in College Athletes at Baseline

Abstract Purpose: Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous work demonstrated that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed at baseline compared to healthy controls (HCs). However, this work only examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance. Methods: 835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into 4 groups (HCs [n = 582], Depression Only [n = 137], Anxiety Only [n = 54], Comorbid Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined via intraindividual standard deviation (ISD) with higher scores indicating greater variability. ISD was examined globally and within composites of attention/processing speed (A/PS) and memory. Results: Linear regression results revealed that the comorbid group exhibited greater variability within the memory composite compared to HCs, (t(829) = 3.28, p = 0.001, d = 0.39), the depression group, (t(829) = −2.62, p = 0.009, d = 0.35), and the anxiety group (t(829) = −2.76, p = 0.006, d = 0.49). The depression group and anxiety group did not differ from HCs on memory ISD. None of the groups differed on A/PS or global ISD. Conclusions: Athletes with comorbid depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that we interpret neuropsychological performance beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance as these underlying secondary factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.

Which patients are at risk for poorer outcomes from testicular cancer (TC) and its treatment?

e24060 Background: TC is a highly treatable disease with a 5-year combined relative survival rate of 95%. Survival, however, can come at a price, and longer-term negative physical and psychosocial sequelae have been described in the literature. We examined unmet needs and psychological and physical well-being in a sample of TC survivors attending a survivorship visit with the aim of describing the outcomes achieved and identifying characteristics of individuals most at risk of poor outcomes. Methods: Patients attending a survivorship clinic visit completed measures assessing 13 common physical and psychosocial needs, anxiety and depression (HADS), and QoL (SF-12V2). These data were described, subjected to hierarchical cluster analysis, and the resulting clusters were examined for disease, treatment, and demographic differences. Results: Participants (N = 312) from the same institution were primarily white (94%), non-Hispanic (98%), middle-aged (M = 42.8, SD = 11.1), married (74%), college graduates (79%), making more than $80,000/year (72%). On average, participants were diagnosed 9.8 (SD = 6.5) years earlier, though that ranged from 2-44 years, with Stage I or II TC (80%) that required surgery (99%) including RPLND (22%), chemotherapy (50%), and/or radiation (12%). Unmet needs were generally low (M = 0.91, SD = 2.1, R = 0-13) with 72% reporting no unmet need, and no unmet need was endorsed at a rate higher than 10%. Depressive symptoms were uncommon (HADS-D M = 2.3 SD = 2.6) with 95% classified as having no depressive symptoms. Symptoms of anxiety were more common (HADS-A M = 4.9; SD = 3.7) although 78% were classified as having no symptoms. QoL was similar to population norm values (M = 50) for both mental (M = 51.8) and physical (M = 51.7) well-being. Hierarchical cluster analysis of unmet needs, anxiety and depressive symptoms, and QoL revealed 2 distinct groups, one (86%) experiencing more positive outcomes than the other (14%). These groups differed significantly in unmet needs (M's 0.5 vs. 3.3), anxiety (M's 3.9 vs. 10.6) and depressive symptoms (M's 1.6 vs. 6.3), and mental QoL (M's 54.4 vs. 34.3; all p's &lt; 0.001). Groups did not differ with respect to physical well-being (M's 51.4 vs. 53.2, ns). Individuals in the less well-functioning group were more likely to have been diagnosed with Stage 3 disease, be unmarried, and have a lower income (all p &lt; 0.05). Treatment intensity, educational attainment, age, and time from diagnosis were not significantly associated with group membership. Conclusions: Most TC survivors report good functioning with few unmet needs and low levels of anxiety and depression during survivorship. A minority of TC survivors, however, experience substantially greater psychosocial but not physical difficulties, and these individuals are likely to be unmarried, have lower income, and been initially diagnosed with more advanced disease.

Independent and concurrent cannabis use with alcohol, cigarettes, and other substances among college students: Rates and consequences

Objective: The purpose of this study was to examine patterns of concurrent cannabis and other substance use and their differential associations with cannabis-related problems and academic outcomes in college students. Participants: Participants were undergraduate students (N = 263; M age = 19.1 years; 61.2% female) who were eligible if they used cannabis at least 3 days in the past month (M = 10.1 days). Method: Substance use, academic-related outcomes, and measures of Cannabis Use Disorder (CUD) severity and problems were obtained in an online survey. Results: The five groups evaluated were cannabis-only users (5.3%), cannabis and alcohol (47.1%), cannabis, alcohol and cigarettes (16.7%), cannabis, alcohol and other substances (14.8%), or all-substances (16%). Cannabis-only and all-substance users reported using cannabis most frequently (ps ≤ .034), but only the latter reported greater CUD severity, problems, and poorer academic outcomes. Discussion: College student polysubstance users may be at increased risk for poorer outcomes compared to cannabis-only users and other groups.

Predicting of poor outcomes in COVID-19 patients: Experience from an Argentinean hospital

Introduction: The pressure over health systems caused by the COVID-19 pandemic brought about the need to develop tools that would allow for the identification of those patients that require immediate attention. Our objective was to identify clinical and biochemical predictors of poor outcomes (PO) in a cohort of patients hospitalized due to COVID-19 in an Argentinean public hospital. Methods: Prospective cohort study conducted from March 3rd, 2020 to February 16th, 2021 in a tertiary care center in Santa Fe, Argentina. Clinical and biochemical characteristics of patients with COVID-19 pneumonia admitted consecutively were analyzed in order to identify predictors of a composite of poor outcomes (PO) -all-cause mortality and/or need for invasive mechanical ventilation. Results: 421 patients were included. The mean age was 56.13 ± 15.05 years. 57.0% were males. 79.7% presented at least one comorbidity. 27.7% (n=116) presented PO. In the multivariate analysis, a higher 4C-score and a higher LDH, as well as a lower SatO2/FiO2, were associated with a higher risk of PO. No variable reached an AUC of 0.800 in the ROC analysis. 4C-score presented a numerically higher AUC (0.766 IC 95% 0.715-0.817). Conclusions: Each point that the 4C-score increases, the risk of PO rises by 28%. Also, for every 100-units increase in LDH or 50-units decrease in SatO2/FiO2 at admission, there is a 20% increased risk of PO.

S3306 Impact of COVID-19 Pandemic on Smoking Habits in Patients With Inflammatory Bowel Diseases

Introduction: Smoking negatively impacts disease progression in Crohn’s disease (CD). Patients who start or continue smoking after CD diagnosis are at risk for poorer outcomes, higher therapeutic requirements, and have higher rates of relapse often requiring surgery. Race, gender, socioeconomic factors, and stressors all affect smoking status in the general population but have not been explored in patients with inflammatory bowel diseases (IBD). Importantly, smokers are at an increased risk of complications from COVID-19 infection. This study aims to determine the risk factors for change in smoking habits in patients with IBD during the COVID-19 pandemic. Methods: Surveys were sent via email to 1589 patients with an electronic medical record coded diagnosis of IBD who were seen at our IBD clinic between January 2017 and September 2020. Those who self-identify as active or former smokers were invited to complete the unpaid, anonymous, online survey regarding demographics, socioeconomic factors, IBD disease phenotype, general anxiety, and smoking habits during the COVID-19 pandemic. Results: One hundred and thirty-nine participants completed the survey. One hundred and three participants either remained non-smokers or did not change the amount they were smoking, 22 started smoking again after previous cessation or increased smoking, and 10 stopped smoking, switched to vaping, or decreased the amount they were smoking. Statistically significant independent risk factors by Fisher’s exact test for change in smoking habits during the COVID-19 pandemic revealed both age 18-34 years (P= 0.011) and never married (p< 0.001) as most likely to change smoking amount. Those with CD (P= 0.041) were least likely to decrease smoking amount. Frequency of anxiety (P= 0.013), preoccupation with anxiety (P= 0.003), nervousness (P= 0.036), uneasiness (P= 0.034) and feeling tense (P= 0.021) were associated with increased smoking during COVID-19 pandemic. Conclusion: Smoking is known to have a negative impact on CD disease progression. In our cohort, participants with CD were least likely to decrease smoking amount during COVID-19 pandemic. Participants with frequent anxiety, preoccupation with anxiety, nervousness, uneasiness, and tension reported increased smoking during the pandemic. Routine screening for anxiety and smoking habits should be performed in all IBD clinical visits.

511Effects of educational activities prior to school entry are more important for socioeconomically disadvantaged children

Abstract Background We examined whether time in educational activities at 2-3 years and language ability at school entry differed among children from diverse socioeconomic backgrounds. Methods Data were drawn from the Longitudinal Study of Australian Children (n = 4253). Educational activities were collected using time-use diaries. Household income was measured using parent self-report. Language ability was assessed using the Peabody Picture Vocabulary Test. Marginal structural models with inverse probability of treatment weights were used to assess modification of the effect of time spent in educational activities on language ability by income. Results Children exposed to both &amp;lt;30 minutes/day in educational activities and being in a low-income household were at greater risk of poorer outcomes than the simple sum of their independent effects. Compared with children who spent ≥30 minutes/day in educational activities and from higher-income households, children who experienced &amp;lt;30 minutes/day from low-income households had a 2.30 (95% CI: 1.88, 2.80) higher risk of having lower language ability. The Relative Excess Risk Due to Interaction of 0.15 (95% CI:-0.15, 0.67) was greater than zero indicating a super-additive effect measure modification by income. Conclusions Our results suggest that boosting time in educational activities to 30 minutes/day would benefit the lower-income group relatively more than the higher-income group. Key messages If there was an intervention of sufficient dose to increase the amount of time spent in educational activities to 30 minutes/day for children in the lower-income group, the risk of children having lower language ability at school entry could be reduced by 45%.

Longitudinal bidirectionality of emotion knowledge and inhibitory control in low‐income children using cross‐lagged panels

AbstractUnderstanding how to support children from low‐income families as they begin kindergarten is paramount, because they may have delays in developing cognitive and social skills in preschool, putting them at risk for poorer outcomes. Importantly, further research needs to be conducted on how specific constructs that relate to school readiness interact, such as inhibitory control (IC) and emotion knowledge (EK). Previous research has examined relations between IC and EK, but the directionality reported is inconsistent, and few studies have the longitudinal data necessary to assess the interaction fully. Thus, the present study (N = 539) aimed to expand previous research by assessing the directionality of the relationship over four time points using cross‐lagged panel models in a low‐income population. The results showed positive bidirectional relations between the two constructs from preschool to kindergarten, but not kindergarten to first grade, perhaps indicating a shift in these constructs’ interdependency to increased specificity. This study clarified the directionality of these related constructs from preschool into first grade, expanding previous research that focuses on this interaction primarily in the preschool years in samples of convenience. Implications for curricula and intervention for children from low‐income families are discussed.

Real-World Performance of High-Flux Dialyzers in Patients With Hypoalbuminemia.

There is little research on factors that influence the choice of dialyzer in patients undergoing hemodialysis. In patients at risk for poorer outcomes, including those with hypoalbuminemia, understanding how this choice impacts clinical parameters could inform patient management. The objective of this real-world analysis was to evaluate the use and performance of four single-use (i.e., nonreuse [NR]), high-flux Optiflux dialyzers with varying surface areas (F160NR [1.5 m2], F180NR [1.7 m2], F200NR [1.9 m2], and F250NR [2.5 m2]) in patients (N = 271) with baseline hypoalbuminemia (≤3.5 g/dl) receiving hemodialysis at a medium-sized dialysis organization. Thrice weekly, in-center dialysis was delivered for 6 months without adjustments to the hemodialysis prescription. Larger dialyzers were more frequently used in men, patients with higher body mass indices, and those with diabetes. Increases in serum albumin from baseline (month 1) to month 6 (p < 0.05) were observed with all dialyzer sizes. A mean increase in hemoglobin of 0.31 g/dl was also observed (p < 0.001). Among patients exhibiting increased serum albumin levels (n = 177), reductions in the neutrophil-to-lymphocyte ratio, a marker of inflammation, were observed (mean: 0.90; p < 0.001). These results support the use of high-flux dialyzers in patients with hypoalbuminemia.

Preoperative Psychosocial Factors and Short-term Pain and Functional Recovery After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Low mental health scores, depression, and anxiety are associated with worse pain and functional outcomes after hip arthroscopy for patients with femoroacetabular impingement syndrome (FAIS). Preoperative screening of psychosocial factors such as self-efficacy, kinesiophobia, and pain catastrophizing may further aid in identifying patients at risk for poorer outcomes. To compare preoperative function and psychosocial factors between patients with and those without elevated postoperative pain 3 months after hip arthroscopy for FAIS. Prospective cohort study. University health center. Fifty-one individuals with FAIS (41 women, 10 men; age = 37.6 ± 12.3 years, body mass index = 27.1 ± 4.1 kg/m2). Preoperatively, participants completed the Pain Self-Efficacy Questionnaire (PSEQ), Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), 12-Item International Hip Outcome Tool (iHOT-12), and a 10-point visual analog scale (VAS) for hip pain at rest and during activity. Three months postoperatively, they completed the PSEQ, TSK, PCS, iHOT-12, and VAS. Preoperative scores were compared between those with (VAS ≥ 3) and those without (VAS < 3) elevated postoperative pain using Mann-Whitney U tests, and odds ratios were calculated to determine the odds of having elevated postoperative pain and lower postoperative function. Participants with elevated postoperative pain at rest and during activity had worse preoperative psychosocial health (P ≤ .04). Those with elevated postoperative pain at rest had worse preoperative function (P < .001). The odds of having elevated postoperative pain at rest were 45 times and 4.5 times higher for those with low self-efficacy and high pain catastrophizing, respectively (P values ≤ .03). The odds of having elevated postoperative pain during activity were 7.1, 6.2, and 3.5 times higher for those with low self-efficacy, high kinesiophobia, and high pain catastrophizing, respectively (P values ≤ .04). The odds of having lower postoperative iHOT-12 scores were 7.5 and 14.0 times higher for those with high kinesiophobia and pain catastrophizing, respectively (P values ≤ .03). Poor preoperative psychosocial health increased the odds of elevated pain and worse function 3 months after hip arthroscopy for FAIS. This is a first step in identifying the psychosocial factors that may contribute to poorer long-term hip arthroscopy outcomes.

A systematic review of the role of hypovitaminosis D in coronavirus disease-19 (COVID-19) infection and mortality: Is there a role of recommending high dose vitamin D supplementation?

There are several studies corelating Vitamin D deficiency and risk of poorer outcomes in coronavirus disease −19 (COVID-19) patients. Our aim was to perform systematic review of the existing literature on the role of vitamin D deficiency in COVID-19 infection and mortality and whether high dose vitamin D supplementation might be helpful in reducing risk and improving outcomes.A systematic search was conducted in PubMed, EMBASE and Cochrane Library up to 5th June 2020. The quality of included studies was evaluated using the Downs and Black risk of bias scale. The available literature was critically appraised. 61 reports were shortlisted. After removing duplicates and reassessing eligibility, three articles were included in final review. The three included studies in this review scored from 10 to 17 (out of 31) on the risk of bias assessment tool; all of them scored low on the power criterion based on the low number of subjects included in these studies. On reporting and selection of bias, all the studies scored an average or above average. All studies failed to reach an average score on confounding. Two studies which showed positive correlation between Vitamin D levels and COVID-19 infection rates scored low on risk of bias assessment. Study showing no impact of Vitamin D scored average. There is only circumstantial evidence that links outcomes of COVID-19 and vitamin D status. Role of high dose Vitamin D against COVID-19 needs to be thoroughly evaluated in observational studies or high-quality randomized controlled studies before recommending it.

Psychological intervention, antipsychotic medication or a combined treatment for adolescents with a first episode of psychosis: the MAPS feasibility three-arm RCT.

When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological intervention. Research is needed to determine the clinical effectiveness and cost-effectiveness of psychological intervention versus antipsychotic medication versus a combined treatment for adolescents with psychosis. The objective of Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) was to determine the feasibility of conducting a definitive trial to answer the question of clinical effectiveness and cost-effectiveness of these three treatment options. This was a prospective, randomised, open-blinded, evaluation feasibility trial with a single blind. Participants were allocated 1 : 1 : 1 to receive antipsychotic medication, psychological intervention or a combination of both. A thematic qualitative study explored the acceptability and feasibility of the trial. Early intervention in psychosis services and child and adolescent mental health services in Manchester, Oxford, Lancashire, Sussex, Birmingham, Norfolk and Suffolk, and Northumberland, Tyne and Wear. People aged 14-18 years experiencing a first episode of psychosis either with an International Classification of Diseases, Tenth Revision, schizophrenia spectrum diagnosis or meeting the entry criteria for early intervention in psychosis who had not received antipsychotic medication or psychological intervention within the last 3 months. Psychological intervention involved up to 26 hours of cognitive-behavioural therapy and six family intervention sessions over 6 months, with up to four booster sessions. Antipsychotic medication was prescribed by the participant's psychiatrist in line with usual practice. Combined treatment was a combination of psychological intervention and antipsychotic medication. The primary outcome was feasibility (recruitment, treatment adherence and retention). We used a three-stage progression criterion to determine feasibility. Secondary outcomes were psychosis symptoms, recovery, anxiety and depression, social and educational/occupational functioning, drug and alcohol use, health economics, adverse/metabolic side effects and adverse/serious adverse events. We recruited 61 out of 90 (67.8%; amber zone) potential participants (psychological intervention, n = 18; antipsychotic medication, n = 22; combined treatment, n = 21). Retention to follow-up was 51 out of 61 participants (83.6%; green zone). In the psychological intervention arm and the combined treatment arm, 32 out of 39 (82.1%) participants received six or more sessions of cognitive-behavioural therapy (green zone). In the combined treatment arm and the antipsychotic medication arm, 28 out of 43 (65.1%) participants received antipsychotic medication for 6 consecutive weeks (amber zone). There were no serious adverse events related to the trial and one related adverse event. Overall, the number of completed secondary outcome measures, including health economics, was small. Medication adherence was determined by clinician report, which can be biased. The response to secondary outcomes was low, including health economics. The small sample size obtained means that the study lacked statistical power and there will be considerable uncertainty regarding estimates of treatment effects. It is feasible to conduct a trial comparing psychological intervention with antipsychotic medication and a combination treatment in young people with psychosis with some adaptations to the design, including adaptations to collection of health economic data to determine cost-effectiveness. An adequately powered definitive trial is required to provide robust evidence. Current Controlled Trials ISRCTN80567433. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 4. See the NIHR Journals Library website for further project information.