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When the world turned upside down: A Veterans Affairs PTSD specialty clinic in the COVID-19 era.1 month agoAvailable options for mental health care have expanded, particularly during the COVID-19 pandemic. As pandemic mitigation measures catalyzed innovation, acceptance of virtually delivered mental health care rose to unprecedented levels. The Veterans Health Administration nationwide system of care was no exception, expanding its use of video-to-home telehealth during the pandemic to meet veteran needs and, in later pandemic years, preferences. This study leverages clinical data to assess the impact of the pandemic on treatment for posttraumatic stress disorder (PTSD) in a single PTSD clinical team at a large Veterans Health Administration hospital between two time periods. Analyses compare data from 2018-2020 (pre-COVID) and 2022-2024 (postpeak COVID) regarding the demographic composition of the clinic's population, modality by which evidence-based psychotherapy (EBP) was delivered within the clinic, veteran treatment engagement, and impacts of EBP on PTSD symptom severity among treatment completers. Results indicate that, inverse to before the pandemic, most treatment provided through the PTSD clinical team post-peak-COVID-19 was delivered through virtual modalities. Importantly, impact of EBP completion on PTSD symptom severity did not differ from pre- to postpeak COVID-19, and although veteran EBP completion rates also did not differ, veterans engaged in a greater average number of EBP sessions post- (vs. pre-) COVID-19. These results suggest that virtually delivered EBP is acceptable to veterans with PTSD and may be associated with increased treatment duration. This study also highlights the importance of clinic-level data analysis in response to historical events. Future opportunities for studies regarding clinic design, treatment approaches, and innovation are also discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).Mental HealthCare/Management
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Structural brain imaging biomarkers for predicting seizure recurrence after a first unprovoked seizure.1 month agoPredicting seizure recurrence following a first unprovoked seizure (FUS) remains a significant clinical challenge, especially when routine clinical magnetic resonance imaging (MRI) and EEG do not reveal abnormalities diagnostic of epilepsy. Here, we incorporate quantitative structural MRI-derived biomarkers into prediction models for seizure recurrence at 12 months and identify brain structural features that are predictive of seizure recurrence.
We analyzed a retrospective, multicenter cohort of 197 adult patients with FUS, comprising 83 with seizure recurrence and 114 with no seizure recurrence at 12 months. All participants had normal or nondiagnostic MRI and EEG findings. Morphometric features were extracted from clinical 3 T T1-weighted MRI using FreeSurfer. Machine learning algorithms were trained on combined imaging and clinical features using nested cross-validation for model selection. Performance was compared with a logistic regression model based on clinical features only.
The best-performing model, a support vector machine (SVM) trained on a combination of imaging features and clinical factors, achieved an AUC of 0.65 (95% CI: 0.57-0.73), significantly better than chance (p = 0.01 when compared with an AUC of 0.5). In contrast, the logistic regression model trained on clinical factors alone yielded an AUC of 0.57 (95% CI: 0.49-0.65), not statistically different to chance (p = 0.28). Direct comparison between the SVM and the logistic regression clinical factor-only model was not statistically significant (95% CI for the difference in AUC: -0.019 to 0.173, p = 0.11). The most important imaging features for prediction were inter-hemispheric asymmetry of subcortical and cortical gray matter volumes and regional gyral curvatures, particularly in fronto-parietal and limbic regions.
Quantitative structural MRI contributes additional information beyond clinical factors for machine learning models predicting seizure recurrence. Changes to cortical folding and gray matter asymmetries in cortical and subcortical regions show potential as prognostic biomarkers of seizure recurrence risk after a FUS.
Identifying individuals who will have another seizure after their first unprovoked seizure is difficult when routine brain scans and EEG appear normal. We developed a tool that combines MRI-derived markers with clinical information to predict seizure recurrence. Subtle structural differences in the brain, especially asymmetries between left and right hemispheres and changes to cortical folding, were associated with a higher chance of another seizure within a year. This approach has potential in identifying individuals at risk of seizure recurrence earlier.Mental HealthCare/Management -
Impaired Cognitive Domains in Surgical Patients: A Systematic Review and Meta-Analysis.1 month agoCognitive impairment is a highly prevalent but frequently overlooked issue among surgical patients preoperatively. This systematic review and meta-analysis aimed to (1) determine the perioperative prevalence of impaired cognitive domains in surgical patients, (2) explore perioperative changes in the different domains, and (3) examine postoperative outcomes associated with preoperatively impaired cognitive domains.
Five electronic databases were searched from inception to March 19, 2024. Inclusion criteria were (1) surgical patients ≥18 years of age; (2) preoperative cognitive assessments using a neuropsychological battery; (3) reported the prevalence of impairment in specific cognitive domains or changes perioperatively; and (4) sample size of ≥100 surgical patients. The exclusion criteria included studies involving neurological surgery; cross-sectional, case-control, and case series studies; non-English articles; and studies with overlapping data.
In total, of the 12,082 articles identified from 5 databases, 21 studies (5725 patients, 11 non-cardiac surgery studies, and 10 cardiac surgery studies) were included. Among the 6 cognitive domains assessed preoperatively, the pooled prevalence of impairment was highest in executive function (18%; 95% CI, 13%-24%), visuospatial function (16%; 95% CI, 6%-26%), and attention/working memory/processing speed (14%; 95% CI, 9%-18%). Perceptual-motor control (13%; 95% CI, 9%-36%), language (13%; 95% CI, 8%-17%), and learning/memory (12%; 95% CI, 8%-16%) had lower pooled prevalence. The cognitive domains that were assessed postoperatively showed a high prevalence of impairment at 1 week, with 35% (95% CI, 4%-66%) in attention/working memory/processing speed, 34% (95% CI, 16%-51%) in executive function, and 28% (95% CI, 16%-40%) in learning/memory. The pooled prevalence subsequently decreased within 3 months to 16% (95% CI, 3%-35%) in attention/working memory/processing speed, 15% (95% CI, 6%-24%) in executive function, and 12% (95% CI, -2% to 25%) in learning/memory.
The prevalence of preoperatively impaired cognitive domains was the highest in executive function, followed by visuospatial function and attention/working memory/processing speed. Identifying commonly impaired cognitive domains may help optimize cognitive assessments in the perioperative setting. Further research is needed to clarify the clinical utility of assessing specific cognitive domains in surgical populations to improve postoperative outcomes and reduce cognitive deterioration.Mental HealthCare/Management -
Exploring quality of care through the eyes of formal and informal caregivers for residents with Huntington's disease: A qualitative descriptive study.1 month agoAimTo gain insight into factors contributing to the quality of care in nursing homes specialized in Huntington's disease from the perspectives of formal and informal caregivers.DesignA qualitative descriptive focus group study.MethodsFormal and informal caregivers from three specialized nursing homes in the Netherlands were separated into six focus groups. All data was analyzed using reflexive thematic analysis.ResultsFrom both groups, three main themes were explored: (1) care approaches and principles, (2) attention to specific care domains, and (3) preconditions for delivering care. Formal caregivers highlighted the importance of balancing residents' autonomy and restrictions, the need to work systematically, and adopting a resident-centered approach. Furthermore, attention to palliative care, nutritional care, and emotional support are needed. Informal caregivers emphasized the need for providing structure, supportive conversations, and the importance of the nursing home environment itself. Attention to the transition phase immediately after admission to the nursing home, as well as guidance on future care planning, is important. There is a need for care teams that consist of knowledgeable, familiar caregivers within a care organization that (im)materially supports its staff.ConclusionMaintaining autonomy despite disease-related restrictions, providing structure, applying palliative care principles, and offering emotional support are essential components of quality of care, as emphasized by both formal and informal caregivers. Achieving this requires systematic nursing practices performed by a team of knowledgeable caregivers. Although informal caregivers' descriptions are more superficial, key elements in them are similar to those of formal caregivers.Mental HealthCare/Management
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Burden of Mild-to-Moderate Atopic Dermatitis in Adults in the United States: Results from the National Health and Wellness Survey.1 month agoBackground: Knowledge about the impact of mild-to-moderate atopic dermatitis (AD) on patients' physical and mental health in the United States (US) is limited.Objective: To describe clinical, humanistic, and economic burdens of mild-to-moderate AD in US adults.Methods: Data were analyzed from the 2017 National Health and Wellness Survey (NHWS). NHWS respondents with a self-reported physician's diagnosis of AD or eczema comprised the AD cohort. Self-reported outcomes assessed included the presence of comorbidities, AD-related sleep disruption severity and impact, anxiety, depression severity, quality of life, mental health, and work and activity impairment.Results: A total of 4321 respondents in the AD cohort were matched with 4321 respondents in a non-AD control cohort. Comorbidities reported more commonly in the AD versus control cohort included allergies, pain, hypertension, high cholesterol, and food allergies (P < 0.05 for all). Self-reported anxiety, sleep difficulties, and depression were more frequent in the AD versus control cohort (P < 0.0001 for all). Poorer quality of life, worse functional status, and greater impairments to work productivity and daily activity were reported in the AD versus control cohort (P < 0.0001 for all).Conclusions: Mild-to-moderate AD negatively impacts physical, mental, and social domains in adults in the US.Mental HealthCare/Management
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Clinical and Electrophysiological Profile of Patients with Functional Hiccups.1 month agoMental HealthCare/Management
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Understanding How Childhood Obesity Influences Educational Outcomes: A Literature Review.1 month agoChildhood obesity represents one of the most significant public health and educational challenges of the modern era. The prevalence of overweight and obesity among children and adolescents has risen substantially worldwide over recent decades, affecting a large number of young people. In the United Kingdom, childhood obesity remains highly prevalent and is disproportionately concentrated in socioeconomically deprived communities. While cardiometabolic and psychosocial consequences are well established, evidence is accumulating that obesity also compromises neurocognitive development and academic achievement. This link has major implications for lifelong well-being and social mobility. This review was conducted to systematically evaluate contemporary evidence (2015-2025) exploring the relationship between childhood overweight or obesity and academic outcomes, including test performance, grades, attendance, and cognitive function, and to synthesize mechanistic explanations across biological, psychological, and social domains. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, Web of Science, and Scopus were searched for English-language studies from January 2015 to July 2025. Eligible designs included cross-sectional, longitudinal, and interventional studies that measured overweight or obesity via BMI or equivalent anthropometric indices and reported at least one academic or cognitive outcome. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane RoB 2.0 tool for randomized trials. Twenty studies (seven cross-sectional, ten longitudinal, and three interventional) met the inclusion criteria. Across diverse contexts, elevated BMI was consistently associated with poorer academic performance. Longitudinal analyses confirmed directionality: persistent overweight predicted slower progress in literacy and numeracy, independent of parental education or socioeconomic status (SES). Proposed mediators included inflammatory neuromodulation, sleep disturbance, stigma, and deprivation. School-based interventions integrating physical activity, nutrition education, and psychosocial support improved engagement and executive function despite modest BMI change. A modest but consistent inverse association exists between childhood obesity and academic achievement. The relationship is multidimensional, reflecting interactions between biology, behavior, and social context, and highlights the need for school-centered, equity-focused prevention strategies. Addressing obesity as both a health and educational issue could yield dual benefits in cognitive development and long-term well-being.Mental HealthCare/ManagementEducation
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Dyadic and Sexual Functioning in Psoriasis: A Comparative Study in the Turkish Population.1 month agoPsoriasis is a chronic inflammatory papulosquamous skin disease whose psychological and interpersonal effects are underrecognized. This study aimed to evaluate dyadic adjustment and sexual functioning in patients with psoriasis and their spouses, in comparison with healthy controls.
The study included three groups: psoriasis patients (n=47), their spouses (n=40), and healthy controls (HC) (n=42). The Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were administered to the patient group, while the Family Dermatology Life Quality Index (FDLQI) was administered to the spouse group. The Short Form-12 Health Survey (SF-12), the Dyadic Adjustment Scale-Revised (RDAS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Arizona Sexual Experiences Scale (ASEX) were administered to all three groups.
Sexual dysfunction was observed in 83% of patients, 65% of spouses, and 50% of healthy controls. RDAS total and subscale scores (consensus, cohesion, satisfaction) were significantly lower in patients and spouses compared with healthy controls (p<0.001). Patients had significantly higher BDI scores than both spouses (p=0.016) and controls (p=0.002), and significantly lower physical and mental SF-12 scores. In spouses, FDLQI scores positively correlated with BDI (r=0.369, p=0.021) and negatively with SF-12 mental scores (r=-0.505, p=0.001). Regression analysis revealed that depressive symptoms (p=0.004) and disease duration (p=0.049) significantly predicted sexual dysfunction.
Psoriasis exerts a substantial psychosocial burden not only on patients but also on their spouses. Addressing relational and sexual well-being in clinical care may improve overall quality of life for affected couples.Mental HealthCare/Management -
Cesarean Sections and Racial Birth Trauma: A Qualitative Analysis for Obstetric Racism among Black Women in the United States.1 month agoThe United States has one of the highest cesarean section (c-sections) rates among high-income countries. Birthing people who self-report as Black women in the United States are not only are three to four times more likely to die from preventable prenatal challenges, but also are the most prevalent racial group to receive either planned or unplanned c-sections.
Our initial aim focused on the lived experiences of prenatal care and the variety of birth types among Black women that was analyzed for a prior publication. In this secondary analysis, we noticed there was a large portion of study participants who discussed their perceptions of cesarean births.
In this specific analysis and due to c-section prevalence among Black women, we solely focused on the perceptions of c-sections, whether of planned or unplanned mode of delivery.
We analyzed interviews from 25 women in the South Florida region of the United States who had at least one recent pregnancy and/or birth of a living child (<24 months) at the time of data collection. Data were thematically analyzed and coded using NVIVO 12 software by our research team.
Nineteen Black women had high-risk prenatal status, with n = 15 of the 25 Black women having c-sections. Regardless of whether c-sections were planned or unplanned, perceptions of c-sections were expressed as traumatizing and coercive. We also noticed how participants described their experiences with intergenerational trauma from the collective memory and triggers of their familial social groups who also had adverse experiences with c-sections. Participants who desired vaginal-births-after-cesarean sections or wanted to incorporate approaches with midwives or doulas further experienced constrained choices due to their high-risk prenatal diagnosis and limited insurance coverage. Based on our results, we designed a conceptual model to illustrate how our findings can be applied to better understand the overlap between medical racism and obstetric racism, which has implications for the perpetuation of unwarranted c-sections, high-risk pregnancies, negative mental health issues, and racial birth trauma.
Social factors, including medical racism, contribute to obstetric racism and racial birth trauma throughout postpartum and impact mental health.Mental HealthCare/ManagementAdvocacy -
A comparison of characteristics of individuals with psychosis and substance use disorders seeking vocational rehabilitation.1 month agoUnemployment is high among individuals with schizophrenia spectrum disorders (SSDs) and substance use disorders (SUDs). Vocational rehabilitation (VR) programs have demonstrated effectiveness on occupational outcomes for both groups. The aim of this study is to compare characteristics of individuals with SSD and SUD seeking VR.
This study draws on data from two independent projects: the Job Management Program (JUMP) for individuals with SSD and the IPS in SUD (IPS-SUD) study, comprising a total of 341 participants. Baseline demographic, occupational, and diagnostic characteristics are described, with group comparisons.
The groups differed significantly in age, employment history, and benefit status. Restricting the sample to participants aged 18-49, differences in prior employment remained but were attenuated. Overall, SUD participants were older and more frequently received full disability benefits, whereas JUMP participants were younger and more often received partial disability benefits.
These findings highlight the heterogeneity of populations targeted by VR interventions and underscore the need for tailored program adaptations. Demographic and clinical differences should guide the design, implementation, and evaluation of VR services to enhance their relevance and effectiveness.Mental HealthCare/Management