Comparison of asynchronous telepsychiatry (ATP) with traditional synchronous telepsychiatry (STP) in skilled nursing facilities (SNFs) in California, United States.

Patient-level randomized, controlled noninferiority trial.

A total of 235 residents aged ≥18 years from 9 SNFs were referred for psychiatric symptom or medication evaluations.

Patients were individually randomized to receive ATP or STP. Visits were conducted at baseline and 1, 2, 3, 6, and 12 months. The primary outcome was change in psychiatric symptom severity from baseline to 6 months, using the clinician-rated Clinical Global Impressions (CGI) Severity of Illness scale, with a predetermined noninferiority margin of 0.5 points. Secondary analyses examined medication reduction recommendations. Data were analyzed using generalized linear mixed-effects models.

Both groups showed improvement in symptoms. At 6 months, the intention-to-treat analysis (113 ATP, 109 STP) showed an adjusted CGI change of -0.47 (95% CI -0.64 to -0.29) for ATP and -0.68 (95% CI -0.86 to -0.49) for STP, with a between-group difference of 0.21 (95% CI -0.04 to 0.47), supporting noninferiority. The per-protocol analysis (79 ATP, 68 STP) showed an adjusted CGI change of -0.47 (95% CI -0.67 to -0.28) for ATP and -0.74 (95% CI -0.96 to -0.53) for STP, with a difference of 0.27 (95% CI -0.02 to 0.56). Because the upper bound of the confidence interval (0.56) exceeded the noninferiority margin (0.5), the per-protocol analysis did not support the noninferiority hypothesis. Overall rates of antipsychotic and antidepressant reduction recommendations were similar (P = .35 and P = .12, respectively).

ATP was noninferior to STP in the intention-to-treat analysis but not in the per-protocol analysis, possibly due to the reduced sample size. ATP has significant implications for improving access to mental health care for patients within SNFs. Larger replication studies are warranted to validate and further refine these findings.

Previous research has linked higher exposure to air pollution to increased cognitive impairment at older ages. We aimed to extend the existing evidence in this area by incorporating exposures across the life course in addition to measures of cognition and brain structural imaging in participants at midlife to older age.

For this population-based study, we used data from the Medical Research Council National Survey of Health and Development (NSHD; also known as the 1946 British Birth Cohort) and a neuroimaging substudy of the NSHD known as Insight 46. Participants were recruited after birth in a single week during March, 1946. Our objectives were to assess whether exposure to air pollutants in midlife (age 45-64 years) was associated with poorer processing speed and poorer verbal memory between the ages of 43 years and 69 years, and whether exposures were associated with poorer cognitive state and brain structure outcomes at age 69-71 years. Air pollution exposure data were available for nitrogen dioxide (NO₂; ages 45-64 years); particulate matter with diameter less than 10 μm (PM₁₀; ages 55-64 years); and nitrogen oxides (NO_x) and particulate matter with diameters less than 2·5 μm (PM_2·5) and between 2·5 μm and less than 10 μm (PM_coarse) and particulate matter absorbance (PM_2·5abs) as a measure of black carbon absorption (ages 60-64 years), with adjustments for early-life exposures to black smoke and sulphur dioxide. Verbal memory was tested with a 15-item recall task and processing speed with a visual search task at ages 43, 53, 60-64, and 69 years. The Addenbrooke's Cognitive Examination III (ACE-III), a measure of cognitive state, was conducted at age 69 years. Whole-brain, ventricular, hippocampal, and white matter hyperintensity volumes were assessed by MRI at age 69-71 years. Generalised linear models and generalised mixed linear models were used to explore associations between pollution exposure, cognitive measures, and brain structural outcomes, adjusted for sociodemographic factors including smoking status and neighbourhood deprivation.

Between the ages of 43 years and 69 years, we included 1534 NSHD participants in the verbal memory and processing speed analysis. Of 2148 participants who underwent testing during the wave of follow-up in 2015-16, at age 69 years, 1761 were included in the ACE-III analysis. Of the 502 NSHD participants recruited into the Insight 46 substudy, 453 were included in the analysis. Higher exposure to NO₂ and PM₁₀ was associated with slower processing speed between the ages of 43 years and 69 years (NO₂ β -8·121 [95% CI -10·338 to -5·905 per IQR increase in exposure]; PM₁₀ β -4·518 [-6·680 to -2·357]). Higher exposure to all tested pollutants was associated with lower ACE-III score at age 69 years (eg, NO₂ β -0·589 [-0·921 to -0·257]). Higher exposure to NO_x was associated with smaller hippocampal volume (β -0·088 [-0·172 to -0·004]) and higher exposure to NO₂ and PM₁₀ was associated with larger ventricular volume (NO₂ β 2·259 [0·457 to 4·061]; PM₁₀ β 1·841 [0·013 to 3·669]) at age 69-71 years.

Acknowledging the probable effects of exposure early in life, higher exposure to nitrogen dioxide, nitrogen oxides, and coarse particulate matter in midlife to older age was associated with poorer cognition, processing speed, and brain structural outcomes, strengthening evidence for the adverse effects of air pollution on brain function in older age.

The National Institute for Health and Care Research, the Medical Research Council (MRC), Alzheimer's Research UK, the Alzheimer's Association, MRC Dementias Platform UK, and Brain Research UK.

Residual cognitive deficits are commonly reported by individuals in remission from depression, often affecting daily life functioning and mental health. To provide tailored and personalized cognitive enhancement interventions for this population, there is a need for a better understanding of the characteristics of those who benefit from such interventions. Therefore, this study aimed to identify predictors of changes in subjective executive functioning following an internet-delivered cognitive enhancement intervention for adults in remission from depression.

Data were collected from a randomized controlled trial investigating the efficacy of an internet-delivered cognitive enhancement intervention. Changes in subjective executive functioning from pre-treatment to the six-month follow-up were assessed in 44 participants in remission from depression, using the Behavior Rating Inventory of Executive Function Adult Global Executive Composite. Linear mixed model analyses were conducted to investigate the impact of demographic, clinical, and treatment credibility variables on change in subjective cognitive functioning over time.

The results showed that shorter lifetime depression duration predicted greater improvements in subjective executive functioning (p = 0.031). Higher levels of treatment expectancy and credibility were related to greater improvements in subjective cognitive functioning (p = 0.024). Participants with a partner showed better treatment response than those without a partner (p < 0.001).

This study builds on previous research on cognitive enhancement interventions in remitted depression, highlighting the impact of depression duration, treatment expectancy, and credibility on treatment response. Interventions targeting cognitive deficits appear most effective for those with a shorter lifetime duration of depression. Therefore, efforts should be made to enhance outcomes in those with a chronic course. To maximize engagement and outcomes, these interventions should be delivered in a way that individuals in remission from depression view them as credible and capable of reducing their deficits. Previous research has not found partner status to predict change in subjective executive functioning. The effect of partner status on treatment response should be investigated further.

To compare the utilization patterns of expert vocabulary (EVo) in diagnosing pediatric anxiety between mental health and non-mental health clinical notes from electronic health records (EHR) to understand the role of Evo in informing classification and decision-making in anxiety diagnoses.

We conducted a retrospective study using a cohort less than age 25 from Cincinnati Children's Hospital including 897,685 patients with 61,586,446 notes. We analyzed EVo, collected from mental health clinicians, in both mental and non-mental health notes. We compared classification accuracy using EVo-based patient-level embedding from all clinical notes, mental-health notes, and non-mental health notes for two tasks: 1) pre- vs post-diagnosis anxiety patients, and 2) pre-diagnosis anxiety vs non-anxiety patients.

EVo usage was highest in pre-diagnosis anxiety, lower in non-anxiety, and lowest in post-diagnosis. Classification models using EVo features from all, mental-health, and non-mental health notes showed similar F1 scores for pre-diagnosis anxiety (0.70 ± 0.2 for two categories). For anxiety vs non-anxiety classification, all clinical and non-mental health notes had better F1 scores than mental-health notes (above 0.90 for three categories). There was a notable difference in class-wise performance across both tasks.

There are significant differences in anxiety EVo use between mental health and non-mental health clinicians. Despite less anxiety-specific terminology, non-mental health notes still captured key aspects of patient presentations, emphasizing the importance of including all clinicians' notes in analysis. EVo's utility for anxiety classification is most effective in pre-diagnostic phases, suggesting the need for a dedicated diagnostic lexicon and further study before incorporating EVo into classification models.

To investigate whether presence of aphasia was associated with differences in acute stroke care quality; and to describe in-hospital outcomes.

Observational cohort study of cross-sectional data from the biennial Stroke Foundation National Stroke Audit of Acute Services (2017, 2019 and 2021). Descriptive statistics and multivariable regression models were used to compare quality of care and in-hospital outcomes by aphasia status (care adjusted for hospital variation; outcomes adjusted for age, sex, prior function, stroke type and severity indicators, and hospital variation).

Acute hospital services in Australia.

Patients with stroke and aphasia status recorded (n=11,613) were included in the study. 3122 (26.9%) had aphasia documented in clinical notes (aphasia 51% male; median age 78 years; no aphasia 58% male; median age 74 years).

Quality of care indicators aligned with national evidence-based guidelines. In-hospital outcomes included complications, level of independence, survival, and discharge destination.

Patients with aphasia were less likely to be assessed for mood impairment (23% versus 30%; aOR 0.73 95% CI 0.65, 0.81), receive risk factor education (59% versus 70%; aOR 0.55 95% CI 0.48, 0.64), or be involved in care plan development (83% versus 95%; aOR 0.22 95% CI 0.18, 0.28). Patients with aphasia were more likely to have a more severe stroke and had more in-hospital complications (aOR 1.46 95% CI 1.30, 1.63) and in-hospital deaths (aOR 2.86 95% CI 2.36, 3.49). They were less independent at discharge (aOR 0.48 95% CI 0.42, 0.56); less often discharged home (aOR 0.63 95% CI 0.56, 0.72); and more likely to be discharged to residential care (aOR 1.52 95% CI 1.08, 2.15). They were more likely to receive inpatient rehabilitation (aOR 1.15 95% CI 1.01, 1.30).

Important differences exist in the quality of acute stroke care received by patients with aphasia. Targeted quality improvement in mood screening and risk factor education is needed.

Accumulating evidence suggests that psilocybin can produce rapid and sustained clinical benefits when administered in conjunction with psychological support. Though non-pharmacological procedures are considered integral, the field lacks therapeutic guidelines and little is known about current practices. This systematic review sought to provide a comprehensive and cross-diagnostic synthesis of current psilocybin therapy (PT) protocols across contemporary mental health related trials. Primary objectives were to define and compare PT models with respect to overall therapeutic framework, evidence-based psychotherapeutic adaptations, and therapeutic standardization measures. Database search identified 22 recent trials assessing psilocybin as treatment for major and treatment-resistant depression, medical condition-related distress, substance use, obsessive-compulsive disorders, and eating disorders. Cross-diagnostic review revealed broad consistency in therapeutic structure (i.e. before, during, and after psilocybin treatment), session themes, and external context during drug administration. However, trials varied in therapeutic intensity, diagnostic adaptations, and incorporation of evidence-based psychotherapies. Less than half of reviewed trials reported standardization measures such as manualized procedures, PT-specific training, or adherence and fidelity monitoring. With non-pharmacological treatment mechanisms still unclear, results highlight potential confounds and standardization gaps that undermine the replicability and generalizability of recent psilocybin interventions. Until adjunctive support protocols are adequately operationalized, mechanistic insight and uptake into clinical practice will remain a challenge.

Police violence is a public health crisis that disproportionately impacts Black youth, worsens their mental health, and potentially heightens their efforts to circumvent police surveillance (i.e., police avoidance). Even so, the link between Black youths' police avoidance and depressive symptoms has yet to be empirically examined. The present study examined this association, adjusting for police violence stress and diverse police exposures. Heterogeneity by youth sex was also assessed.

Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a recent, cross-sectional, non-probability survey of Black youth (~52% male) aged 12-21 in Baltimore City.

Police avoidance was significantly associated with depressive symptoms, above and beyond stress relating to police violence and diverse exposures to police violence (e.g., police violence news; direct, witnessed, and/or intrusive police stops). Notably, the association between police avoidance and depressive symptoms was significantly larger among male (v. female) participants.

Findings suggest that Black youths' police avoidance is an understudied but important factor associated with their depressive symptoms, particularly for young Black males.

None.

Chronic cough (CC) is one of the commonest presentations to primary care and to respiratory outpatient clinics ^1-4. The Triggers and Sensations Provoking Coughing (TOPIC) questionnaire is a 15-item questionnaire designed to capture sensations and triggers associated with CC in a fashion that discriminates between Refractory Chronic Cough (RCC) and other causes of CC.

Is there a relationship between TOPIC scores and other measures of cough in patients referred to three specialist cough clinics? Can patients with CC be clustered based on reported sensations and triggers as captured by the TOPIC questionnaire?

This was a multi-centre observational study. Data was collected including: Leicester Cough Questionnaire (LCQ) score, verbal cough severity, day and night cough VAS, 24-hour cough frequency and TOPIC questionnaire results. Patterns of TOPIC responses were explored using cluster analysis.

Baseline data was collected on 101 participants. Demographics of study participants were typical of CC patients; 65% female with a mean (SD) age of 59 (+/- 12.9) years. Baseline TOPIC score correlated moderately negatively with baseline LCQ score (r=-0.59, p<0.001) but not with other subjective or objective measures of cough. Hierarchical and K mean cluster analysis were used to group study participants into 4 distinct clusters based on triggers and sensations of cough as captured by the TOPIC questionnaire: i) "high sensations burden"; ii) "vocal triggers"; iii) "eating triggers"; and iv) "need to throat clear". These groups showed statistically significant differences in their demographics and subjective measures of cough (p<0.01).

Patients with CC reported unpleasant somatic sensations and cough triggers captured by the TOPIC questionnaire, associated with lower LCQ scores and worse Quality of Life (QOL). TOPIC questionnaire responses can be used to cluster patients into clinical phenotypes based on reported sensations and triggers.

This study evaluated the potential of panoramic radiographs (PR) for assessing temporomandibular joint (TMJ) osseous changes compared to Cone-beam Computed Tomography (CBCT). Our ultimate goal is to understand the value of PR as a screening tool and to get guidance for when CBCT should be requested for further investigation.

This cross-sectional retrospective study included patients 18 years or older with a PR and CBCT of TMJ from the School of Dentistry, University of Alberta, between 2021 and 2024. Exclusion criteria included poor image quality, an interval between PR and CBCT over 6 months, and TMJ not fully captured. Assessed findings from the images included condyle and articular eminence flattening, altered size, osteophyte formation, sclerosis, and erosion. Statistical analyses verified the diagnostic accuracy of PR in identifying TMJ degenerative findings compared to CBCT, the reference standard.

One hundred and two TMJs from 51 patients (40 females and 11 males) were included in the study. PR sensitivity was below diagnostic thresholds recommended by current guidelines, ranging from 0 to 0.57, with only condyle flattening (0.55) and condyle altered shape/size (0.57), with a sensitivity above 0.50. A true negative was the most frequent score for all osseous findings except for flattening the condyle, with a high true positive in 32.25% of the cases. The specificity of PR ranged from 0.71 to 1.00.

PR is an opportunistic screening tool but does not meet sensitivity thresholds to serve as a stand-alone diagnostic method for TMJ DJD. Abnormal findings seen in the PR should prompt CBCT to confirm osseous pathology.

PR is widely used in dental practice and may reveal gross TMJ abnormalities. When these findings align with clinical signs or symptoms, CBCT should be considered for further assessment. This approach supports earlier detection of DJD while adhering to the ALADAIP principle.

In recent years, there has been a growing research interest focused on identifying traces of mental disorders through social media analysis. These disorders significantly impair millions of individuals' cognitive and behavioral functions worldwide. Our study aims to advance the understanding of four prevalent mental disorders: Anorexia, Depression, Gambling, and Self-harm. We present a comprehensive framework designed for the domain adaptation of models to analyze and identify signs of these conditions on social media posts. The language models' adapting strategy consisted of three key stages. First, we gathered and enriched substantial data on the four psychological disorders. Second, we adapted the different models to the language used to discuss mental health concerns on social media. Finally, we employed an adapter to fine-tune the models for multiple classification tasks (specific to each mental health condition). The intuitive idea is to adapt a language model smoothly to each domain. Our work includes a comparative study of different language models under in- and cross-domain conditions. This allows us to, for example, assess the ability of a depression-based language model to detect signs of disorders such as anorexia or self-harm. We show that the resulting mental health models perform well in early risk detection tasks. Additionally, we thoroughly analyze the linguistic qualities of these models by testing their predictive abilities using conventional clinical tools, such as specialized questionnaires. We rigorously examine the models across multiple predictive tasks to provide evidence of the adaptation approach's robustness and effectiveness. Our evaluation results are promising. They demonstrate that our framework enhances classification performance and competes favorably with state-of-the-art models.