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Mental Health, Psychosocial Functioning, and Quality of Life in Adolescents With Hirschsprung Disease
Full text linkBackground: Studies of mental health in adolescents with Hirschsprung disease (HD) are scarce. This cross-sectional study investigates mental health, psychosocial functioning and quality of life in HD adolescents.
Methods: Adolescents (12-18 years) treated at the Department of pediatric surgery at Oslo University Hospital were invited for participation. Mental health was assessed by interview; Child Assessment Schedule (CAS) and questionnaires; parental Child Behavior Checklist (CBCL) and adolescent Youth Self-Report (YSR). Psychosocial functioning was rated by Child Global Assessment Scale (cGAS). Adolescent Quality of Life was assessed by Pediatric Quality of Life inventory (PedsQL) and chronic family difficulties (CFD) by interview. Medical records were reviewed for somatic history.
Results: Thirty-seven adolescents, 28 males, median age 14.3 years, participated. By CAS interview, 8 of 37 (44% of females and 14% of males) fulfilled criteria for psychiatric diagnosis all within emotional and related disorders. Twenty-seven percent had CBCL internalizing scores and 16% had YSR internalizing scores in clinical range indicating emotional problems. By interviewer rated cGAS, 27% were scored in clinical range. By PedsQL 16% reported reduced psychosocial health score. Increased CFD, lower psychosocial functioning and reduced QoL as well as less paternal education were significantly associated with psychiatric diagnosis. Twice as many (4/8) adolescents who either had a stoma or bowel management had a psychiatric diagnosis compared to those who had neither stoma nor bowel management (7/28).
Conclusion: Nearly one in four adolescents with HD fulfilled criteria for psychiatric diagnosis. Mental health problems were associated with reduced psychosocial function and reduced QoL.
Level of evidence: III.The study has financial support from the Norwegian DAM foundation (2019/FO249474).publishedVersio
Prevalence of transthyretin amyloid cardiomyopathy in pacemaker patients
Full text linkAims: Transthyretin amyloid cardiomyopathy (ATTR-CM) is characterized by increased wall thickness, diastolic dysfunction and progressive heart failure symptoms. The disease may infiltrate the conduction system leading to conduction disturbances requiring an implantation of permanent cardiac pacemaker (PM), but the extent is unknown. Here, we report the prevalence of ATTR-CM in patients ≥65 years with PM. Methods and results: In this prospective, cross-sectional single-centre study patients were recruited from our out-patient pacemaker clinic. Eligibility criteria were age above 65 years, permanent cardiac pacemaker and competent to give informed consent. Patients underwent echocardiography at the pacemaker visit and were referred to 99mTc-DPD-scintigraphy (DPD) and blood samples if septum thickness was ≥12 mm, defined as left ventricular hypertrophy (LVH). Fifty eight of the 128 patients had LVH on echocardiography. Eleven patients had a DPD-scintigraphy based diagnosis of ATTR-CM, which represent 19% of patients with LVH and 9% of the total cohort. Patients diagnosed with ATTR-CM had higher concentrations of cardiac biomarkers (P < 0.001), higher E/E' (P = 0.001), and lower global longitudinal strain (P = 0.003) on echocardiography and more heart failure symptoms (P = 0.001). Conclusions: The prevalence of ATTR-CM in elderly patients with PM and LVH on echocardiography was 19%.publishedVersio
Normal range and risk factors for deviating body temperatures during the first 24 hours in term-born infants under standardised care: an observational study
Full text linkObjective Body temperature for a known ambient temperature is not known for infants born at term. We aimed to determine the normal range and the incidences of hypothermia and hyperthermia during the first 24 hours of life in healthy term-born infants nursed according to WHO recommendations. Design Prospective observational study. Setting Norwegian single centre district hospital. Infants were observed during skin-to-skin care or when dressed in cots. Participants Convenience sample of 951 healthy infants born at term. Methods Delivery room temperature was aimed at 26–30°C and rooming-in temperature at 24°C. We measured rectal and room temperatures at 2, 4, 8, 16 and 24 hours of age. Main outcome measures Percentile curves for rectal temperature. Proportions and risk factors for hypothermia and hyperthermia. Results The mean (SD) room temperature was 24.0°C (1.1), 23.8°C (1.0), 23.8°C (1.0)., 23.7°C (0.9) and 23.8°C (0.9). The median (2.5, 97.5 percentile) rectal temperature was 36.9°C (35.7–37.9), 36.8°C (35.9–37.5), 36.9°C (36.1–37.5), 37.0°C (36.4–37.7) and 37.1°C (36.5–37.7). Hypothermia (37.5°C) occurred in 12% and most commonly in large infants after 8 hours of life. Risk factors for hyperthermia were high birth weight (OR 2.2 (95% CI, 1.4 to 3.5), per kg), being awake, nursed skin to skin and being born through heavily stained amniotic fluid. Conclusions Term-born infants were at risk of hypothermia during the first hours after birth even when nursed in an assumed adequate thermal environment and at risk of hyperthermia after 8 hours of age.Normal range and risk factors for deviating body temperatures during the first 24 hours in term-born infants under standardised care: an observational studyThis work was supported by the Regional Health Authority (Helse Sør-Øst RHF), grant number 2012089, and Innlandet Hospital Trust (Sykehuset Innlandet HF), grant number 150124.publishedVersio
International Delphi Study on Wound Closure and Dressing Management in Joint Arthroplasty: Part 1: Total Knee Arthroplasty
Full text linkBackground: The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA). Methods: The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review. Consensus was developed for the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of ≥ 75% was required for consensus. Results: All 26 statements achieved consensus after three rounds of anonymous voting. Wound closure-related interventions that were recommended for use in TKA included: 1) closing in semi-flexion versus extension (superior range of motion); 2) using aspirin for venous thromboembolism prophylaxis over other agents (reduces wound complications); 3) barbed sutures over non-barbed sutures (lower wound complications, better cosmetic appearances, shorter closing times, and overall cost savings); 4) mesh-adhesives over other skin closure methods (lower wound complications, higher patient satisfaction scores, lower rates of readmission); 5) silver-impregnated dressings over standard dressings (lower wound complications, decreased infections, fewer dressing changes); 6) in high-risk patients, negative pressure wound therapy over other dressings (lower wound complications, decreased reoperations, fewer dressing changes); and 7) using triclosan-coated over non-antimicrobial-coated sutures (lower risks of surgical site infection). Conclusions: Using a modified Delphi approach, the panel achieved consensus on 26 statements pertaining to wound closure and dressing management in TKA. This study forms the basis for identifying critical evidence supported by clinical practice for wound management to help reduce variability, advance standardization, and ultimately improve outcomes during TKA. The results presented here can serve as the foundation for knowledge, education, and improved clinical outcomes for surgeons performing TKAs.Funding was provided by Ethicon.publishedVersio
Associations between depression and anxiety in midlife and dementia more than 30 years later: The HUNT Study
Full text linkIntroduction: It is unclear how midlife depression and anxiety affect dementia risk. We examined this in a Norwegian cohort followed for 30 years.
Methods: Dementia status at age 70+ in the fourth wave of the Trøndelag Health Study (HUNT4, 2017-2019, N = 9745) was linked with anxiety and depression from HUNT1 (1984-1985), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4. Longitudinal anxiety and depression score, and prevalence trajectories during 1984-2019 by dementia status at HUNT4 were fitted using mixed effects regression adjusting for age, sex, education, and lifestyle and health factors.
Results: Dementia at HUNT4 was associated with higher case prevalence at all waves, from 1.9 percentage points (pp) (95% CI: 0.1-3.7) higher at HUNT1 to 7.6 pp (95% CI: 5.7-9.6) higher at HUNT4.
Discussion: Our findings show that depression and anxiety was more common more than 30 years before dementia onset in those who later developed dementia.
Highlights: Older individuals with dementia had a higher prevalence of mixed anxiety- and depressive symptoms (A + D), both concurrently with and more than three decades prior to their dementia diagnosis.Older individuals with dementia had higher levels of anxiety, both concurrently and up to two decades prior to their dementia diagnosis.Depressive symptoms increased by time among those who developed dementia, but not among others.Results were similar for all cause dementia, Alzheimer's disease, and other types of dementia; however, for vascular dementia, the difference was not significant until dementia was present.Foundation Dam, Grant/Award Number: 2020/FO297384;
Wellcome Trust,Grant/Award Number: 221854/Z/20/ZpublishedVersio
Linear growth beyond 24 months and child neurodevelopment in low- and middle-income countries: a systematic review and meta-analysis
Full text linkAim: To synthesize available evidence on the association between change in linear growth (height for age z score, HAZ) beyond the first two years of life with later child neurodevelopment outcomes in Low- and middle-income countries (LMICs). Methods: We searched PubMed, Web of Science, and EMBASE for cohort studies on the association between change in HAZ after age two and neurodevelopment outcomes in middle or late childhood. Data extraction was done independently by two reviewers. Results: A total of 21 studies, that included 64,562 children from 13 LMICs were identified. Each unit increase in change in HAZ above two years is associated with a + 0.01 increase (N = 8 studies, 27,393 children) in the cognitive scores at 3.5 to 12 years of age and a + 0.05-standard deviation (SD) increase (95% CI 0.02 to 0.08, N = 3 studies, 17,830 children) in the language score at 5 to 15 years of age. No significant association of change in HAZ with motor (standardized mean difference (SMD) 0.04; 95% CI: -0.10, 0.18, N = 1 study, 966 children) or socio-emotional scores (SMD 0.00; 95% CI: -0.02, 0.01, N = 4 studies, 14,616 participants) was observed. Conclusion: Changes in HAZ after the first two years of life appear to have a small or no association with child neurodevelopment outcomes in LMICs. Keywords: Child development; Cognition; Height for age z scores; Length for age z scores; Low-and middle-income countries; Motor and language performance; Psychomotor performance.publishedVersio
Opportunities and Challenges of Chatbots in Ophthalmology: A Narrative Review
Full text linkArtificial intelligence (AI) is becoming increasingly influential in ophthalmology, particularly through advancements in machine learning, deep learning, robotics, neural networks, and natural language processing (NLP). Among these, NLP-based chatbots are the most readily accessible and are driven by AI-based large language models (LLMs). These chatbots have facilitated new research avenues and have gained traction in both clinical and surgical applications in ophthalmology. They are also increasingly being utilized in studies on ophthalmology-related exams, particularly those containing multiple-choice questions (MCQs). This narrative review evaluates both the opportunities and the challenges of integrating chatbots into ophthalmology research, with separate assessments of studies involving open- and close-ended questions. While chatbots have demonstrated sufficient accuracy in handling MCQ-based studies, supporting their use in education, additional exam security measures are necessary. The research on open-ended question responses suggests that AI-based LLM chatbots could be applied across nearly all areas of ophthalmology. They have shown promise for addressing patient inquiries, offering medical advice, patient education, supporting triage, facilitating diagnosis and differential diagnosis, and aiding in surgical planning. However, the ethical implications, confidentiality concerns, physician liability, and issues surrounding patient privacy remain pressing challenges. Although AI has demonstrated significant promise in clinical patient care, it is currently most effective as a supportive tool rather than as a replacement for human physicians.publishedVersio
Sleep characteristics and changes in sleep patterns among infants in Bhaktapur, Nepal
Full text linkObjective Sleep undergoes major changes during the first year of life, but the characteristics of sleep among infants in low and middle-income countries are not well documented. This study describes sleep characteristics and changes in sleep patterns in infants at 6 and 12 months of age from Bhaktapur, Nepal. Methods This was a community-based longitudinal study comprising 735 infants. Sleep characteristics were obtained by interview with the mother using the Brief Infant Sleep Questionnaires. The stability of sleep duration and night awakenings were estimated by logistic regression analysis. Results Cosleeping in the parent’s bed at 6 and 12 months of age was almost universal (>97%). At 6 months of age, 254 (35%) and at 12 months of age, 341 (46%) infants had a total 24-hour sleep duration 3 times per night were common (65%) both at 6 and 12 months of age. Infants with frequent nightly awakenings at 6 months had increased odds of frequent nightly awakenings at 12 months (OR = 2.2; 95% CI: 1.6, 2.9). Very few (<3%) mothers reported sleep problems in their infants at 6 and 12 months of age. Conclusions Cosleeping was almost universal among Nepalese infants, and very few of the mothers reported sleep problems in their infants. Infants at 6 and 12 months had similar patterns for both sleep duration and nocturnal awakenings. For infants, there were increased odds of having similar sleep duration and nocturnal awakening at 6 and 12 months.This study has been funded by the Research Council of Norway
(project number 223269), the GC Rieber Foundation, and the
University of Bergen (UiB), Norway, to the Centre for Intervention
Science in Maternal and Child Health (CISMAC).publishedVersio
Is home environment associated with child fluid reasoning abilities in middle childhood in high-risk settings? findings from a cross-sectional study in Pakistan
Full text linkBackground: Evidence from low- and middle-income countries (LMIC) suggests that home environment is associated with early childhood development outcomes. However, studies from LMIC that have examined how the home environment during middle childhood is associated with intellectual abilities are scarce. The objective of the study was to explore the association between different aspects of the home environment at 7-8 years and fluid reasoning abilities in a rural, high-risk cohort in Pakistan.
Methods: We employed a cross-sectional research design to examine 1172 children between 7 and 8 years and their families, utilizing the Home Observation for Measurement of Environment for Middle Childhood (HOME-MC) to evaluate various aspects of the home environment and the Fluid Reasoning Index (FRI) of the Wechsler Intelligence for Children (WISC)-5th edition to assess the fluid reasoning abilities of the children. Multivariable regression analyses were used to examine the association between different components of HOME-MC (scored as indices) and FRI scores.
Findings: Learning materials and opportunities (β = 1.74, 95% CI = 1.15, 2.33) and Responsivity (β = 1.73, 95% CI = 1.07, 2.38) indices had the strongest association with FRI score followed by Family companionship index (β = 1.27, 95% CI = 0.63, 1.90). The eight different indices of the HOME-DC explained 22% of the total variation in FRI scores.
Conclusion: We conclude that concurrent learning opportunities, parental responsivity and family companionship at home are associated with fluid reasoning abilities during middle childhood which is comparable to what has been found in early childhood years.Open access funding provided by University of Bergen. This study was part of the funded project by the Research Council of Norway through its Centres of Excellence scheme and the University of Bergen (UiB), Norway to the Centre for Intervention Science in Maternal and Child Health (CISMAC; Project No. 223269) to MR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.publishedVersio
Iowa Gambling Task performance in individuals with schizophrenia: The role of general versus specific cognitive abilities
Full text linkObjective: We aimed to explore how specific cognitive processes, such as attention and executive functions, account for variance in decision-making measured by Iowa Gambling Task (IGT) performance among individuals with schizophrenia spectrum disorders. Methods: Adults (N = 65, Mage = 25.4) with schizophrenia spectrum disorders participating in a clinical trial (registered at clinicaltrials.gov NCT03048695) completed the IGT, neuropsychological tests of attention, response inhibition, mental flexibility, working memory, and planning, as well as subtests from the Wechsler tests of intelligence to estimate IQ. Associations between performance on specific tasks, a composite score of executive function and attention, and IGT performance measured in two ways, one using the total net score, decks (C+D) -(A+B) and the other as preference for decks with more frequent gains than losses, decks (B+D) -(A+C), were analyzed with correlational and hierarchical regression analysis controlling for estimated IQ and psychotic symptoms, measured by the Positive and Negative Syndrome Scale. Results: In the regression analyses, the strongest predictor of IGT performance measured as the total net score was estimated IQ (b = 1.43, p < .001). Neither specific cognitive tasks nor the composite score of executive functioning significantly contributed to explaining variance in IGT total net score beyond IQ and symptoms of psychosis. However, IQ and symptoms of psychosis did not predict tendency towards selecting decks with different gain-to-loss frequency, whereas poorer composite executive functioning predicted a pattern of selecting decks A and C with more frequent losses, (b = 8.30, p < .05). Discussion: The results suggest that both IQ and executive functions contribute to IGT performance, but in distinct ways. Whereas lower IQ may contribute to overall more disadvantageous decision-making, poorer executive functioning may contribute to a more risk-aversive decision-making style. A clinical implication may be that individuals with schizophrenia and lower IQ or poorer executive functioning will have a higher need for support and interventions targeting decision-making.The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the South-Eastern Norway Health Authority under Grant number 2017012; Innlandet Hospital Trust under Grant number 150602 and 150648; and University of Oslo under Grant number 353139.publishedVersio