Standardized Diagnostic Tools Research Articles

Prevalence, Risk Factors, and Maternal Outcomes of Atrial Fibrillation during Pregnancy

Objectives: This study aims to assess the prevalence, identify contributing risk factors, and evaluate the maternal outcomes associated with atrial fibrillation (AF) during pregnancy. Methodology: A prospective cohort study was conducted between July 2022 and June 2024, involving 150 pregnant women diagnosed with AF. Data on demographics, medical history, and clinical outcomes were collected through structured patient interviews, clinical examinations, and standardized diagnostic tools, including electrocardiograms (ECG) and echocardiography. Results: The mean age of participants was 29.4 years, with an average body mass index (BMI) of 25.1 kg/m². Hypertension (45%) and diabetes (18%) were the most prevalent comorbidities. More than half of the participants were aged 35 years or older. Atrial fibrillation was diagnosed at an average gestational age of 24.5 weeks. Maternal outcomes included heart failure in 9.3% of cases, thromboembolic events in 5.7%, and 42% of pregnancies requiring cesarean section. Vaginal delivery was achieved in 58% of cases. Preterm labor occurred in 16% of pregnancies. Neonatal outcomes included a 12% NICU admission rate and a neonatal mortality rate of 1.5%. The average birth weight was 2,800 grams, with Apgar scores of 7.2 at one minute and 8.5 at five minutes. Conclusion: Atrial fibrillation during pregnancy is associated with significant maternal and neonatal complications, including heart failure, thromboembolic events, and preterm birth. These findings underscore the importance of close monitoring and individualized care for pregnant women with AF. Further research is necessary to develop targeted intervention strategies to improve maternal and neonatal outcomes for this high-risk group.

The psychometric properties of the Jordanian version of the Modified Checklist for Autism in Toddlers-Revised (M-Chat-R/F)

This study aims to explore the psychometric properties of the Jordanian version of the Modified Checklist for Autism in Toddlers-Revised (M-Chat-R/F). The Jordanian version of M-CHAT-R/F was administered within the Jordanian context among 134 children aged between 6 and 30 months; 37 were diagnosed with autism spectrum disorder (ASD), and 97 were without ASD. The M-CHAT-R/F consists of the modified Autism Spectrum Screening Questionnaire (ASSQ) and a follow-up model. The results revealed that M-Chat-R/F demonstrates acceptable levels of validity and reliability. The content validity was deemed suitable for the Jordanian environment, and the construct validity showed that items relying on a single factor reached saturation. The results also revealed acceptable levels of reliability, with Pearson correlation coefficients ranging between 0.209 and 0.693, all positive, high, and statistically significant. The Cronbach’s alpha coefficient was 0.870, the sensitivity coefficient was 0.786, and the specificity coefficient was 0.957, indicating the checklist's ability to classify cases of ASD in children. In conclusion, the M-CHAT-R/F is a highly valid and reliable instrument that can effectively classify cases of ASD in children aged between 16 and 30 months. A score of 6 or below on the checklist indicates a high probability of ASD, reaffirming the confidence in the potential of the M-CHAT-R/F checklist for healthcare professionals in the field of child development and autism spectrum disorders. Finally, this study emphasizes that the Jordanian version of M-Chat-R/F is a screening rather than a standardized diagnostic tool for ASD, underscoring the need for further validation.

Unveiling a hidden burden: exploring sarcopenia in hospitalized older patients through concordance and cluster analysis

BackgroundSarcopenia has been shown to be an important condition with the ability to predict negative health outcomes, especially in hospitalized older adults; hence, its accurate identification has an important role in the prognosis of older patients.AimThe prevalence of sarcopenia among hospitalized older adults was assessed by employing three distinct diagnostic methods.MethodsOlder adults who were hospitalized were recruited. Bioelectrical impedance analysis was used to assess muscle mass and body composition. Sarcopenia was diagnosed via the European and Asian criteria and via a modified approach in which the Colombian cutoff points for handgrip and gait speed were used. Finally, a cluster analysis was performed to classify the population.ResultsThe prevalence rates of sarcopenia and severe sarcopenia ranged from 7.3 to 31.6%. The agreement between approaches revealed substantial or almost perfect agreement in 30% of the sarcopenia comparisons and 46.6% of the severe sarcopenia comparisons. The cluster analysis defined three different clusters. The first cluster was associated with increased age, BMI and body fat and poorer functional status and muscle. The second cluster was the healthiest, with high functional status and muscle mass. The third cluster had intermediate characteristics.DiscussionThis study highlights the requirements for standardized diagnostic criteria and precise body composition assessment tools in acute geriatric units and highlights the heterogeneity of older adults. Accurate assessment and well-defined diagnostic criteria will facilitate the implementation of appropriate management and interventions.ConclusionSarcopenia is highly prevalent in hospitalized older adults, but the adjusted criteria and the inclusion of other parameters must be considered in the assessment.

Understanding the Dry Eye Disease-Related Symptoms in South America: Prevalence and Associated Factors-A Systematic Review.

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations.

Glymphatic System and Psychiatric Disorders: A Rapid Comprehensive Scoping Review.

Since discovering the glymphatic system, there has been a looming interest in exploring its relationship with psychiatric disorders. Recently, increasing evidence suggests an involvement of the glymphatic system in the pathophysiology of psychiatric disorders. However, clear data are still lacking. In this context, this rapid comprehensive PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between the glymphatic system and psychiatric disorders. We conducted a comprehensive review of the literature and then proceeded to discuss the findings narratively. Tables were then constructed and articles were sorted according to authors, year, title, location of study, sample size, psychiatric disorder, the aim of the study, principal findings, implications. Twenty papers were identified as eligible, among which 2 articles on Schizophrenia, 1 on Autism Spectrum Disorders, 2 on Depression, 1 on Depression and Trauma-related Disorders, 1 on Depression and Anxiety, 2 on Anxiety and Sleep Disorders, 8 on Sleep Disorders, 2 on Alcohol use disorder and 1 on Cocaine Use Disorder. This review suggests a correlation between the glymphatic system and several psychiatric disorders: Schizophrenia, Depression, Anxiety Disorders, Sleep Disorders, Alcohol Use Disorder, Cocaine Use Disorder, Trauma-Related Disorders, and Autism Spectrum Disorders. Impairment of the glymphatic system could play a role in Trauma-Related Disorders, Alcohol Use Disorders, Cocaine Use Disorders, Sleep Disorders, Depression, and Autism Spectrum Disorders. It is important to implement research on this topic and adopt standardized markers and radio diagnostic tools.

Yoga as Potential Therapy for Burnout: Health Technology Assessment Report on Efficacy, Safety, Economic, Social, Ethical, Legal and Organizational Aspects.

PURPOSEOF REVIEW: This health technology assessment aimed to systematically assess the efficacy and safety of yoga as therapy for burnout. Economic, ethical, legal, social and organizational aspects were considered as well. RECENT FINDINGS: Yoga as a therapy has been shown to have positive effects on a range of symptoms, including stress, anxiety and depression. Regarding work-related stress and burnout, the effects of yoga have mainly been examined in a preventative context. Meta-analyses revealed no effects on burnout severity comparing yoga with passive controls in general. Compared with passive controls, yoga had a positive effect on subjective stress. Compared to active control, yoga had an effect on the burnout subscale depersonalization on individual study level. Yoga may have positive effects on burnout, but the results are mixed. Common definitions and standardized diagnostic tools are necessary to improve research and further assess yoga as therapy for burnout. TRIAL REGISTRATION: The HTA is registered with PROSPERO, CRD42022299405, on 6th February 2022.

A Protocol to Determine Circadian Phase by At-Home Salivary Dim Light Melatonin Onset Assessment.

Internal circadian phase assessment is increasingly acknowledged as a critical clinical tool for the diagnosis, monitoring, and treatment of circadian rhythm sleep-wake disorders and for investigating circadian timing in other medical disorders. The widespread use of in-laboratory circadian phase assessments in routine practice has been limited, most likely because circadian phase assessment is not required by formal diagnostic nosologies, and is not generally covered by insurance. At-home assessment of salivary dim light melatonin onset (DLMO, a validated circadian phase marker) is an increasingly accepted approach to assess circadian phase. This approach may help meet the increased demand for assessments and has the advantages of lower cost and greater patient convenience. We reviewed the literature describing at-home salivary DLMO assessment methods and identified factors deemed to be important to successful implementation. Here, we provide specific protocol recommendations for conducting at-home salivary DLMO assessments to facilitate a standardized approach for clinical and research purposes. Key factors include control of lighting, sampling rate, and timing, and measures of patient compliance. We include findings from implementation of an optimization algorithm to determine the most efficient number and timing of samples in patients with Delayed Sleep-Wake Phase Disorder. We also provide recommendations for assay methods and interpretation. Providing definitive criteria for each factor, along with detailed instructions for protocol implementation, will enable more widespread adoption of at-home circadian phase assessments as a standardized clinical diagnostic, monitoring, and treatment tool.

Épidémiologie des troubles psychiatriques en prison : un casse-tête méthodologique et clinique

A 2006 study reported high rates of psychiatric disorders among inmates in French prisons. This study also highlighted the challenges of applying standardized diagnostic tools in prison, a context where psychological suffering is influenced by isolation and the stress associated with prolonged incarceration. The present article revisits these points, illuminating them with the results of a qualitative study that assessed the impact of isolation, relational dynamics in prison, and reflections on punishment and guilt on the psychological functioning of inmates. The article argues for a more clinical approach to phenotypic assessment in the prison environment.

A Review of Cold-Wet Mizaj and Phlegm Dominance Indices in Persian Medicine

Background: Personalized medicine, an emerging approach, considers individual differences to tailor treatments optimally. Persian medicine (PM) incorporates individual differences through Mizāj (temperament). A comprehensive understanding of each Mizaj type's characteristics is essential in designing standardized diagnostic tools. Objectives: This study aims to explore the attributes of one of the most significant Mizaj groups, namely cold-wet Mizaj, and its subtypes, including cold-wet Su-e-Mizaj (dystemperament), as well as phlegm dominance in PM sources. Methods: Persian medicine literature, including the Canon of Medicine, was reviewed for relevant concepts. Reliable scientific databases, including PubMed, Scopus, and MagIran, were searched using keywords such as Mizaj, temperament, Su-e-Mizaj, dystemperament, cold-wet dystemperament, phlegm, and Balgham. The obtained results were studied and categorized. Results: Out of the 196 articles obtained related to Mizaj, 16 investigated indices. No studies were found on the indices of cold-wet Mizaj and phlegm dominance separately. PM sources exhibit high congruence in describing the characteristics of cold-wet Mizaj. Specifically, emphasis is placed on characteristics such as coldness and softness of the skin to the touch, high fat mass, pale and white complexion, excessive body secretions, weakness and slowness of physical and physiological actions, low vitality, timidity, poor memory, and slow-wittedness. In cold-wet dystemperament, symptoms are more severe, and in the presence of phlegm, a feeling of heaviness is also mentioned as a specific symptom. Conclusions: By compiling indices of cold-wet Mizaj/dystemperament and phlegm dominance, this study can contribute to the development of standardized PM questionnaires, facilitating a personalized approach to the diagnosis and treatment of diseases.

Prevalence of adult attention deficit hyperactivity disorder in India: a systematic review and a cross-sectional study among young adults in Delhi-NCR.

The epidemiology of adult attention deficit hyperactivity disorder (ADHD) is not well explored in India. The present study aims to systematically review the literature on the prevalence of adult ADHD in India and also estimate the prevalence and sociodemographic correlates of adult ADHD among the young adults in Delhi-NCR. For the systematic review, 494 articles were identified of which 10 were included in the review. Simultaneously, a cross-sectional study was conducted involving 1665 adults (18-25 years; mean age 19.92) of both sexes (69.1% females) from different colleges in Delhi-NCR, India. Data was collected using structured interviews and standardized diagnostic tool ASRS V1.1 was used for screening of ADHD. The systematic review revealed a high prevalence of adult ADHD ranging from 5.48 to 25.7% among general and specific populations of India. Further, in the cross-sectional study, 14% of participants were screened positive for ADHD. While factors like South Indian origin and higher maternal education were associated with an increased risk of adult ADHD, low socioeconomic status was found to be protective. Considering the high prevalence of adult ADHD in India, there is an urgent need to increase awareness regarding adult ADHD and identify vulnerable populations to facilitate informed interventions.

An Observational Multi-Center Study Protocol for Distribution of Pattern Identification and Clinical Index in Parkinson’s Disease

Objectives: This study investigated the pattern identification (PI) and clinical index of Parkinson’s disease (PD) for personalized diagnosis and treatment.Methods: This prospective observational multi-center study recruited 100 patients diagnosed with PD from two Korean medicine hospitals. To cluster new subtypes of PD, items on a PI questionnaire (heat and cold, deficiency and excess, visceral PI) were evaluated along with pulse and tongue analysis. Gait analysis was performed and blood and feces molecular signature changes were assessed to explore biomarkers for new subtypes. In addition, unified PD rating scale II and III scores and the European quality of life 5-dimension questionnaire were assessed.Results: The clinical index obtained in this study analyzed the frequency statistics and hierarchical clustering analysis to classify new subtypes based on PI. Moreover, the biomarkers and current status of herbal medicine treatment were analyzed using the new subtypes. The results provide comprehensive data to investigate new subtypes and subtype-based biomarkers for the personalized diagnosis and treatment of PD patients. Ethical approval was obtained from the medical ethics committees of the two Korean medicine hospitals. All amendments to the research protocol were submitted and approved.Conclusions: An objective and standardized diagnostic tool is needed for the personalized treatment of PD by traditional Korean medicine. Therefore, we developed a clinical index as the basis for the PI clinical evaluation of PD.

Abstract 4355: Characterizing HRD in ovarian cancer: Insights from copy number signatures

Abstract Copy number changes are defining features in ovarian cancers. Two distinct methods by Steele et al. and Drews et al., published back-to-back in 2022, detail features and categories of copy number signatures. However, these methods have not been benchmarked for ovarian cancer. Mutational signatures are pivotal in understanding cancer biology and serve as predictive and prognostic biomarkers. This study aims to examine the landscape of copy number signatures to characterize the diversity of Homologous Recombination (HR) impairment within ovarian cancer. While assessing Homologous Recombination Deficiency (HRD) is crucial for targeted treatments, current HRD tests lack clarity. Using signature extraction tools SigProfilerExtractor and CINSignature, we analyzed whole-genome sequencing data (mean depth 100x) from 416 ovarian cases from Genomics England (GeL), employing both copy number signature methods. Among the signatures extracted, HRD signature CN17 from Steele et al. methodology was identified in 37% of the samples and primarily found in the high-grade serous ovarian cancer (HGSOC) subtype (77%). Additionally, higher exposure levels (median of 0.4 in n=154 compared to median of 0.29 in n=416) of Drews et al. methodology’s most complex HRD signature, CX3, was detected in samples exhibiting CN17 activity. This ongoing exploration of the copy number signatures landscape works towards identifying the spectrum of HR impairment, aiming to benchmark these two methods for a standardized diagnostic tool. This study contributes to our understanding of the mutational landscape of ovarian cancer and its potential implications for prevention and personalized treatment strategies. Citation Format: Aliah Hawari, Avraam Tapinos, Claire J. Kramer, Andreas J. Gruber, Richard Houlston, James Brenton, David Wedge. Characterizing HRD in ovarian cancer: Insights from copy number signatures [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4355.

Giggle incontinence: a scoping review.

Giggle incontinence (GI) is poorly described, defined, and understood. It is considered a bladder storage disorder in which laughter causes an uncontrollable episode of urinary incontinence that cannot be stopped until the bladder is completely emptied. It has been confused with stress urinary incontinence and overactive bladder. A thorough analysis of 26 articles on the subject of "giggle incontinence" and associated terms was performed, including all articles since the phrase first appeared. To date, 351 GI cases have been reported. It occurs mainly in women (69.5%) at 5 years of age, with a prevalence ranging from 8.4 to 16.2 years (average age of 12.4 years), and some cases have a family history of the disease (13-16.7%). This review discusses the historical background, current understanding, and challenges related to GI. It primarily affects females after the age of 5 years, causing complete bladder emptying during uncontrollable laughter. The exact cause is unknown, but hypotheses suggest involvement of the central nervous system. Diagnosis relies on clinical history, physical tests, and urine frequency evaluation. Management involves urotherapy techniques, biofeedback, and methylphenidate. Understanding GI will aid in developing more effective management techniques. IMPACT: Highlights limited awareness among healthcare professionals about giggle incontinence as a distinct condition, emphasizing the need for standardized diagnostic criteria and assessment tools. Addresses insufficient understanding of the underlying mechanisms and contributing factors, providing valuable insights for better diagnosis and treatment. Emphasizes the importance of patient education and support, calling for improved resources and counseling. Urges further research and evidence-based guidelines to enhance treatment strategies.

Arthroscopic Anatomic Anterior Cruciate Ligament Primary Repair Restores Anterior Tibial Translation Intraoperatively at Time Zero With No Additional Effect of Suture Augmentation

PurposeTo intraoperatively evaluate the ability of Anterior Cruciate Ligament Primary Repair (ACLPR) to restore anterior-tibial translation (ATT) at time-zero, and to assess the influence of additional suture augmentation (SA) on ATT. MethodsPatients with proximal ACL tears undergoing arthroscopic ACLPR with dual suture anchor fixation (ACLPR-SA) were included in this time-zero clinical study. Lachmeter laxity measurements were taken to evaluate ATT stability preoperatively in the office (T0) as a standardized diagnostic tool, preoperatively under anesthesia (T1), at time-zero intraoperatively after ACLPR but prior to SA fixation (T2) and following SA fixation (T3). ResultsA total of 27 patients (35.1 ±12.0 years) with proximal ACL tears and significant preoperative (T0) ATT side-to-side difference (SSD) (mean ±SD, 4.1 ±1.5mm) were evaluated. ACLPR was shown to restore ATT SSD at time-zero (mean ±SD, 0.2 ±1.1mm), as a significant reduction in ATT SSD (mean difference ±SE, -4.7 ±.21 mm; p < .001) was achieved comparing pre- and intraoperative measurements after separate refixation of both ACL bundles with suture anchors. Additional SA fixation did not further decrease ATT, comparing measurements of the ipsilateral leg (IL) after ACL refixation and after fixation of the SA (mean difference ±SD, 0.03 ±0.22 mm; p =.496). ConclusionACLPR with dual suture anchor fixation restores time-zero ATT in adults with proximal ACL tears. Additional suture augmentation fixated in full knee extension does not further decrease ATT.Clinical Relevance: This study provides important information about the effectiveness of ACL primary repair in restoring anterior tibial translation. Suture augmentation with the knee fixed in full knee extension does not further decrease ATT, therefore augmentation may not overconstraint the knee or stress shield the repaired ACL.

Optimized strategy for real-time qPCR detection of Onchocerca volvulus DNA in pooled Simulium sp. blackfly vectors.

Onchocerca volvulus is a filarial parasite that is a major cause of dermatitis and blindness in endemic regions primarily in sub-Saharan Africa. Widespread efforts to control the disease caused by O. volvulus infection (onchocerciasis) began in 1974 and in recent years, following successful elimination of transmission in much of the Americas, the focus of efforts in Africa has moved from control to the more challenging goal of elimination of transmission in all endemic countries. Mass drug administration (MDA) with ivermectin has reached more than 150 million people and elimination of transmission has been confirmed in four South American countries, with at least two African countries having now stopped MDA as they approach verification of elimination. It is essential that accurate data for active transmission are used to assist in making the critical decision to stop MDA, since missing low levels of transmission and infection can lead to continued spread or recrudescence of the disease. Current World Health Organization guidelines for MDA stopping decisions and post-treatment surveillance include screening pools of the Simulium blackfly vector for the presence of O. volvulus larvae using a PCR-ELISA-based molecular technique. In this study, we address the potential of an updated, practical, standardized molecular diagnostic tool with increased sensitivity and species-specificity by comparing several candidate qPCR assays. When paired with heat-stable reagents, a qPCR assay with a mitochondrial DNA target (OvND5) was found to be more sensitive and species-specific than an O150 qPCR, which targets a non-protein coding repetitive DNA sequence. The OvND5 assay detected 19/20 pools of 100 blackfly heads spiked with a single L3, compared to 16/20 for the O150 qPCR assay. Given the improved sensitivity, species-specificity and resistance to PCR inhibitors, we identified OvND5 as the optimal target for field sample detection. All reagents for this assay can be shipped at room temperature with no loss of activity. The qPCR protocol we propose is also simpler, faster, and more cost-effective than the current end-point molecular assays.

Fungal extracellular vesicle-mediated regulation: from virulence factor to clinical application.

Invasive fungal disease (IFD) poses a significant threat to immunocompromised patients and remains a global challenge due to limited treatment options, high mortality and morbidity rates, and the emergence of drug-resistant strains. Despite advancements in antifungal agents and diagnostic techniques, the lack of effective vaccines, standardized diagnostic tools, and efficient antifungal drugs contributes to the ongoing impact of invasive fungal infections (IFI). Recent studies have highlighted the presence of extracellular vesicles (EVs) released by fungi carrying various components such as enzymes, lipids, nucleic acids, and virulence proteins, which play roles in both physiological and pathological processes. These fungal EVs have been shown to interact with the host immune system during the development of fungal infections whereas their functional role and potential application in patients are not yet fully understood. This review summarizes the current understanding of the biologically relevant findings regarding EV in host-pathogen interaction, and aim to describe our knowledge of the roles of EV as diagnostic tools and vaccine vehicles, offering promising prospects for the treatment of IFI patients.

Molecular techniques drive cutting edge advancements in management of cutaneous T cell lymphoma.

Cutaneous 5T cell lymphoma (CTCL), characterized by malignant T cells infiltrating the skin with potential for dissemination, remains a challenging disease to diagnose and treat due to disease heterogeneity, treatment resistance, and lack of effective and standardized diagnostic and prognostic clinical tools. Currently, diagnosis of CTCL practically relies on clinical presentation, histopathology, and immunohistochemistry. These methods are collectively fraught with limitations in sensitivity and specificity. Fortunately, recent advances in flow cytometry, polymerase chain reaction, high throughput sequencing, and other molecular techniques have shown promise in improving diagnosis and treatment of CTCL. Examples of these advances include T cell receptor clonotyping via sequencing to detect CTCL earlier in the disease course and single-cell RNA sequencing to identify gene expression patterns that commonly drive CTCL pathogenesis. Experience with these techniques has afforded novel insights which may translate into enhanced diagnostic and therapeutic approaches for CTCL.

Pornography-Watching Disorder and Its Risk Factors Among Young Adults: Cross-Sectional Survey.

The widespread availability of internet-based pornography has led to growing concerns about its impact on mental health, particularly among young adults. Despite increasing recognition of problematic pornography use, standardized diagnostic criteria for pornography addiction are lacking. This study aimed to address this gap by applying adapted DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria to evaluate "pornography-watching disorder" (PWD) in a large sample of young adults in Hungary. The primary objective was to assess the prevalence of PWD among young adults and identify key risk factors associated with its development using DSM-5 criteria adapted for pornography use. It also aimed to advance the understanding of PWD as a potential behavioral addiction. A cross-sectional web-based survey was conducted between September and December 2018, targeting young adults aged 18-35 years in Hungary. Participants were recruited through social media and the University of Szeged Albert Szent-Györgyi Medical School's web page. Of the 9397 respondents, 7187 (76.5%) had previously consumed pornography and were included in the analysis. PWD was measured using 10 statements adapted from the DSM-5 substance use disorder criteria. Multivariable binary logistic regression was used to identify significant predictors of PWD. The prevalence of PWD in the sample was 4.4% (n=315). Frequent pornography consumption was a significant risk factor, with weekly users (odds ratio [OR] 0.45, 95% CI 0.33-0.62, P<.001), monthly users (OR 0.18, 95% CI 0.11-0.28, P<.001), and less than monthly users (OR 0.05, 95% CI 0.03-0.10, P<.001) showing significantly lower odds compared with daily users as a reference category. Male sex was associated with a higher risk (OR 0.53, 95% CI 0.39-0.72, P<.001), as were early exposure to pornography (OR 0.94, 95% CI 0.90-0.98, P=.006), paraphilia (OR 3.95, 95% CI 2.37-6.56, P<.001), dissatisfaction with sexual life (OR 0.94, 95% CI 0.90-0.98, P=.006), difficulty forming personal relationships (OR 0.93, 95% CI 0.88-0.98, P=.005), and strong adherence to religious norms (OR 1.12, 95% CI 1.06-1.19, P<.001). Protective factors included adequate sexual education (OR 0.67, 95% CI 0.53-0.87, P=.02) and residing in the capital (OR 0.52, 95% CI 0.30-0.91, P=.02). The use of an anonymous web-based questionnaire likely reduced the influence of stigma, resulting in more accurate self-reporting of sensitive behaviors. This study is among the first to apply DSM-5 criteria to evaluate PWD, providing important insights into its prevalence and associated risk factors in young adults. The findings highlight the need for standardized diagnostic tools for PWD and suggest targeted interventions, particularly for high-risk groups. These results contribute to the ongoing discussion about whether pornography addiction should be recognized as a distinct behavioral disorder.

The German version of the Revised Children's Anxiety and Depression Scale-Psychometric properties and normative data for German 8- to 17-year-olds.

Anxiety and depression are internalizing mental disorders often commencing in childhood and manifesting in adolescence. The Revised Anxiety and Depression Scale (RCADS) is an internationally widely used standardized diagnostic tool, but the German version has only been validated in a pediatric chronic pain sample; normative data are not available. The aim of this study is to test its reliability (internal consistency) and validity (factorial, convergent, known-groups) in a representative German school sample and to provide norm data. Data were collected from N=1562 German schoolchildren (Mage =12.2; SDage =2.33; range 8-17years; 52.4% girls). Cronbach's α ranged from 0.73 to 0.96 for the total and the six subscales (five anxiety and one depression). Confirmatory factor analysis showed the 6-factor model had acceptable to good model fit with CFI=0.93, TLI=0.93, RMSEA=0.05, SRMR=0.05, which was better than 1- and 2-factor models. The (sub)scales correlated moderate to high negatively with health-related quality of life (-0.31≤ τ≤-0.51; p<0.001) and positively with functional impairment (0.31≤τ≤0.48; p<0.001). Mean scores of anxiety and depression scales were significantly higher in girls and partly in adolescents. Findings provide support for the good psychometric properties of the German RCADS in a community sample.

Moderate-to-severe pruritus in untreated or non-responsive hemodialysis patients: results of the French prospective multicenter observational study Pruripreva.

Chronic kidney disease-associated pruritus (CKD-aP) is a common condition in patients treated with hemodialysis, and has a negative impact on quality of life (QoL). Due to the lack of standardized diagnostic tools and frequent underreporting, pruritus prevalence remains poorly documented. Pruripreva was a prospective multicenter observational study that aimed to evaluate the prevalence of moderate to severe pruritus in a cohort of French hemodialysis patients. The primary endpoint was the rate of patients with mean Worst Itch Numerical Rating Scale (WI-NRS) score ≥4 calculated over 7 days (moderate pruritus, 4-6; severe, 7-8; very severe, 9-10). Impact of CKD-aP on QoL was analyzed according to its severity (WI-NRS), using 5-D Itch scale, EQ-5D and Short Form (SF)-12. Mean WI-NRS was ≥4 in 306 patients (mean age, 66.6 years; male, 57.6%) out of 1304 and prevalence of moderate to very severe pruritus was 23.5% (95% confidence interval 21.2-25.9). Pruritus was unknown prior to the systematic screening in 37.6% of patients, and 56.4% of those affected were treated for this condition. The more severe the pruritus, the poorer the QoL according to the 5-D Itch scale, EQ-5D and SF-12. Moderate to very severe pruritus was reported in 23.5% of hemodialysis patients. CKD-aP was underrated although it is associated with a negative impact on QoL. These data confirm that pruritus in this setting is an underdiagnosed and underreported condition. There is an urgent demand for new therapies to treat chronic pruritus associated with CKD in hemodialysis patients.