Profiles of caregiving behaviors among children and adolescents with perinatally acquired HIV

Although parenting behaviors are widely considered an important factor in the adjustment of children and adolescents with chronic physical health needs, few studies have addressed this topic as it pertains to youth with perinatally-acquired human immunodeficiency virus (PHIV). We examined profiles of child-centeredness, control through guilt, consistent discipline, and detachment, and whether these profiles differed in terms of parent- and youth-reported psychiatric disorder symptoms in a cohort of HIV infected youth (N?=?314). Latent profile analyses of caregiving behaviors were conducted separately for children (6–12 years) and adolescents (13–18 years). Two profiles were identified among children: (a) moderate caregiving (87%, n?=?130) and (b) high detachment caregiving (13%, n?=?19), and three profiles were identified among adolescents: (a) moderate caregiving (55%, n?=?88), (b) high detachment caregiving (19%, n?=?30), and (c) high control through guilt caregiving (26%, n?=?42). The high detachment and high control through guilt caregiving profiles displayed higher levels of parent-and youth-reported symptoms than the moderate caregiving profile. These findings suggest that caregiver behaviors of PHIV youth vary as a function of children’s developmental period and differ in terms of youth psychological symptoms.     

RCAM: a proposed model of recovery capital for adolescents

Problematic substance use is a challenge worldwide among adolescents. The recovery process requires holistic support addressing multiple and intersecting substance use risk factors; yet, there remains a lack of evidence on how to best understand and support adolescents in recovery. Recovery capital (RC) is a model that can be used to identify areas of assets that could be enhanced and barriers to address in one’s recovery process; however, this construct was generated through a study of adults who achieved natural recovery and it has since been used to frame adult recovery-related literature across the world. The primary aim of this article is to outline the rationale for and present a Recovery Capital for Adolescents Model (RCAM). The article will discuss the original recovery capital model, describe adolescent development, substance use, and recovery, and detail proposed developmental adaptations. Future qualitative and quantitative research should explore the RCAM to assess whether the proposed dimensions are complete as well as to assess its utility in clinical settings for identifying strengths and barriers for adolescents in or seeking recovery.     

Integrated models of care for people who inject drugs and live with hepatitis C virus: A systematic review

BackgroundDespite the key role that people who inject drugs (PWID) play in the hepatitis C virus (HCV) epidemic, HCV treatment rates among this population have been historically low. Integrated models of HCV and substance use care have the potential to overcome some barriers to access; however, the evidence base is uncertain. This systematic review assesses the impacts of integrated HCV and substance use services on engagement in HCV care among PWID.MethodsWe searched five databases up to December 2018 to identify original quantitative studies evaluating the impacts of co-location of HCV and substance use services on engagement in the HCV cascade of care among adult PWID. We conducted a narrative synthesis, categorizing models based on patient entry point (a: HCV facility, b: substance use disorder (SUD) facility, and c: other facilities), and levels of integrated services offered (a: HCV/substance use testing only, b: HCV/substance use treatment, and c: testing/treatment + other services).ResultsA total of 46 articles corresponding to 44 original studies were included. Almost all studies (n = 42) were conducted in high-income countries and only six studies in the Direct-Acting Antiviral (DAA) era. Twenty-six studies discussed the integration of services at SUD facilities, one at HCV facilities, and seventeen at other facilities. Analysis of included studies indicated that overall integrated care resulted in improved engagement in HCV care (e.g., testing, treatment uptake and cure). However, the quality of evidence was predominantly low to moderate.ConclusionsAvailable evidence suggests that integration of HCV and substance use services may improve engagement along the continuum of HCV care among PWID. Given limitations in data quality, and very few studies conducted in the DAA era and in low- and middle-income settings, further research is urgently needed to inform strategies to optimize HCV care access and outcomes among PWID globally.     

Level of work stress and factors associated with bruxism in the military crew of the Peruvian Air Force

BackgroundMilitary life leads to a great personal sacrifice and labor in the aircrew because they are constantly subjected to innumerable activities which have a great work pressure; therefore, the aim of this study was to determine the level of work stress associated with bruxism in the aircrew of the Peruvian Air Force.MethodsThis was a cross-sectional study. A total of 204 crew members of the Peruvian Air Force from the Air Group were surveyed, and the stomatological clinical inspection was carried out. Each crew member was evaluated using the validated International Labor Organization-World Health Organization (ILO-WHO) Work Stress Scale, and clinical records were used to diagnose bruxism using the Smith and Knight wear index.ResultsIt was found that 93.7% (n = 191) of the crew members were men and 6.3% (n = 13) were women; and the percentage of intermediate-level stress was found to be high in the grade of non-commissioned officers, whereas in the officer grade, the level of stress was low. There was also a statistically significant association between the variables military grade, sex, and age group. The sub-officers presented a higher percentage in the category "with bruxism", while in the rank of officers the category of "non-bruxism" was the most prevalent.ConclusionsThis study showed a statistically significant association between the variable bruxism and the level of work stress between the military aviators of the Peruvian Air Force (p<0.001).     

Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.     

Continuous theta burst stimulation over the supplementary motor area in refractory obsessive-compulsive disorder treatment: A randomized sham-controlled trial

BackgroundObsessive-compulsive disorder (OCD) is a complex disorder with 40 to 60 % of patients resistant to treatment. Theta burst transcranial magnetic stimulation (TBS) is a promising new technique that has been shown to induce potent and long lasting effects on cortical excitability. The present study evaluated for the first time therapeutic efficacy and tolerability of continuous TBS (cTBS) over the supplementary motor area (SMA) in treatment resistant OCD patients using a double blind, sham-controlled design.MethodsThirty treatment resistant OCD outpatients were randomized to receive either active cTBS or sham cTBS for 6 weeks (5 sessions per week). Each treatment session consisted of 600 stimuli at an intensity of 70% of resting motor threshold. Patients were evaluated at baseline, at the end of treatment (week 6), and follow-up (week 12). Response to treatment was defined as at least 25% decrease on the Yale-Brown Obsessive Compulsive Scale.ResultsThere was no significant difference between active and sham cTBS groups in treatment efficacy. Responder rates were not different between the two groups at week 6 (cTBS 28% versus sham 36%; p = 0.686) and week 12 (cTBS 28% versus sham 36%; p = 0.686). Depressive and anxious symptoms improvements were similar in the two groups.ConclusionThis study is the first controlled trial using cTBS in treatment resistant OCD patients. The use of cTBS over the SMA is safe but not sufficient to improve OCD symptoms. Further studies are needed to identify the optimal parameters to be used in OCD patients.     

How is Anxiety Identified and Diagnosed in Individuals with Autism Spectrum Disorder and Intellectual Disability? A Scoping Review

ABSTRACT

Introduction: Individuals with Autism Spectrum Disorder display a pattern of social communication deficits and restricted and repetitive behaviors that leave them particularly vulnerable to developing anxiety. The presence of a co-occurring Intellectual Disability further complicates the situation, compromising traditional diagnostic techniques and processes. The dual diagnosis of ASD and ID appears to result in specific behavioral patterns that affect the way anxiety is identified in this population.

Method: A scoping review was undertaken to explore what is currently known about the way anxiety is identified and diagnosed in individuals with ASD and ID.

Results: In the limited research available consistent themes of difficulties with the diagnostic process, inconsistencies among measurement tools and the need to consider behavioral symptomology were found.

Conclusion: Further research needs to be conducted to enhance our understanding of how anxiety is identified in those with ASD and ID. This research could more accurately inform reliable diagnostic processes and lead to better treatment and outcomes for this population.